The concept of 'care' has come a long way in the last two hundred years. In the early nineteenth century, people with mental health problems were locked up - treated as criminals or lunatics. Over the years there has been a very gradual shift away from imprisonment towards what we have now come to know as community care.

Community care should enable people with needs to live as independently as possible in the community. This obviously means different things to different people. For instance, some people will need only a little extra help in order to live independently in their own home. Others will need more help, preferring the added support of living in a residential home or sheltered accommodation.

Often carers, families and friends have specific needs too. For example with getting practical help, information and support.

The NHS and Community Care Act 1990 made legislative changes, setting in place a system of assessment, which acts as a 'gateway' to services. The Act also heralded changes to the way in which health and social services were planned and provided in an attempt to increase the range, diversity and cost effectiveness of service provision.

In November 1989, the then Government published the White Paper Caring for People, which laid out a framework for community care changes. Its objectives were:

To promote the development of domiciliary, day and respite services to enable people to live in their own homes wherever feasible and sensible.
To ensure that service providers make practical support for carers a high priority.
To make proper assessment of need and good case management the cornerstone of high quality care.
To promote the development of a flourishing independent sector, along with high quality public services. (Social services would now be 'enabling' agencies - it would now be their responsibility to make maximum use of the private and voluntary sectors.)
To clarify the responsibility of agencies and to make it easier to hold them to account for their performance.
To ensure better value for taxpayers' money by introducing a new funding structure for social care.

The NHS and Community Care Act 1990 made all the legal changes necessary for the implementation of 'Caring for People'. Local Authorities, in collaboration with medical, health and other agencies, became responsible for assessing need, designing care arrangements and securing their delivery 'within available resources'.