Movement and change: independent sector domiciliary care providers between 1995 and 1999.
Promoting the development of a flourishing independent sector alongside good quality public services was a key objective of the community care reforms of the last decade. This paper charts some of the ways the independent domiciliary care sector is changing, as local authorities shift the balance of their provision toward independent sector providers and away from a reliance on in-house services. Two surveys of independent domiciliary care providers were carried out in 1995 and 1999. The aims of the studies were to describe the main features of provider organisations, such as size of business, client group and funding sources; to examine the nature of provider motivations and their past and future plans; to consider how local authorities manage the supply side of social care markets; and to examine the effects on providers of the development of the mixed economy. The first survey in 1995 was conducted in eight local authority areas, which by 1999 had increased to 11 because of the creation of three new unitary authorities. The findings are based on 261 postal surveys together with 111 interviews between the two studies. The research illustrates a domiciliary care market that is still relatively young with many small but growing businesses. There are considerable differences in the split between in-house and independent sector services in individual authorities and a common perception among independent providers that in-house services receive favourable treatment and conditions. Spot or call-off contracts continue to be the most common form of contract although there are moves toward greater levels of guaranteed service and more sophisticated patterns of contracting arrangements. There remains an ongoing need to share information between local authorities and independent providers so that good working relationships can develop with proven and competent providers.
Ware
P
P
Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK.
Matosevic
T
T
Forder
J
J
Hardy
B
B
Kendall
J
J
Knapp
M
M
Wistow
G
G
D000368:Aged; D017048:Health Care Costs; D019981:Health Care Sector / Q000639:trends*; D019538:Health Care Surveys; D006302:Health Services Research; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration* / Q000639:trends; D006801:Humans; D017149:Private Sector / Q000639:trends*; D013222:State Medicine; D006113:United Kingdom