ABSTRACT
Even more confusing, many “community” services—for example going into a care home—are likely to be as disruptive as going to hospital. With the closing-down of much institutional care, community became for a time a god-word. The concept of patient-centred care has become devalued. King’s Fund research investigated reactions of hospital staff to the concept of patient-centred care and basic care, person-centred care, personalized care, dignity and respect, humanity, and customer care. The discharge of patients from hospital may, paradoxically, be experienced as contributing to a breakdown of health care and invalidate the good work done in the hospital as a community system. Care systems for the elderly manage their own boundaries to ensure the most effective use, as they see it, of their own resources in relation to the needs of an ageing population. Referral in the middle range is an attempt to get an output by transfer within and between care systems.
