User-Practitioner Transactions in the New Culture of Community Care

Abstract

This article describes the findings of a research project which examined the views and practice of social workers undertaking assessments in one local authority following the implementation of the NHS and Community Care Act 1990. While the assessors expressed dissatisfaction with some aspects of the new system of care management, overall they appeared to be taking the new culture on board. Managers were consistently more enthusiastic than practitioners. Both groups saw needs-led assessment, user choice and keeping users in their own homes as central objectives of care management. The shadowing of ten community care assessments allowed the degree to which these objectives were realized in practice to be explored. Users' experience of the new culture was also studied. The user-practitioner transactions observed suggest that those users who were able to articulate their own needs forcefully were most likely to be able to exercise choice. It is argued that the new culture of community care embodies ‘consumer choice’ rather than ‘user choice’.