Two than the adjustm:nt of peohe needs of

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Two concerns one financial and the other organizational inform these general changes. First, the UK government, under pressure to control. Voluntary sector provision in a mixed economy of care 145 growing public spending on health and social care, was concerned with using exisi.:.’s budgets more .`efficiently’.

Consequently, ‘value for money’ and preventing the waste and inappropriate targeting of resources, identified by various reports, emerge as central aspects of government policy. Second, government policy has questioned thf; responsiveness and accessibility of community care services. Griffiths’s agenda for action on community care, for example, argued that community service delivery was poorly related to need.

This echoed the concerns of an earlier Audit Commission report, which emphasized the importance of `a flexible service response’ that offered a wider range of options. The report concluded by calling for ‘the adjustment of servi es to meet the needs of people rather than the adjustm:nt of peohe needs of services’.

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Ensuring that provision was tailored to more systematically assessed needs and preferences of individual users and their carers became a fundamental policy goal for future community care services. ‘Citizenship’, `consumerism’, `participation’ and ‘choice’ have emerged as key ideals in attempts to empower recipients of health and social services.

A mixed economy of care is a practical attempt by government policy to realize these political ideals and ensure an individualized service response in social care. Social service departments are allocated the strategic tasks of mobilizing new sources of care and coordinating their delivery. In this respect they are to become enabling authorities that make `maximum possible use of private and voluntary providers’.

The statutory sector has never had a monopoly on social care provision and a mixed economy of care which includes private, voluntary and social services is not entirely new.

It would, however, be a mistake to over-state the degree of continuity in the responsibilities of social service departments and the expected role of voluntary organizations following the community care legislation. The important difference is the application of ‘market principles’ to the mixed economy of care. This ‘quasi-market’ transforms the previous relationship between social services and voluntary sector providers. The idea that market efficacy rather than collective planning is the best way of ensuring efficiency, accountability and choice in health and social services is at the heart of government health care policy. To achieve this the 1990 NHS and Community Care Act separated purchasing and providing functions in public health and social care agencies a fundamental prerequisite to ensuring market efficacy.

Caring (or People, for example, described the responsibilities of social service devartments as ‘securing the delivery of services, not simply by acting as direct providers but by developing the purchasing and contracting role to become enabling authorities’.

Social service departments, therefore, would no longer prov:de services ‘out become purchasers and care managers, with responsibility for preparing community care plans for the locality, assessing individual needs and arranging packages of care. This was to Karl Atkin be achieved through the principles of market competition. Voluntary sector and private organizations the independent sector would compete to provide these services. Government policy recognizes that the emerging market orientation requires a ‘cultural’ revolution that radically alters the traditional relationship berween social services and voluntary organizations.

An enabling role based on market principles is far less compatible with the traditional and established values of local authority social service departments.

None the less, the ‘contract economy’ and the changes it implies provide the context in which the ‘particular care needs’ of black and ethnic minorities will be met. An understanding of the delivery and organization of voluntary services to black and ethnic minorities is, therefore, fundamental to the debate on the future of community care, especially since the purpose of stimulating the development of the non-statutory sector was expressed in terms of benefits to the consumer.

These included: a wider range of choice; more flexible and innovatory ways of meeting individual needs; and better value for money resulting from competition between providers.

The iKreased importance of voluntary sector provision, therefore, seems to offer a potential solution to the inaccessibility and inappro- priateness of mainstream service delivery. This chapter, by critically evaluating the operation of voluntary services in multiracial Britain, will examine the extent to which voluntary provision is able to meet the social care needs of people from black and ethnic minorities.

First, it considers the role of so-called ‘mainstream’ voluntary provision and its ability to provide accessible and appropriate service support to people from black and ethnic minorities. Second, it explores the specific role of voluntary sector provision provided by minority groups and the difficulties these organizations face. Third, it examines the extent to which the enabling and purchasing roles of social services departments can ensure a mixed economy of care that meets the needs of people from black and ethnic minorities.

Categories: Public Health


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