How outsourcing has contributed to England’s social care crisis

Benjamin Goodair and colleagues argue that growth of private provision in adult social care in England has resulted in worse care and should be rolled back Adult social care in England is in crisis. Chronically underfunded services are struggling to accommodate unmet need, and inequalities are widening. The number of people applying and being rejected for care provision is rising year on year, and unmet need is twice as high in the most economically deprived areas compared with the least deprived.12 Meanwhile, 9 in 10 adult social service directors in England did not believe there was adequate funding or workforce to meet care needs of older and disabled people in their area.3 These deficiencies have seen the social care sector brought “to its knees.”4 Care for older people and people with physical and mental disabilities is facing record demand but performing worse than any time in recent history. One contributor to this is the outsourcing of care provision to the private sector. Although competition from private sector provision was championed as a solution to achieve cheaper and better quality care, evidence from the past few decades in the UK and elsewhere challenges this view.567 In England, in particular, adult social care now faces a reality where reform is needed but the capacity for change is constrained by a model of care where most providers are run by for-profit companies. Social care in England, sometimes referred to as community, residential, or personalised care, constitutes services that support people with activities of daily living and maintaining independence. In England, care services are largely divided between healthcare and social care, with local government responsible for organising and funding social care and the NHS a distinct service directly funded by central government. All health and social care …