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Care in the Community (also called "Community Care" or "Domiciled Care") is the British policy of deinstitutionalization, treating and caring for physically and mentally disabled people in their homes rather than in an institution. Institutional care was the target of widespread criticism during the 1960s and 1970s,〔(Report of the Committee of Inquiry ), ''Socialist Health Association'', Retrieved February 28, 2010〕 but it was not until 1983 that the government of Margaret Thatcher adopted a new policy of care after the Audit Commission published a report called 'Making a Reality of Community Care'〔''Making a Reality of Community Care'', Audit Commission for Local Authorities in England and Wales, ISBN 978-0-11-701323-0〕 which outlined the advantages of domiciled care. Although this policy has been attributed to the Margaret Thatcher government in the 1980s, community care was not a new idea. As a policy it had been around since the early 1950s. Its general aim was a more cost-effective way of helping people with mental health problems and physical disabilities, by removing them from impersonal, often Victorian, institutions, and caring for them in their own homes. Since the 1950s various governments had been attracted to the policy of community care. Despite support for the policy, the number of in-patients in large hospitals and residential establishments continued to increase. At the same time, public opinion was gradually turned against long-stay institutions by allegations from the media. Some might argue that such allegations were politically driven and that the deliberate underfunding, mismanagement and thus undermining of some institutions by the government was used as an excuse by the government to shut them down. It could also be argued that although there might have been incidents of where care should have been improved, the care in many such institutions may have been satisfactory or good. In the 1960s Barbara Robb put together a series of accounts in a book called ''Sans Everything'' and she used this to launch a campaign to improve or else close long stay facilities. Shortly after this the brutality and poor care being meted out in Ely, a long stay hospital for the mentally handicapped in Cardiff, was exposed by a nurse writing to the ''News of the World''. This exposure prompted an official enquiry. Its findings were highly critical of conditions, staff morale and management. Rather than bury this report it was in fact deliberately leaked to the papers by the then Secretary of State for Health Richard Crossman, who hoped to obtain increased resources for the health service. Following the situation at Ely Hospital a series of scandals in mental hospitals hit the headlines.〔(【引用サイトリンク】url=http://www.sochealth.co.uk/national-health-service/democracy-involvement-and-accountability-in-health/complaints-regulation-and-enquries/the-production-and-reproduction-of-scandals-in-chronic-sector-hospitals-1981/official-inquiry-reports-into-national-health-service-mental-hospitals/ )〕 All told similar stories of abuse and inhumane treatment of patients who were out of sight and out of mind of the public, hidden away in institutions. At the same time Michael Ignatieff and Peter Townsend both published books which exposed the poor quality of care within certain institutions. In the 1980s there was increasing criticism and concern about the quality of long term care for dependent people. There was also concern about the experiences of people leaving long term institutional care and being left to fend for themselves in the community. Yet the government was committed to the idea of 'care in the community'. In 1986 the Audit Commission published a report called 'Making a Reality of Community Care'. This report outlined the slow progress in resettling people from long stay hospitals. It was this report which prompted the subsequent Green and White papers on community care. ==Aims of community care policy== The main aim of community care policy has always been to maintain individuals in their own homes wherever possible, rather than provide care in a long-stay institution or residential establishment. It was almost taken for granted that this policy was the best option from a humanitarian and moral perspective. It was also thought to be cheaper. The Guillebaud Committee, reporting in 1956, summed up the assumption underlying policy. It suggested that: ''Policy should aim at making adequate provision wherever possible for the care and treatment of old people in their own homes. The development of domiciliary services will be a genuine economy measure and also a humanitarian measure enabling people to lead the life they much prefer''〔(【引用サイトリンク】url=http://www.sochealth.co.uk/2013/09/10/guillebaud-report/ )〕 Three key objectives of Community Care policy: * The overriding objective was to cap public expenditure on independent sector residential and nursing home care. This was achieved in that local authorities became responsible for operating a needs-based yet cash-limited system. * There was a clear agenda about developing a mixed economy of care, i.e. a variety of providers. The mixed economy provision in residential and nursing home care has been maintained despite the social security budget being capped. And there are now many independent organisations providing domiciliary care services. * To redefine the boundaries between health and social care. Much of the continuing care of elderly and disabled people was provided by the NHS. Now much of that has been re-defined as social care and is the responsibility of local authorities. An important point to note though is: that NHS services are free, whereas social services have to be paid for. So how the care you require is defined, that is health or social care, determines whether or not it will be free. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Care in the Community」の詳細全文を読む スポンサード リンク
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