Jose-Luis Fernandez reflects on his first large project after joining CPEC (formerly PSSRU) almost 20 years ago was to investigate how community services affect the well-being of older people and their carers.
We started this project in 1995, two years after the community care reforms had come into effect. The aim was to understand, in the context of those reforms, how the provision of community care services affects the well-being of individuals and their carers, and how this varies for different types of clients. For the first time we were able to model these relationships quantitatively and link investment in services with social care outcomes for different groups of older people.
The 1993 reforms had brought major changes to community care in England and the Department of Health commissioned this research to help understand their impact. One of the main reform objectives was to prevent older people from moving into residential care. To this end, care management was introduced so that responsibility for planning an individual’s care package was concentrated on a care manager, who would act both as an agent of the state and as a representative of the care user and their family. The intention was that care packages would fit the individual needs of users, thereby improving outcomes. Separately, the responsibility of purchasing and providing social care services was split, opening up a market for outsourced services.