Where has all the care management gone? The challenge of Parkinson's disease to the health and social care interface

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Abstract
The delivery of health and social care has undergone massive change in the UK in the 1990s. A key factor in the drive for reform was the failure of joint working arrangements between health and social services and the need to provide integrated care for people who have overlapping health and social care needs. This article draws on a research study investigating the community care provided to people with Parkinson's disease in the wake of the 1990 National Health Service and Community Care Act. As a chronic progressive disease predominantly affecting older people, the management of Parkinson's provides an exemplar of some of the key features of supporting people with continuing care needs. This study found serious deficits in the assessment and meeting of need, arising from weaknesses at the health and social care interface. The article concludes by considering an approach which resources and supports the service user/carer in managing their own care pathway.

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