Care in The Community

Care in the Community (also called "Community Care" or "Domiciled Care") is the British policy of deinstitutionalization, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional care was the target of widespread criticism during the 1960s and 1970s, but it was not until 1983 that the government of Margaret Thatcher adopted a new policy of care after the Audit Commission published a report called 'Making a Reality of Community Care' which outlined the advantages of domiciled care.

Although this policy has been attributed to the Margaret Thatcher government in the 1980s, community care was not a new idea. As a policy it had been around since the early 1950s. Its general aim was a more cost effective way of helping people with mental health problems and physical disabilities, by removing them from impersonal, often Victorian, institutions, and caring for them in their own homes. Since the 1950s various governments had been attracted to the policy of community care. Despite support for the policy, the number of in-patients in large hospitals and residential establishments continued to increase. At the same time, public opinion was gradually turned against long-stay institutions by allegations from the media. Some might argue that such allegations were politically driven and that the deliberate underfunding, mismanagement and thus undermining of some institutions by the government was used as an excuse by the government to shut them down. It could also be argued that although there might have been incidents of where care should have been improved, the care in many such institutions may have been satisfactory or good.

In the 1960s Barbara Robb alleged that her personal experience of being treated at a hospital in Ely were bad. She put together a series of accounts in a book called Sans Everything and she used this to launch a campaign to improve or else close long stay facilities. Shortly after this the brutality and poor care being meted out in Ely, a long stay hospital for the mentally handicapped in Cardiff, was exposed by a nurse writing to the News of the World. This exposure prompted an official enquiry. Its findings were highly critical of conditions, staff morale and management. Rather than bury this report it was in fact deliberately leaked to the papers by the then Secretary of State for Health Richard Crossman, who hoped to obtain increased resources for the health service.

Following the situation at Ely Hospital a series of scandals hit the headlines. All told similar stories of abuse and inhumane treatment of patients who were out of sight and out of mind of the public, hidden away in institutions. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of care within certain institutions.

However, it is important to note that the facilities and care at some institutions were held in high regard by both patients and staff. Graylingwell Hospital, Chichester was an example of the best modern type of mental institution. The Observer reported: "Patients have every convenience at hand for night requirements, even down to carpet slippers. Blinds and curtains give a home-like comfort to the windows. Books, papers and magazines are liberally provided, while dominoes, cards and games of many kinds serve to cheer and lighten the evenings. Patients are encouraged to take part in outdoor sports, a good cricket and football field being provided. In the winter, dances, theatrical entertainments and concerts in the commodious theatre will continue treatment of the highest curative value.

The notion that films were regarded as an integral part of the therapy and entertainment offered to patients was confirmed by the installation of the hospital's own projection equipment in 1912-1913. Thereafter the hospital increased the frequency of its film shows and would put on three consecutive weekly performances, two of them in conjunction with a concert and band. Graylingwell was unlike most Victorian asylums of that time with the absence of high walls, locked iron gates and implements of restraint. With 130 acres of cultivated farmland the patients also benefited from the occupational therapy which farming provided. This also allowed the hospital to be self-sufficient in farm produce, including a dairy herd, poultry runs, a kitchen garden, fruit-bearing trees and beehives.

In the 1980s there was increasing criticism and concern about the quality of long term care for dependent people. There was also concern about the experiences of people leaving long term institutional care and being left to fend for themselves in the community. Yet the government was committed to the idea of 'care in the community'. In 1986 the Audit Commission published a report called 'Making a Reality of Community Care'. This report outlined the slow progress in resettling people from long stay hospitals. It was this report which prompted the subsequent Green and White papers on community care.