Challis L, Henwood M
School of Social Sciences, University of Bath.
BMJ. 1994 Jun 4;308(6942):1496-9. doi: 10.1136/bmj.308.6942.1496.
The implementation of the NHS and Community Care Act 1990 made local authority social services departments responsible for the organisation and funding of support and care in the community. This development took effect at the same time as a blurring of the boundaries between health and social care. One consequence is that the relevance of equity (a guiding principle of the 1946 National Health Service Act, but relatively lacking from the 1948 National Assistance Act, the foundation of many social services) has come to be more keenly appreciated within personal social services. Equity questions arise in community care over the distribution of public resources between different client groups, income groups, generations, and localities. Moreover, no mechanisms exist to monitor the trends that emerge from different ways that people get access to care. Yet there is a risk that substantial divisive consequences may occur, particularly between generations.
1990年《国民健康服务与社区护理法案》的实施,使地方政府社会服务部门负责社区支持与护理的组织和资金筹集。这一发展与健康和社会护理之间界限的模糊同时出现。结果之一是,公平(1946年《国民健康服务法案》的一项指导原则,但在1948年《国家援助法案》中相对缺乏,而该法案是许多社会服务的基础)在个人社会服务中得到了更深刻的认识。社区护理中出现了公平问题,涉及公共资源在不同客户群体、收入群体、代际和地区之间的分配。此外,不存在监测人们获得护理的不同方式所产生趋势的机制。然而,存在产生重大分裂后果的风险,尤其是在代际之间。