Quasi-Markets and the Reform of Community Care

Abstract

The White Paper, Caring for People: Community Care in the Next Decade and Beyond (Department of Health, 1989a) was published in November 1989. Its main recommendations were subsequently included in the National Health Service and Community Care Act 1990. This chapter looks at the early attempts of social services departments in two shire counties to think through their response to the emphasis of the White Paper on the need for social services to develop an enabling role which makes maximum use of the independent sector. This emphasis upon developing a range of service providers flows from a belief that the introduction of market elements into the provision of social care services will improve their efficiency and consumer responsiveness. The first section places the case studies into this national context not only by looking at recent debates about community care and the proposals of the White Paper but also by reflecting upon the broad trend to introduce market elements into a wide range of public services. This is followed by a description of community care arrangements, both present and proposed, in the two shire counties and a consideration of the extent to which the future pattern of provision is likely to possess the characteristics of an efficient market. The paper concludes with a general discussion of implementing markets in social care.