Home care in England: markets in the context of under-funding

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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.
Original languageEnglish
Pages (from-to)292-299
Number of pages8
JournalHealth and Social Care in the Community
Issue number3
Early online date24 Feb 2012
Publication statusPublished - May 2012


  • home care services
  • social care services
  • residential care
  • public sector funding
  • long-term care services
  • personalisation
  • choice

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