Efficient targeting of community care - the case of the home help service

By 1985 community care, of which the home help service is one of the cornerstones, was on the brink of a major change which would fundamentally affect targeting. The new focus is a concentration on those in greatest need, responsiveness to the needs of carers, and to the potential for the self financing of care. The analysis given here indicates that huge changes in targeting of the service will have been needed from the situation in 1985 to meet these new policies, changes which might be expected to move the service away from its traditional role of monitoring the very old living alone. Analysis of the period between 1980 and 1985, using the General Household Survey, shows that the targeting effect of new policies is not easy to predict. The slight increase in home care during the period did not reflect an improvement in targeting on the demonstrably most needy, but instead apparently spread the service more widely. Re-examination of equity, territorial and gender issues shows that only limited progress had been made. Indeed, gender discrimination may even have increased. While the UK may not wish to go as far as some other countries in allocating community care according to fixed eligibility criteria, come what may, targeting concepts will be increasingly salient for monitoring the community care policy's achievement.