Geographical and structural change in nursing care provision for older people in England, 1993-2001

This paper offers an investigation of the geographical and structural contexts of change in the provision of independent nursing care home resources in England between 1993 and 2001. This period: (i) immediately follows the implementation of the community care provisions of the 1990 National Health Service (NHS) and Community Care Act in 1993, and (ii) concludes immediately prior to the implementation of the main provisions of the 2000 Care Standards Act and the 2001 Health and Social Care Act. While the first half of the period witnessed the continued growth of nursing care home resources, the second half was characterized by absolute losses due mainly to closures of homes. The data of this study are elicited from Department of Health (DoH) sources relating to national, regional (DoH regions), and intra-regional (Health Authority areas) levels of resolution. The analytical methods comprise a variety of descriptive and spatial statistical methods that include the location quotient and the coefficient of variation. At the national scale, the findings reveal that the increasing importance of the dual-registered care homes partly cushioned the effect of home closures during the second half of the study period. At both the regional and intra-regional scales, structural changes and declining resource provision resulted in a trend towards a more geographically equitable distribution of nursing home beds. The findings are evaluated in light of current government policy that is committed to the provision of an increasingly flexible and seamless range of care services for older people.