PRIVATISATION AND OUTSOURCING IN SOCIAL
CARE
JO MORIARTY, JILL MANTHORPE, SHEREEN HUSSEIN, MICHELLE CORNES, MARTIN STEVENS, JESS HARRIS
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PRIVATISATION AND OUTSOURCING IN SOCIAL CARE:
COMPETITION, HYBRIDISATION AND ‘MARKET SHAPING’
OUTLINE OF PRESENTATION AND BACKGROUND
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OUTLINE
 Drawing on two studies:
 Social Care Practice with Carers
 Longitudinal Care Work Study (LoCS)
 Arguing social care helps us understand where we are in terms
of wider developments in social policy
 Placing discussion in context of Care Act 2014
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‘If the National Health Service “is the closest thing the English
have to a religion”, then ‘the social care system is probably the
least understood part of Britain’s
welfare state’
Independent Commission on the Future of Health and Social
Care in England (2014)
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PROVIDERS
WHO PROVIDES WHAT AND HOW MUCH IS IT WORTH?
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WHO PROVIDES SOCIAL CARE SUPPORT?
Home care services
Care home places
100
100
90
90
80
80
70
70
60
60
50
50
40
40
30
30
20
20
10
10
0
0
1993
Local councils
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2013
Independent sector
1979
Local councils & NHS
2012
Independent sector
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THE CARE HOME MARKET
 488,000 care home places across
the UK
 Estimated market value of £24.1
billion (Grant Thornton, 2014)
 EBITDARM in 2012
 £7,935 per annum per nursing bed
 £7,696 per annum per residential
bed (Knight Frank, 2014)
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Carlton Court in Barnet
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THE HOME CARE MARKET
 Harder to capture
 517,000 adults received local
authority funded home care in 201112 (Francis, 2013)
 169,000 adults paid for own home
care (Institute of Public Care, 2011)
 Home care market worth £652
million in 2010 (Institute of Public Care, 2011)
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Image from Care to be Different website
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VOLUNTARY SECTOR
 Active voluntary organisations
 98,000 in 1991
 153,000 in 2001
 164,000 in 2010
(Dayson et al., 2013)
 Voluntary sector income from
central & local government £7
billion in 2010 (Bhati and Heywood, 2013)
 Not broken down by type so not all for
social care
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Picture from The Guardian
http://www.theguardian.com/news/datablog/2011/aug/0
2/voluntary-sector-cuts-fair-economy
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PERSONAL BUDGETS
 Meant to give people greater choice and control
 Can be taken in different ways
 Managed personal budgets
 Individual Service Funds
From Cornwall
Council website
 Direct payment
 Combination
 2012-2013 figures:
 611,000 personal budgets in
 148,000 of these direct payment (Health & Social Care Information Centre, 2013)
 People with ‘complex needs’ to have merged health/social care budgets
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INCREASED DEMAND
 Number of people with dementia
set to double in next 40 years
(Alzheimer’s Society, 2014)
 Number of people with three or
more long term conditions
expected to rise from 1.9 million
to 2.9 million by 2018 (Campbell, 2014)
http://www.alzheimers.org.uk/infographic
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ANOTHER VIEW
 Concerns about quality of care
 BBC Panorama programme ‘Elderly
Care Exposed’
 8% respondents to Adult Social Care
Survey (2013) felt they were not
treated in dignified way
 Continuing risks to quality of care
and continuity of services (Public
Accounts Committee 2014)
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Reproduced with permission –
Thank you @MartinShovel
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BALANCING PROFIT AND BEING PERSON CENTRED?
@kateswaffer, https://twitter.com/KateSwaffer/status/482765833651773441, 28 June 2014
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EXPECTATIONS AND REALITY?
