Introduction

The United Kingdom is in the midst of considerable policy turbulence in respect of health and social care provision. As a consequence, the prospects for long-term care over the next decade are unclear but potentially of considerable concern. The NHS and Community Care Act 1990 is firmly on the Statute Book and the NHS changes were introduced on 1 April 1991 as planned. But there is continuing political uncertainty and ambivalence about aspects of the reforms particularly as they impinge upon the future of community care. There is a view that the reforms do little to address the fundamental issue of who is responsible for long-term care — is it individuals, or their families, or society at large? A deep seated ambivalence about policy prevails centring not only on its content but also on its implementation.

This chapter is in three sections. The first section comprises a brief review of the position of elderly people in the UK in terms of demography and services, and puts these trends in a wider European context. The second section sets out the present state of policy in respect of long-term care for elderly people and the likely prospects over the next year or so.