Commissioning for quality: Ten years of social care markets in England

The introduction of social care markets was one of the main planks of the C onservative government's community care reforms of 1990, The Labour governm ent, whilst emphasising collaboration rather than competition, has not soug ht to reverse this policy. What have been the consequences? We discuss a de cade of market-related change under five heads: purchasers, providers, comm issioning, care planning and delivery, and users and carers. There have bee n quite substantial changes effected by social care markets in each domain, in turn generating a number of pertinent questions for the future success of social care policy in England. One is the very suitability of market-lik e arrangements in social care. Another is whether transaction costs are too high. More generally, are social care markets structured in a way that wil l generate the efficiency improvements that successive governments expect o f them! Fourth, to what extent will price competition damage quality of car e! Finally, will commissioning arrangements mature so as to achieve a bette r balance between competitive and collaborative modes of working?