Negotiating needs, access and gatekeeping: developments in health and community care policies in the UK and the rights of disabled and older citizens

Abstract

This article argues that the cumulative consequences of community care policies in the UK have resulted in a move from universal access to NHS services to discretionary access to residual local authority services. Drawing on an empirical study of the experiences of disabled and older people in obtaining access to community care assessments, the article argues that the traditional ‘gatekeeping’ activities of professionals have been augmented by a range of managerial and bureaucratic gatekeeping procedures. It examines the implications of these additional layers of gatekeeping for disabled and older people's status as citizens.