Commissioning for Quality: Ten Years of Social Care Markets in England

Abstract

The introduction of social care markets was one of the main planks of the Conservative government's community care reforms of 1990. The Labour government, whilst emphasising collaboration rather than competition, has not sought to reverse this policy. What have been the consequences? We discuss a decade of market-related change under five heads: purchasers, providers, commissioning, care planning and delivery, and users and carers. There have been quite substantial changes effected by social care markets in each domain, in turn generating a number of pertinent questions for the future success of social care policy in England. One is the very suitability of market-like arrangements in social care. Another is whether transaction costs are too high. More generally, are social care markets structured in a way that will generate the efficiency improvements that successive governments expect of them? Fourth, to what extent will price competition damage quality of care? Finally, will commissioning arrangements mature so as to achieve a better balance between competitive and collaborative modes of working?

Case management method applied to older adults in the primary care centres in Burjassot (Valencian Region, Spain)

“…The adjustments made as a result of proposals to reduce or control public spending (Comas et al 2006) have led to an absence of growth in the supply of public resources and a shift to private supply and/or family or informal care (Field and Peck 2003;Knapp et al 2001).…”

The role of formal and informal networks in supporting older people’s care during extreme weather events

“…This is particularly significant given the role which carers, voluntary sector groups and social support services play in providing and supporting informal networks of care. We have shown above that continuation of the types of networks described here is far from certain given the ongoing cuts to public sector funding and the continued restructuring of health and social care, that have given the independent sector a growing role in health and social care delivery (for example, see Knapp et al, 2001 andMilligan, 2009). The independent sector was seen as less reliable than public sector systems during extreme weather events in the case study area.…”

Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region

“…Although the composition of supply sometimes has turned into an oligopoly (Brennan et al, 2012), it remains to prove the most important aspects of efficiency such as the reduction of nursing-homes prices and the improvement of quality of these services. This is one of the most important challenges in this process since information of elder services is scarce, especially on results and quality (Knapp et al, 2001). Despite of this, Caravaglia et al (2011) advocate that competition seems to produce positive effects on efficiency in Italian nursing-homes, mainly due to better control on labour costs.…”