Journal of Social Policy



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


MARTIN KNAPP a1, BRIAN HARDY a2 and JULIEN FORDER a3
a1 Professor of Social Policy and Director. Also Professor of Health Economics, Personal Social Services Research Unit, London School of Economics and Political Science and Institute of Psychiatry, King's College, London
a2 Senior Research Fellow, Nuffield Institute for Health, University of Leeds
a3 Research Fellow, Personal Social Services Research Unit, London School of Economics and Political Science

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?