2. Case management: problems and possibilities

We are now in a period of changing structures, organisations and vocabularies. Hence, it is probably helpful to begin with a definition of terms. Care Management and Case Management are phrases which are currently assuming such currency that their meaning may be lost in a blur of positive value as has happened in recent years to words such as ‘community’ or ‘decentralisation’. Within the Griffiths report (1988) and the prior influential Report of the Audit Commission (1986) are two potentially distinct definitions of the organisational position of those who could be seen as care managers or case managers. The Audit Commission (1986) recommended (para. 174): ‘A single budget under the control of a single manager who will purchase from whichever public or private agency he sees fit the appropriate services for elderly people in the community’. It would be easy to understand this as that of a resource manager at a relatively high tier in an organisation rather than that of a case manager in the sense of being a key worker and close to the client. On the other hand Griffiths (1988) recommended (para. 6.6): ‘In cases where a significant level of resources are involved a "care manager" should be nominated from within the social service authority’s staff to oversee the assessment and reassessment function and manage the resulting action.’ To provide a distinction between care management and case management I take the definition of case management to be the