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There is a strong tradition of integration in rural community hospitals which has been largely unrecognised in the past. The national strategy for health in England now gives community hospitals a central role in providing integrated health and social care, in a policy referred to as ‘care closer to home’. The evidence emerging from international and national studies is demonstrating the benefit of the community hospital model of care. Public support for community hospitals over their 100‐year history has been strong, with value being placed on accessibility, quality and continuity. There is, however, a tension between the national policy and the current financial pressures to close or reduce services in one in three community hospitals in England. Innovative ways of owning and managing these services are being put forward by communities who are actively seeking to maintain and develop their local hospitals. The challenge is to demonstrate that community hospital services are valued models of person‐centred integrated care, and to demonstrate their contribution to the health and well‐being of their communities.

Care and support agendas have tended to focus on the need to develop effective services to meet individualised needs within communities of interest. In contrast, community development and regeneration policy have concentrated on the needs of the broader ‘community’ but with little regard to support and care. Rarely do these two important policy domains meet in practice. A three‐year pilot initiative, the Hull Community Care Development Project, aimed to develop the capacity of local communities to respond to their own support and ‘community care’ needs. An independent evaluation documented how such an approach could begin to bridge community and care, and how this produced new challenges, communities prioritising broad neighbourhood issues over specific care and support concerns.

The purpose of this paper is to explore the whole system cost of the care pathway for older people (aged 65-years old and over) admitted to hospitals as a result of falls in Torbay, a community of 131,000 in the southwest of England with a high proportion of older residents, over a two-year period.

The paper analysed patient-level linked acute hospital, community care and local authority-funded social care data to track patients’ care costs – for those patients admitted to an acute hospital due to their fall – in the 12 months before and after their fall.

On average, the cost of hospital, community and social care services for each admitted for a fall were almost four times as much in the 12 months after admission, than the cost of the admission itself. Over the 12 months that followed admission for falls, costs were 70 per cent higher than in the 12 months before the fall. The most dramatic increase was in community health care costs (160 per cent), compared to a 37 per cent increase in social care costs and a 35 per cent increase in acute hospital care costs. For patients who had a minor fall and those who survived 12 months after the fall, the costs of care home services increased significantly; for patients with hip fracture, the costs of community care services increased significantly; for patients who did not survive 12 months after the fall, the cost of acute inpatient and community health visits increased significantly.

This is the only study that has assessed the costs across the acute hospital, community care and social care pathway for this group of patients, in an English population. This will help commissioners and providers understand and develop better-integrated responses to frail elderly patients needs.

Community Care is a major policy initiative in Scotland, involving an annual expenditure of nearly £750m by local authority social work departments and substantial investment by health and housing agencies. The principles of the policy that people should be cared for at home or in homely settings are broadly supported, but unease about implementation remains. Scotland has retained a greater ratio of long‐stay hospital provision, and dependence on residential solutions to community care needs remain high. The inception of the new Scottish Parliament in 1999 will bring new challenges and opportunities for the development of this key policy.

The aim of this study was to test whether the client homebound score (CHS), the case management intensity score (CMIS) and the client priority visit score (CPVS) could be used to predict in‐home time of professional caregivers in the Aspen community care program. A random sample of 34 community care clients from the different geographical areas of the Aspen Regional Health Authority was selected and the home visits for each client were tracked for three months. Information such as client demographics, the client diagnostic category, number and in‐home time of visits was collected. In addition, the CHS, the CMIS and the CPVS were measured for each client. Data were analyzed, using a robust variance estimator regression model. CMIS was found to be the best predictor of in‐home time (coefficient 9.521, p > 0.001), followed by the CHS and the CPVS.

This article demonstrates how the role of the community matron has developed in Cornwall over the past three years, and how this role can be understood as the lynchpin of an integrated approach to the care and management of patients with complex needs and multiple long‐term conditions. In recent years there has been growing recognition that current models of care delivery would be likely to struggle to meet the future demands of an ageing population. Cornwall's approach is to build on the introduction of the community matron service, and to support a new model of care delivery which will encompass use of assistive technology as an additional tool to support those with long‐term conditions. The article will demonstrate the current effectiveness of the service in terms of savings for the health and social care community, and presents a case study to show how integrated working can be used to facilitate improved outcomes for patients.

This article will examine the potential gap between the rhetoric of reducing bureaucracy to achieve better outcomes for individuals, and the reality for community care in the framework of the introduction of a single reporting system focused on a Single Outcome Agreement (SOA), developed between local and central government in Scotland. The article will provide a description of current arrangements in Scotland and draw on a major analysis of all 32 08/09 SOAs conducted by Community Care Providers Scotland to examine whether or not this framework could be a driver or barrier to better outcomes.

The United Kingdom as it approaches the millennium is frequently described as both an ‘information society’ and an ‘ageing society’. This paper outlines the findings of a piece of research exploring the relationship between older people and information, with particular references to the National Health Service and Community Care Act, 1990. The research findings suggest that urgent action is required if older people are fully to participate in and benefit from the information society.

There has been much research focusing on contracting and its effect on individual voluntary sector organisation, and some mapping of the extent of voluntary sector participation in joint community care planning. Each of these is a new and formal relationship with the statutory sector, and in many cases the tasks are fulfilled by the same voluntary sector worker (usually the senior paid officer of the agency). But the impact that these two new relationships have on the voluntary organisation’s perception of its dependence and inter‐dependence has received less attention. The paper will draw on structured interviews in three local authorities, with voluntary sector participants in contracts for social care, and with participants in joint community care planning groups, as well as on documentary research. It will explore the impact of the evolving roles for those seeking to operate effectively in the pluralist provision of public services. It will analyse experiences within joint community care planning structures, and will analyse experiences of contractual relationships. The paper will seek to identify the elements present in each research site which influence the culture of joint working within the two statutory/ voluntary relationships.

Recently arrived older refugees in resettlement countries are a particularly vulnerable population who face many risks to their health and well‐being, and many challenges in accessing services. This paper reports on a project undertaken in Victoria, Australia to explore the needs of older people from 14 recently arrived refugee communities, and the barriers to their receiving health and aged care. Findings from consultations with community workers and service providers highlight the key issues of isolation, family conflict and mental illness affecting older refugees, and point to ways in which policy‐makers and service providers can better respond to these small but deserving communities.