Health services and community care policy
Health care policy, it is argued in this chapter, is an essential ingre dient of community care, but the policy decisions have been shackled by traditional organisational divisions between health and social care. Again, health policies reflect the ideological perspectives of government, and, in this respect, the substantial changes effected in health policy and adm inistration during the 1980s and 1990s not only represent responses to dem ographic and social developments in the society, but also much broader ideological strategies in social policy per se, whereby collectivism gives way to individualism; public needs cede to managerialism and the market; and equity gives way to cost effectiveness and income generation. Yet such tendencies constitute part of the ‘paradigm ’ shift occurring in a num ber of other countries where the burgeoning cost of health is posing a m ultitude of policy problems. The particular solutions being offered vary to an extent, but they are also clearly related to social and community care strategies - hence the great significance attached to the means for effective collaboration between health and social care agencies. In many cases, organisational cultures constitute the barrier; tradi tional professional hegemony and power are at stake, particularly between the medical profession and the allied ‘caring’ professions.