Introduction

There are clearly problems with the operation of a market in adult social care; what is less evident is how to respond to this situation. Logically, there are three options: retain and reform the market; replace the market with a state-run service along the lines of the 1970s’ model; and develop a new approach that is distinct from both of these options. This chapter is concerned with the first two options – put simply, state or market? Chapter 7 explores the scope for a third approach.

Renationalising the adult social care sector

As noted in Chapter 2, the outsourcing of public services to non-statutory providers, especially the private sector, has been the delivery model of choice in the UK for around 30 years. The budget devoted to such contracts is hard to estimate but is reckoned to be in excess of £100 billion (Walker and Tizard, 2018), equivalent to about 8 per cent of gross domestic product. The model has also changed in nature over the years, moving beyond back-office functions and into front-line service delivery.

A number of high-profile problems and outright failures have brought the limitations of this model into more prominent view. Perhaps the most spectacular was the collapse of the outsourcing giant Carillion, which managed services across education, the NHS, prison services and transport – indeed, 60 per cent of its work came from government contracts to deliver public services and facilities. The scathing inquiry by two joint committees of the House of Commons (House of Commons Business, Energy and Industrial Strategy Committee and Work and Pensions Committee, 2018) discovered not just incompetence, but ethical failings rooted in fecklessness, hubris and greed.

Concerns have also been raised across a number of other outsourced public services, including probation (HM Inspectorate of Probation, 2017; National Audit Office, 2019), the prison service (Dockley and Loader, 2016), the forensic science service (Commons Science and Technology Committee, 2016), the NHS (NHS Support Federation, 2017) and children's social care services (Jones, 2018). It is little wonder that in its inquiry into the wider issue of outsourcing and contracting, the Commons Public Administration and Constitutional Affairs Committee (2018) concluded that: it was unclear how and why the government decided whether to outsource a particular service; the evidence used to support outsourcing decisions was ‘thin or non-existent’; and there had been a depressing inability to learn from repeated mistakes.