User Empowerment and the Reform of Community Care

This paper reports on the first phase of an evaluation project which is studying the implementation of the community care changes introduced by the NHS and Community Care Act 1990. Research has been carried out in four contrasting local authorities with an emphasis upon the implications of their differing implementation strategies for user aand carer empowerment. The paper firstly examines the reforms in relation to user and carer empowerment and outlines the Rowntree Foundation's Community Care Programme. It then describes progress during the first year of the research and the difficult context within which local authorities are attempting to implement the changes. The concept of empowerment and the variety of models which might operate at the local level are explored and the paper also examines the extent to which the case studies are moving towards empowering users and carers both through their collective involvement in planning and through the development of a mixed economy of care. It concludes by looking in general at the progress being made towards participation and empowerment and examines some of the issues which are raised by attempting such an assessment.