Abstract:

In April 1993, national reforms of the method of offering community health and social care have come into effect in the U.K. A cornerstone of the reforms will be the appointment of care managers by local authorities to oversee needs assessment and care of vulnerable people. A survey was undertaken of 65 young people with physical disabilities living in inner south east London, an area of deprivation and ethnic diversity. The aim was to ascertain the perceptions of young adults in terms of access to services, lifestyle and future plans. The information was intended to inform joint work by the local health and social services departments in their own needs assessment in implementing the Community Care Act. The majority of those interviewed were living with informal carers, usually their mother. Most people had complex disabilities and were wheelchair users, but it did not follow that those with greater need were being supported more by either statutory or voluntary sectors. In fact, people were losing what contact they once had, particularly with social services. Access to respite and organised social outlets was strictly limited, particularly for people with complex disabilities. Although over half the interviewees had taken formal examinations, only five were currently employed, and several had lost their job recently. Few had received advice about careers or independent living and almost half of those interviewed did not know where to go for family planning advice. Over 40% of interviewees were from ethnic minorities, and lived in close family networks where coping skills were similar to that of the white British group. However people from ethnic minorities were less optimistic about their future prospects, because they perceived that poverty, disability and ethnic background would serve to isolate them from the wider community. According to community care principles, needs assessment and care management, being person and not service oriented, offer the promise of breaking through the complex web of personal and societal factors encountered among interviewees. However due to poor inter-agency communication, resource restrictions and continued traditional patterns of working in our area the community care reforms may not succeed, particularly for young people with physical disabilities. A flexible team approach is required across the various agencies. This should include the development of shared budgets and more imaginative involvement of the wide range of providers who are working locally. A database of service users which aims to facilitate care management should also be considered and can be used to coordinate activities. Certain national schemes with central funding for people with disabilities (such as the Independent Living Fund) are justifiable because delegating all responsibility for care provision to lower levels in the system has consistently resulted in competing local priorities serving to marginalise disabled people.