Needs: Resources and Abhorrent Choices

Abstract

In every field of welfare provision, but particularly in the case of the chronically sick and disabled, there is a growing tide of need and competition for services which cannot be met by existing resources. Spiralling populations of elderly persons with increased life expectancy have exacerbated this problem.' Treating people in the community, a goal2 which has been perceived by central government to provide a comparatively less expensive way of delivering care, has provided the impetus for a move away from institutional 'care' to community 'care'.3 This policy, however, has not been presented as a purely cost driven exercise. Instead, the movement has been accompanied by language which has emphasised choice and the meeting of individual need. Indeed, escalating costs have not dampened the rhetoric. Despite the gap between the availability of resources and expectation-led demand, central government continued to place emphasis on the paramountcy of consumer choice. While Department of Health circulars and policy guidelines are replete with cautionary statements, which advise local authorities to keep within the limits of available resources, notions of choice, consumer sovereignty and entitlements have been more prominent and more public in documents such as the Citizens Charter and the Government White Paper, Caring for People: Community Care in the Next Decade and