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United Kingdom

2005: Home care


Legislation relating to the provision of home care services

In November 1989, the Government published the White Paper “Caring for People”, which laid out a framework for community care changes. Community care was defined in the White Paper as “providing the right level of intervention and support to enable people to achieve maximum independence and control over their own lives” (Focus on Disability, 2005)

The actual objectives of the White Paper were:

  • To promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible.
  • To ensure that service providers make practical support for carers a high priority.
  • To make proper assessment of need and good case management the cornerstone of high quality care.
  • To promote the development of a flourishing independent sector, along with high quality public services. (Social services would now be 'enabling' agencies - it would now be their responsibility to make maximum use of the private and voluntary sectors.)
  • To clarify the responsibility of agencies and to make it easier to hold them to account for their performance.
  • To ensure better value for taxpayers' money by introducing a new funding structure for social care.

The National Health Service and Community Care Act 1990, which came into force in 1993, made the necessary legal changes to implement the objectives set out in “Caring for People”. This act, as modified by the Health and Social Care Act of 2001, provides the framework for assessment of social care needs (Nolan et al., 2004). If, whilst being assessed, it becomes clear that a person is disabled, the local authority is obliged under the Community Care Act to assess that person under the Disabled Person’s Act 1986. Under the latter act, a person may be entitled to practical assistance in the home amongst other services.

Organisation and financing of home care services

Healthcare is free at the point of delivery and funded by taxes not insurance. However, most social care is provided by local authorities who demand a modest means-tested contribution from patients. Although charges for home care services are at the discretion of local authorities, they are subject to the Fairer Charging Guidance issued to the Social Services Departments (SSD) under section 7 of the Local Authority Social Services Act 1970 (LASSA) (Nolan et al., 2004).

The NHS and Community Care Act 1990 gave local governments the opportunity to concentrate their efforts on community needs rather than on medicalised homes. Responsibility for care fees was transferred from the Department of Social Security to local authorities. They could decide which part of their budget should be allocated to community services and which part should be dedicated to residential care.

The aim of the act is to enable people to stay in their homes for as long as possible. It gives local authorities the responsibility to assess people’s needs. Local authorities differ in the kind of services they offer and the way that they are delivered. There is no obligation to actually provide services, just an obligation to assess needs.

The Community Care Act has resulted in a growing number of different services designed to support people in their own homes. However, the range and level of services vary a great deal from area to area. Financial constraints sometimes mean that it is not possible for someone to be supported at home. Local authorities are not legally obliged to provide community care for individuals if this would cost more than moving them to a residential or nursing home, although they sometimes will. (Cayton, Graham and Warner, 1997)

On 27 March 2001, the UK government published the National Service Framework (NSF) for Older People. This document, which applies just to England, sets national standards for the care of older people who are being cared for at home, in a residential setting or in a hospital.

Carers may, if they wish, receive direct payments to purchase the services they need (i.e. for their own personally assessed needs, not those of the person with dementia), rather than receiving services. People with dementia may be entitled to vouchers to purchase additional support when the carer needs a break. These vouchers are issued on behalf of the person with dementia but the recipient can ask to have them issued in the name of the carer so that the carer can redeem the vouchers (Nolan et al., 2004).

Kinds of home care services available

Services for people at home typically include the following:

  • Domiciliary services e.g. home help, home care etc.
  • Daytime services outside of the home e.g. day centres, lunch clubs or day hospitals
  • Meals on wheels
  • Respite care which allows carers and people with dementia to have a short break from each other
  • Night sitting services
  • Nursing home care
Consultation with people with dementia and carers

The Government White Paper (November 1989), Caring for People, states that:

"... assessments should take into account the wishes of the individual and his or her carer, and of the carer's ability to continue to provide care ... efforts should be made to offer flexible services which enable individuals and carers to make choices."

The method of assessment should follow steps specified in a document called “the Practice Guidance”. This Guidance is used by local authorities when carrying out each part of the community care assessment. The Practice Guidance states that "... people being assessed should feel that the process is aimed at meeting their wishes." Nevertheless, the person carrying out the assessment will obviously be responsible for defining the needs to be met. Furthermore it should be noted that two kinds of guidance are provided by the Department of Health. Policy guidance places a duty on councils to act in a certain way, whereas practice guidance is something which professionals working for the council should take into account when making decisions (Counsel and Care, 2004).

The Guidance also states that carers’ views should be taken into consideration and it should be remembered that the views of disabled people and carers are not always the same. Carers should be told that they may have an assessment of their own if they wish.



Background information about dementia and home care services

According to Alzheimer Scotland, community care is a major priority of the Scottish Parliament. It aims to provide support and services for people with physical and/or mental health problems who are living at home or in a care home.

Legislation relating to the provision of home care services

The relevant legislation in Scotland governing the provision of home care services is “The Community Care and Health (Scotland) Act 2002”. This Act extended the range of duties placed on local authorities and assigned new powers to local authorities and NHS Scotland. The act ensured:

  • free nursing and personal care for people over the age of 65
  • more local collaboration between local authorities and NHS Scotland
  • increased access to direct payments for home care services
  • that the right to assessment was extended to informal carers, including young carers, and that they are made aware of that right
  • that the contribution and views of carers, as well as the person they care for, are taken into account by local authorities before deciding which services to provide.

The Chronically Sick and Disabled Persons Act 1970 requires local authorities to make arrangements for the provision of certain services to individual chronically sick and disabled people resident in their area (Alzheimer Scotland, 2005). People with dementia may sometimes be eligible for services under this act. The services provided are:

  • provision of practical assistance within the home
  • provision of disability aids and equipment
  • assistance with adaptations to the home
  • provision of meals at home or elsewhere
  • provision of, or assistance in, getting a telephone or any special equipment needed to use a telephone
  • provision of holidays
  • provision of, or assistance with taking advantage of, education or recreational facilities both inside and outside the home. This includes provision of, or assistance with, transport to and from such facilities.

Organisation and financing of home care services

In the past, local authorities or councils had main responsibility for assessing local need and for providing and co-ordinating services through their social work departments. However, services can now be provided by a variety of organisations e.g. housing associations, health authorities, voluntary sector agencies such as Alzheimer Scotland and private service providers.

On 1 July 2002, people over 65 years of age were granted free personal as well as nursing care. This was implemented under the Community Care and Health (Scotland) Act 2002. This is not dependent on financial status, capital assets, marital status or the amount of care provided by an unpaid carer. Personal care covers both personal care and personal support (as defined in the Regulation of Care (Scotland) Act 2001.

Kinds of home care services available

Home care services may include:

  • personal care[1]
  • help at home with housework, shopping
  • short breaks/respite care
  • home adaptations; including disabled aids and equipment
  • meals
  • alarm systems to get help
  • information about local services
  • day care
  • transport to and from day care
  • advocacy services
  • befriending services
  • holidays

Consultation with people with dementia and carers

§8 of the Community Care and Health (Scotland) Act 2002 states that both the views of the person whose needs are being assessed and the views of the carer should be taken into account in so far as it is reasonable and practicable to do so.

Under this act, the carer may also request a local authority to make an assessment of their ability to provide or to continue to provide care.

National and local policies recognise the importance of involving service users and carers in planning services in both health and social care. The NHS in Scotland has a policy of Patient Focus and Public Involvement [PFPI]. In ‘Delivering for Health’ (SEHD Nov 2005), the Scottish Executive committed itself to continuing to give patients an influential voice in the future of the health service and in their own individual care. Through initiatives such as Alzheimer Scotland’s local involvement officers and the Scottish Dementia Working Group, people with dementia and carers are now involved at a number of levels in influencing public policy and local service provision (Fearnley, 2006).


[1] E.g. personal hygiene, continence management, problems of immobility linked to personal care needs, simple treatments and assistance with eating (not with the preparation or provision of food)



Last Updated: Wednesday 15 July 2009