Increased User Choice and Provider Competition in Social Care Market Welcomed

Wednesday, 26th October 2011

Published: 26 October 2011.

The National Audit Office recently released a report examining the oversight of user choice and provider competition in the social care market. The report provides a useful insight into both the shift of control from local authorities to users of care services and the services available to these individuals.

Up until the early 1990s, local authorities traditionally provided or commissioned care directly on behalf of individuals eligible to receive public funding. Subsequently, care provision began to be outsourced to independent or voluntary organisations and private providers now supply over 80% of care home and home care services.

In parallel to local authorities closing their in-house care services, publicly funded individuals also began to be given greater choice and control over the care they receive (often referred to as ‘personalisation’). This was implemented through the introduction of ‘personal budgets’, which came in the form of ‘direct payments’ from 1996 (whereby an individual receives cash directly to purchase the care service of their choice), and finally ‘managed budgets’ from 2008 (whereby an individual has choice of provider, but spending is managed by a third party – either the local authority or a provider).

As at March 2011, approximately 1 million people were eligible to receive publicly-funded care in England, of whom 340,000 people have been given a personal budget. Of these, 125,000 received a direct payment and 215,000 have a managed budget. Going forwards, the aim of the Government is to increase the proportion of publicly-funded individuals receiving personal budgets from 35% today to 100% by April 2013.

At the same time as control and choice is increasing for publicly-funded users of care services, an expanding elderly population and funding constraints are expected to result in increasing numbers of individuals and families forced to ‘self-fund’ the care services they receive. Of course this will also result in more people with the freedom to appoint a care provider of their choice.

As personal budgets become more widespread and users of care services gain greater control, it is widely considered that competition amongst care providers will increase with individuals / families actively choosing to use the best services.

This combination of greater user choice and provider competition should help drive up the quality of care on offer to elderly people in England and it is therefore welcomed. However, this process must be accompanied by not only strong market regulation and oversight by both Government bodies (e.g. the Care Quality Commission) and local authorities, but also much better guidance for elderly people and their families around how best to access high quality services.

Carefound is a provider of home care services to elderly people in North Yorkshire, enabling clients to continue to live independently in the comfort of their own home whilst maintaining the highest quality of life achievable. The services provided by Carefound include basic help in the homecompanionship and personal care, and its home care team is trained in specialist conditions such as Dementia. The flexible service ranges from 1 hour to 24 hours per day, 7 days a week, including bank holidays, and can also encompass 24-hour Live-In Care services. For more information about Carefound telephone 01423 774070 or visit their website at

Source: Carefound, National Audit Office, Laing and Buisson.