A new study by the Department of Social Policy and Intervention at Oxford University, funded by the Nuffield Foundation, has shed new light on the extent and impact of outsourcing in England's adult and children's social care sectors.
Our analysis reveals a paradox in England's social care: for-profit providers have grown to dominate the sector, operating over 80% of adult and children's residential care services, even though they consistently underperform public and third sector provision.
Lead author of the report, Dr Anders Bach-Mortensen, Department of Social Policy and Intervention, Oxford University
The report compiles a comprehensive, longitudinal data resource on outsourcing trends, and their associations with critical outcomes nationwide. The findings are crucial to understanding the care crisis impacting both sectors, and the challenges of maintaining quality care amid increased marketisation.
Over the last 30 years, social care services for children and adults in England have been increasingly outsourced to private for-profit providers. However, regulators and commissioners tasked with ensuring quality provision have faced difficulties due to a lack of clear evidence on how these changes have affected care outcomes.
Katharine Sacks-Jones, CEO of Become, the national charity for children in care and care leavers, said: 'This valuable report makes clear the link between private placements for children in care, and increased instability from distant moves. It also highlights the lack of data regarding the quality of care children receive when they're sent to live away from their local area, miles away from everything they know - their school, their friends, and, sadly, often, brothers and sisters.'
Key Findings:
Dramatic increase in outsourcing: Over the past two decades, the outsourcing of residential care services to private providers has surged. In adult social care, 96% of residential services are now outsourced, primarily to for-profit providers, up by over 20 percentage points since 2001. Similarly, more than 80% of children's homes are now run by for-profit companies, a rise of over 20 percentage points since 2010.
Quality concerns: Despite the growth of private for-profit provision, public and third-sector providers consistently outperform for-profit providers on quality measures by industry regulators. Public and third-sector adult care homes and children's homes show higher regulatory inspections ratings. At the same time, for-profit operators experience more frequent involuntary closures and cancellations by the Care Quality Commission (CQC) and Ofsted.
We urgently need a national strategy to increase the supply of suitable residential and foster homes across the country and to address the issues of profiteering, which has no place in children's social care.
Katharine Sacks-Jones, CEO of Become
Geographical inequities: The study highlights disparities in the distribution of services. For-profit adult care homes increasingly cater to self-funded residents in affluent areas, potentially leaving disadvantaged communities with limited access to quality care. In children's social care, for-profit homes are often concentrated in areas with lower property prices. This raises concerns about children placed far from their local authority areas and exacerbates existing issues around access and quality.
Implications for policy and reform:
The findings underscore the need for data-driven approaches to social care reform in England. The growing reliance on private for-profit providers, particularly in residential settings like nursing homes and children's homes, raises important questions about whether current policies deliver sufficient quality and access across the country.
Co-author, Dr Benjamin Goodair (Department of Social Policy and Intervention, Oxford University) said: 'Early data suggests that outsourcing has failed to deliver the expected benefits of private sector efficiencies. Instead, the use of profit-driven providers risks worsening care services. As both adult and children's care sectors face ongoing crises, there is an urgent need for increased scrutiny over the outsourcing of social care.'
Alex Beer, Head of Portfolio Development at the Nuffield Foundation said: "By bringing together publicly available administrative data from multiple sources, and focusing on both adult and children's social care, this research provides a more complete picture of the care crisis than ever before. It raises important questions about the extent of outsourcing, the way it is managed, and the impact for-profit provision can have on vulnerable people.'
The full report 'Evidencing the outsourcing of social care provision in England' is available on the Department of Social Policy and Intervention website.
