Private residential care for older persons: Local impacts of care in the community reforms in England and Wales

The 1990 National Health Service and Care in the Community Act, implemented in 1993, had as a prime objective the creation of social care markets. Prior to these reforms, private residential homes had enjoyed almost guaranteed state financial support for the care of residents, but since then, residential homes have had to complete amongst each other for a finite number of clients funded by limited local budgets. The withdrawal of guaranteed state support and the introduction of a marketplace have had negative impacts on many residential home business. Indeed, many homes are facing financial difficulties. This paper considers the actions and attitudes of proprietors under the new conditions, based on a three-stage survey in Devon. The private residential sector illustrates that local social care markets have the potential to produce negative outcomes that are far from ideal and, to some extent, the paper highlights a market failure. As a case study this research also demonstrates the value of undertaking locality-based detailed studies over time to investigate the impacts of policy change.