Policy change and policy dilemmas: interpreting the community services White Paper in England

CONTEXT: In 2006 the Labour Government in England published its long awaited White Paper on ‘community services’, following on from the 2005 Green Paper on the future of social care. The policy envisages an unprecedented shift of activity and resources from acute care to community settings, along with a much stronger focus on preventive care. Several mechanisms are to be put in place to ensure this shift takes place, most notably practice-based commissioning, payments-by-results and enhanced partnership working. PURPOSE: This article outlines the intended changes and assesses the extent to which they add up to a coherent strategy. CONCLUSION: It is argued that although there is widespread support for the overall vision, the strategy contains some difficult policy tensions that are common to other welfare systems. These will have to be addressed if the vision is to be a reality.