title: Allocation of services in England: facts and myths about the equity and efficiency of social care agencies.
abstract: The growing pressure of demands on resources has focused attention on efficiency improvement. The consequence is the growing influence of a new efficiency-focused managerialism whose promise is to reduce what is assumed to be widespread and large inefficiency by applying the nostre of management theorists. The paper first discusses evidence about the nature and extent of various forms of inefficiency in the long-term social care of the elderly, and whether the prescriptions of the new managerialists take adequate account of it, showing that new managerialist argument has overstated (A) the extent to which community service resources are allocated to those benefiting little from them and ignored the large pool of unmet need and (B) the degree to which variations in facility costs are due to agency-wide inefficiency. The paper then reviews evidence about new organisational and practice models based on field clinical insight suggesting that great gains in equity and efficiency would indeed be feasible, but that these could be made only over time as personnel are trained to implement and further develop the exemplar models.
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D004526:Efficiency; D004739:England; D006295:Health Resources / Q000706:statistics & numerical data*; D006707:Homes for the Aged; D006801:Humans; D012946:Social Welfare / Q000639:trends*