 Concerns that positive pictures
based on minority who have direct
payments (Beresford, 2014)
 Additional workload for carers of
people who cannot manage own
budgets (Mitchell et al, 2013)
 Cuts to allocations mean people
may only be able to buy personal
care (Lipman, 2014)
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Simon Duffy in The Guardian, 30 January 2014
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INDIVIDUALS AND GOVERNMENTS IN THE MARKETPLACE
 ‘Weaknesses in consumer
knowledge and behaviour’
 Governments find ‘long-
embedded structural designs and
divisions’ hard to change’ (Select
Committee on Public Service & Demographic Change, 2013)
 Paying for care an increasingly
important concern
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METHODS
BRIEF OUTLINE OF STUDY METHODS USED IN TWO STUDIES PRESENTED HERE
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SOCIAL CARE PRACTICE WITH CARERS
• Carers' workers
• Voluntary
organisations
• Commissioners
• Family carers
• Care plans
• Leaflets and
brochures
• Websites
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• National survey of
councils with
social services
responsibilities
Interviews
Survey
Documents
National
workforce
data
• Analysis of Carers
Workers in
NMDS-SC
(Hussein &
Manthorpe, 2012)
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LOCS METHODS
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• 4 areas in England
• Care homes and home care
• 120 interviews (T1 & T2)
• Older people, mental
health, learning disability
• Same 4 areas
• Recruited via
establishments where
managers interviewed or
elsewhere
• 93 (aiming for 120) T1 and
T2
Managers
Staff
• Same 4 areas
• Recruited via participating
establishments or
elsewhere
• 51 interviews (one point in
time)
Service users
and carers
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MARKET SHAPING
THE ROLE OF LOCAL COUNCILS
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MARKET SHAPING
 Care Act 2014 gives new role for local councils in market
shaping
 Variation in extent to which commissioners see their roles in
this
 Market shapers
 Light touch consumerism
 ‘Moral arbiters’
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Quite often residential care is cheaper, particularly in [this city] … What we are
trying to do is to develop the extra care strategy so that people can actually stay
at home but with the same level of support, because that’s infinitely better for
them. And we are … in the process of procuring … extra care placements which
we are hoping is going to affect the local market as a way of erm, helping people to
see alternatives
Nancy, Commissioner01
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What does the social care marketplace need? We are moving so far away from us
being the main commissioner of stuff anyway. This is going to be driven by people
having their own budgets and exercising their own choice. I think the organisations
who are providing specialist workers need to think about their business offer and
what the market is going to need of them
Delia, Commissioner06
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We have lots of rows about it. … They gave their child up at 13, they went to these special
therapeutic communities, isn't it wonderful? … You have to ask yourself, 'Yes, and is that a
meaningful life for the next 60 years?' In terms of human dignity and ownership and identity, isn't
the whole thing about belonging where you live? Why do we deny a certain group of people in our
cohort the lack of identity? No, we're not going to hide them away. They will live here in the
community with their friends and neighbours and become a part of this community
Thomas, Commissioner04
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COMPETITION
DISTINCTIONS BETWEEN ‘PRIVATE’ AND VOLUNTARY PROVIDERS IN CONTRACTING PROCESS BLURRED
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COMPETITION
 Expectation that voluntary sector would bid for contracts in
the same way as the private sector
 Extent to which voluntary organisations saw themselves in
competition with each other differed
 ‘Capital’ of voluntary sector different
 At risk of a different sort of market failure?
 Implications for campaigning work of organisations – often built on collaboration
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I think the competition side of things [will be a challenge]. I think we’ll probably see a lot
more other organisations creeping out of the woodwork who will say … we can provide
the same, a similar sort of service, or even better, for less money which is more of an
impact on us personally, job-wise. But I think yes, I think probably the money side of it is
going to be the biggest issue because although people say, less money doesn’t mean less
quality, it restricts you a huge amount in what you can do and what you can provide
Drew, Worker19
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There is more competition out there now, because obviously you have the private sector
in terms of respite services and you also have other voluntary sector organisations that
are having to diversify and possibly decide that they want to provide support services for
carers … I think the way we are looking at it is, rather than thinking well there is a
competitive environment out there which we appreciate there is, is looking to develop
partnerships with organisations and when services can complement each other … It’s
looking for those marriages if you like that … where there is no competition or stepping
on each other’s toes. By working together you actually create a stronger opportunity.
Kent,VOL14
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And then you find out that [the other organisation] charge for petrol,
or they try to match your petrol, and then charge the … [service
user]
WILLA, Worker37
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HYBRIDISATION
BLURRING BETWEEN PRIVATE AND VOLUNTARY PROVIDERS
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HYBRIDISATION
 Organisations with their roots in one sector take on
characteristics of another (Billis, 2010)
 Billis most concerned with how this happened to third sector organisations
 Distinctions between private and voluntary sector often
seemed to be more about size and values than structure
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‘THEY’VE GOT THE LIFE OF RILEY’
 ‘It started with me, yeah… Just
me. I had four children, four
residents and me’
 At Time 2, 3 residents, 10, 8, 1
year
 Residents chose newest resident
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As I always say, it’s not a five star hotel. It’s not one of these
fantastically purpose built homes that are now being built, but the care
is second to none and if I had to choose a care home for … one of my
loved ones, that’s what I’d ask for before all the chintzy curtains and
nice things
Area2, T2, manager
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DISCUSSION
 Examples of market failure
 Good quality care often down to commitment of individuals rather than system
 Care Act 2014 promises major changes
 Will they make a difference?
 People funded by local councils still form majority of service
users
 Shift away from ‘consumerism’ on grounds of cost?
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DISCLAIMER
 This presentation includes independent research funded by the
NIHR School for Social Care Research and the Department of
Health Policy Research Programme. The views expressed in
this presentation are those of the authors and not necessarily
those of the NIHR School for Social Care Research nor the
NIHR SSCR/Department of Health
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