Will subsidiarity work for long-term care?

摘要

New financial and organization arrangements are changing the distribution of authority and power in the public service affecting managers, professionals and governing committees. The need for new roles like budget holding general practitioners, advocates, brokers and care managers are becoming recognized; traditional professional practice based on narrowly defined skills with the danger of a no-man's land between them is giving way to management arrangements that offer greater recognition of the needs of service users and their families. If the role of care manager and the new arrangements for assessment occur, much of the power now exercised by local authority members and by centrally based managers in local government will in the long-term be devolved locally to care managers. Various key issues are identified. Comprehensive multi-professional assessment is vital, with the results available to all groups of professionals so that a common voice can be presented to government circles in the future. Three broad areas need to be considered in the future implementation of long-term care. Firstly, some of the implications for assessment processes of the changes now taking place in community care will be described. Factors that inhibit good assessment will be discussed as well as key issues that also need to be addressed.