Aspirations and realities: community care at the crossroads*

The community care reforms in the United Kingdom were a response to a broadly based critique of the policy's failure. After an apparently successful first year's implementation, their robustness is increasingly under question. This paper reviews evidence about the early implementation of the reforms. While attention has focused on erecting a structure of systems and processes, the foundations of community care are in danger of being undermined by internal and external policy contradictions. The twin objectives of improved service access and expenditure control are already proving difficult to reconcile. In addition, radical changes in the delivery of acute services are creating additional pressures which the reforms were not designed to bear.