National Health Service and Community Care Act 1990

The National Health Service and Community Care Act 1990 (c 19) introduced an internal market into the supply of healthcare, making the state an 'enabler' rather than a supplier of health and social care provision.

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The Act states that it is a duty for local authorities to assess people for social care and support to ensure that people who need community care services or other types of support get the services they are entitled to. Patients have their needs and circumstances assessed and the results determine whether or not care or social services will be provided. This also ensures that the people giving the care follow a certain set of rules called the care value base.

Local authority resources can be taken into account during the assessment process, but if it is deemed that services are required, those services must be provided by law: services cannot be withdrawn at a later date if resources become limited.

The act also split the role of health authorities and local authorities by changing their internal structure, so that local authority departments assess the needs of the local population and then purchase the necessary services from 'providers'. To become 'providers' in the internal market, health organisations became NHS trusts, competing with each other. Community care ensures that people in need of long-term care are now able to live either in their own home, with adequate support, or in a residential home setting.