Decentralisation from acute to home care settings in England.

The impact of technology and resource constraints on acute care, the concept of a 'primary-care led National Health Service' (NHS), and the emphasis on developing community-based alternatives to institutional care have contributed to a reshaping of the respective roles of acute and home care services over the past 10-15 years in the United Kingdom. In England, recent reforms are allowing GP Fundholders, District Health Authorities representing a specific geographic area, and local government social services departments to purchase both acute and community-based care. In addition, new constraints on further expansion of institutional long-term care are encouraging the substitution of home care for the elderly needing long term care services. The result has been a dramatic increase in use of home care services. However, resource and supply constraints impede further home care expansion. Other forces within the NHS continue to foster unnecessary post-acute institutionalization. The successful decentralization of acute services from hospitals to home care requires an integrated program across the continuum of health and social services. In practice, no such concerted program exists.