Understanding Public Services and Markets. Report Commissioned by the King’s Fund for the Care Services Inquiry (for Summary see DP2123/2). Funded/commissioned by: Report Commissioned by the King’s Fund for the Care Services Inquiry

Abstract

Much of social care of older people now takes place in the context of a market. As a result the welfare of many people is fundamentally dependent on the success of that market in terms of both availability of services and quality of care. This paper considers the functioning of that market to date and the challenges it is likely to face in the future. Social care is unlike most other markets in terms of the nature of the product, characteristics of consumers, the relationship between prices, fees and charges, and the dominant role and influence of the public sector. This paper starts by describing and defining what we mean by social care and the context in which the markets have developed. The extent and nature of the market are then outlined in terms of levels, distribution and types funding, the development of the commissioning role by public bodies and the impact on the market of changes in the regulatory system. The role of and involvement of service users as consumers in this market is described before describing in more detail the markets for three services: home or domiciliary care, care homes and the emerging field of extra care housing. The final section looks considers overall market performance, future challenges and how some of the problems that are emerging might be addressed through existing and potential policy and practice levers.</p