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Home care in England: markets in the context of under‐funding
Author(s) -
Glendinning Caroline
Publication year - 2012
Publication title -
health and social care in the community
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.984
H-Index - 68
eISSN - 1365-2524
pISSN - 0966-0410
DOI - 10.1111/j.1365-2524.2012.01059.x
Subject(s) - restructuring , business , purchasing , public sector , context (archaeology) , private sector , mixed economy , welfare state , welfare , economic growth , service provider , public economics , service (business) , public administration , marketing , economics , political science , finance , market economy , economy , politics , law , biology , paleontology
This paper traces developments in English home care services over two decades from the early 1990s. This longer‐term perspective is used to show how factors shaping the broader restructuring of the English welfare state have impacted on home care services in particular. The two most salient features of these policies have been public sector funding constraints and extensive marketisation. Despite demographic trends, home care services have been deeply affected by the structural underfunding of long‐term care services in general. The sector has been further shaped by the creation first of a ‘mixed economy’ of supply, with local authorities purchasing services from external providers instead of their own in‐house services; and by the more recent introduction of a ‘mixed economy’ of purchasing, as greater emphasis is placed on individual choice and personalisation. The outcomes of these dual pressures are an increasingly residual publicly funded home care service and a growing role for private funding and supply. These outcomes have potentially damaging consequences for the quality of both public and private home care.