Voluntary sector activity and public sector support in care in the community for people with long term care needs

This thesis examines the roles of voluntary sector organisations (including housing associations) in the provision of services for adults with long-term care needs. It particularly explores public sector support (financial and otherwise) for these voluntary sector activities, the assumptions behind that support and the effects of that support on voluntary agencies themselves and the work that they do. Evidence was gathered from a number of sources, and especially from detailed work with public and voluntary sector organisations, and with service users, in four English localities. Data came from statutory bodies, service users and 27 organisations providing services for people with long-term care needs in those four areas. These data were supplemented by other collections, including local and national surveys of voluntary organisations; a case study of one hospital closure; three user (client) evaluations of mental health day services; interviews with local authority social services directors and councillors; interviews with national figures in the voluntary sector; and re-analyses of statistical and other data collected in parallel research. Public sector bodies generally expressed a great deal of trust for voluntary organisations

in the community care field. This trust was based on 'goodwill' rather than on established competence. The voluntary sector appeared to be responsive to consumer needs, and offered specialised services which were not available in the other sectors, the 'alternative' nature of which was highly valued by statutory partners. Concerns were however expressed that choice may be narrowed by the contractual links being introduced to many areas of community care in the early 1990s.

The public sector assumption that the voluntary sector is more flexible and more innovative than other sectors proved impossible to test although there was no shortage of examples of these potentials in all areas (although these were not confined to the voluntary sector alone). However, evidence about the cost-effectiveness assumption examined with data on community mental health care for former long-stay hospital residents revealed that quality of care was highest in facilities run under consort arrangements between the NHS and voluntary organisations, and there were also suggestions in the data that user outcomes were better in these facilities. However, costs were also highest under these care arrangements, leaving purchasers with a difficult trade-off between cost and quality.

Voluntary organisations in the field of community care were found to be heavily reliant on public sources of finance. Concerns about the negative effects of funding of this magnitude on the sector were not verifiable with evidence at the time of this research, although it was clear that the new community care environment posed many new challenges for the voluntary agencies in the studies. The thesis was able to build on the work of other academics writing on the consequences of change to develop a more detailed analysis of these impacts, taking into account the heterogeneity of the sector. The mythology around what each of the sectors did was found to be influential in the decisions which people took over funding, sometimes resulting in poor decisions about

client services. The importance of values at all stages of service provision emerged as a significant variable and the 'cognitive dissonance' which arose from differing values was deemed to be a significant barrier to collaborative working, which was seen to be the key to good community care