The 'quasi-market' in social care and its responsiveness to differentiated need : a case study of service provision for older African-Caribbean people in two London authorities
This study is an exploration of the extent to which the introduction of a 'quasimarket' within Personal Social Services in England had enabled them to respond more sensitively to the different needs of those they served compared to the previous model of large scale local authority provision. This issue was examined in depth by concentrating on the possibly, distinctive needs/preferences of older 'African-Caribbean' people, as an illustration of the opportunities and difficulties that this new style of 'public management' presented in two London Authorities. To explore this question, three discrete, but connected methods of inquiry were pursued. The first focused on the implementation of the 'NHS and Community Care Act 1990', and more specifically the recommended introduction of a range of 'private' and 'not for profit' provider's under contract. The findings suggest this was only partially implemented. There were changes to the way in which services were purchased, and the way they were provided, but these changes did not constitute a genuine 'quasi-market'. The development of the purchasing function offered the potential for local authorities to respond to 'ethnic diversity', but this did not happen. Indeed an Exploration of service developments suggested that the previous model was more responsive to the differentiated needs of older 'African-Caribbean' people than this new model. The second dimension of this research explored the 'mixed economy' of care through a case study of 'meals' provision. The findings suggested a tendency to monopoly provision, with 'risk' and 'cost' operating as more significant factors than 'differentiated need' in shaping purchasing decisions. The third part of this study explored whether there were distinctive service preferences expressed by older 'African-Caribbean' people for 'culturally specific' provision, and found that whilst there were some, there were also a range of preferences within that community.