Introduction

Globalisation and its potential impact upon welfare states has been debated frequently in recent years. The core of this debate has been about the extent to which changes in the world market have placed new constraints on national governments in terms of the economic and social policies they may implement. Deterministic claims that globalisation effectively robs governments of policy autonomy, spelling the end of social democratic arrangements based on closed national economies, have been countered by those arguing that the globalisation of the world economy has been exaggerated, or that states retain substantial room for manoeuvre. This is an important debate that is briefly surveyed in the first section of this chapter. However, what most of these accounts have in common is that they are focused at the level of the nation state and the impact upon it of the world market in general. This chapter shows how debates about welfare and globalisation may be focused at other levels of analysis, concentrating particularly on a meso-level of analysis. The framework developed by Ruigrok and van Tulder (1995) is adapted to an analysis of the relationship between internationalised private providers of long-term care operating in the UK and three other key actors: the state, staff and unions, and older people themselves. The chapter contests deterministic claims about the loss of state power by concluding that the state is the key actor in shaping the long-term care sector. However, the outcome of state policies is likely to be a trend towards greater concentration and internationalisation in the sector, an outcome in the long-term interests of those providers that are already large and internationalised.

Welfare and the globalisation debate

The ‘globalisation’ of the world market is usually seen as resulting from the growing extent and intensity of international trade, investment and financial flows, facilitated by advances in transport and communications technologies. There is disagreement about the significance of these changes, with the ‘hyper-globalists’ (for example, Ohmae, 1990; Reich, 1991) on one side, arguing with the ‘sceptics’ (for example, Ruigrok and van Tulder, 1995; Hirst and Thompson, 1999) on the other. There is not room here to assess these debates fully, but this chapter broadly takes the view of Held et al (1999, p 27) and Perraton et al (1997) that globalisation is best regarded as a contested process, rather than a fully realised end point.