Caring for people efficiently

The UK government's plans and objectives for community care in the 1990s are examined. The objective of providing care in the community 'wherever possible' is unlikely to be efficient unless the costs and benefits of providing such care are accounted for. Even if it were efficient to provide more care in the community, the mechanisms aimed at ensuring the transfer of funds have been inadequate in terms of encouraging such an objective. These same principles (i.e. the need to assess costs and benefits) should be applied to the design of individual packages of care in the community, when the costs and benefits of carers' time become more important. Case management offers the opportunity to assess individual circumstances which is necessary for the design of efficient packages of care. However, case management is likely to suffer from the problems of fragmentation which makes organisation of flexible packages of care difficult.