Introduction

The last chapter looked at the development of the mixed economy of social care in the four case studies. This chapter takes the analysis one stage further by looking at how the four authorities responded to the change agenda required by the 1990 NHS and Community Care Act. More specifically it will look at their approach to establishing what Le Grand and others have called quasi-markets (Bartlett et al, 1994; Le Grand and Bartlett, 1993).

What are quasi-markets?

The previous chapter looked at the growth of the voluntary and private sectors as key providers of social care services within a contract or service agreement culture. These types of development were strongly supported by both the Griffiths Report (1988) and the subsequent White Paper, Caring for people (DoH, 1989a). Both had argued that the contract culture needed to occur in the context of social services authorities being given the lead agency role for a wide range of groups including older people. However, the lead agency role was not about the monopoly provision of services but rather the further development of a mixed economy of social care based largely on the independent sector. As already indicated, many commentators at the time saw this declining emphasis on the state as service provider as part of a long-term strategy to privatise welfare (Biggs, 1990/91; Langan, 1990).

The publications by Le Grand and his colleagues in the early 1990s had referred to such developments as quasi rather than pure markets, and pointed out that they were also being introduced into other areas of the welfare state such as education and the health service. But what are quasi-markets? Propper et al (1994) argued that the main quasi-market reforms of the early 1990s had a number of common features:

• • the separation of purchaser and provider functions within each service;

• • the devolution of managerial autonomy to individual provider units;

• • changes to funding mechanisms based either on the introduction of formula funding or a system of contracting between purchasers and providers.

The approach taken by the Conservative government to welfare reform implementation stressed that efficiency, effectiveness and responsiveness would flow from increased competition within a market. However, the community care and other welfare reforms of the period created quasi rather than pure markets since: