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Author: Martin Knapp

The emphasis on economy, effectiveness and efficiency in the public sector has been one source of encouragement to local authorities to contract-out some of their services. However, the assumption common in some circles of an inefficient public sector and efficient non-public sectors is rarely tested. This paper addresses this assumption. It focuses on private children’s homes and the fees they charge, and compares them with the costs incurred in the public sector. Fees and costs are compared after standardisation for differences in the characteristics of clients, homes and areas. The charging structure adopted by most private homes is relatively simple, and their fees are lower than local authority costs even after standardisation.

There are no discernible quality differences between the sectors. In present circumstances, the private sector appears to offer a cost-effective service to local authorities. However, doubts are expressed about the scope for a very much larger role for the private sector.

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Author: Martin Knapp

This chapter examines fundamental changes that have developed in the delivery of some parts of social care to individuals, aimed at both increasing their choice over service providers, but more recently their control over that choice. It argues that for such policies to succeed requires four elements: a range of services that offers meaningful diversity; accessible and understandable information for service users to make choices between options; empowerment of users and carers to select between services; and control — in some cases with support and monitoring — over those selections. It traces the development of first ‘direct payments’ to people entitled to support for personal care of different kinds since 1996, and more recently the pilot experiments with ‘individual budgets’, where service users are using combined resources from a variety of funding streams within what becomes a real, rather than a ‘quasi’-market.

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The long-awaited report of the House of Commons Social Services Committee (1984), Children in Care, drew attention to two very durable features of policy-making in the personal social services: the influence of costs on both policy and practice, and the dearth of reliable cost data. For example, much of the discussion during the Committee’s examination of witnesses from the Department of Health and Social Security (DHSS) focused on the relative costs of residential and boarding out placements, the escalating costs of care, the cost effectiveness of intermediate treatment as an alternative to custody and the sources of cost variations between different homes, local authorities and sectors. In each case the available cost information was sadly lacking. There have been other developments which have served to emphasise the pressing importance of costs in the social care area. The Social Work Service of the DHSS is being gradually transformed into an inspectorate with a particular interest in differences in provision and practice between authorities. At the same time, the newly established Audit Commission has drawn on a series of special studies to prepare its ‘Value for Money’ guidelines.

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The association between major-party alignment and social class has been of central interest to political scientists for some time, stimulating statistical investigations of varying degrees of sophistication. A particulary appealing approach has been suggested by Butler and Stokes allowing decomposition of a party’s share of the vote into what they term class composition, class support, and interaction effects. The appeal of this method derives not least from the fact that it may be applied to a comparison of only two regions or constituencies, whereas the multiple regression analyses, of for example, Crewe and Payne, and Miller, require many more observations. Closer examination of the Butler and Stokes procedure, however, reveals two unfortunate phenomena – an algebraic error in the derivation of the decomposition equation and, of rather more consequence, a lack of symmetry in the definition of the support, composition, and interaction effects. This asymmetry serves to cast doubt on the practical usefulness of the suggested approach.

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Almost every policy pronouncement at central government and local authority level advocates an increase in the proportion of children placed with foster families from among those admitted to care, that is no longer living with their biological or adoptive parents. Every local authority in England has successfully increased this proportion over a ten year period but they are finding it increasingly difficult to do so as child care populations change. This short paper reports how one London borough experienced a fall in its boarding-out proportion over a four year period, but had nevertheless succeeded in finding foster rather than residential placements for a ‘more difficult’ care population. Far from being castigated for its falling boarding-out proportion over this period the authority deserves congratulation.

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Volunteer inputs to community care (health and social services) are important in the developing mixed economy of welfare. And community care is a common locus for volunteering activity in the UK. But who are these volunteers? And what factors motivate and constrain volunteering? Using data from a UK household survey, the patterns of community care volunteering are examined using multivariate statistical methods. Many individual, household and other characteristics influence volunteering, with quite marked differences in the patterns for distinct types of community care activities: health and social welfare organisations generally, supporting elderly people, visiting sick or elderly people, and transporting or escorting. Methodologically, the results point to failures of previous studies to address adequately the volunteering contributions of, inter alia, black and minority ethnic groups and lower income groups. These and other findings have implications for community care policy and practice.

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English

Two prominent features of mental health policy in the UK in recent years have been the run-down of hospital provision and the changing of the balance between public and other provider sectors. This article examines the cost, quality of care and outcome implications. Public, voluntary and private providers of mental health care are compared, based on a long-term study of people moving out of psychiatric hospitals in London. Costs are found to be lowest in the private (for-profit) sector, and highest in the NHS and consortium (NHS and voluntary sector partnership) sectors. However, quality of care indicators suggest that the lowest cost sector is performing least well, and the highest cost sectors offer the best quality. These are associated with some differences in user outcome.

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This article explores the poverty and disadvantage experienced by prisoners’ families living at or below the level officially recognised as ‘poor’. Current social policy ignores the priority given to the care needs of children by predominantly female relatives and partners of prisoners. In conjunction with criminal justice and immigration legislation, social policies have combined to impoverish, disadvantage and exclude prisoners’ families. Reforms of the welfare system may improve the adequacy of state welfare benefits, but unless fundamentally reshaped, social policy could continue to penalise the ‘care’ offered by prisoners’ families and so further entrench inequalities.

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The Care Act 2014 amended legislation relating to government responsibilities for adults with care needs. It set out new statutory responsibilities for the support of family or informal carers. As part of a study investigating the impact of the Care Act 2014 on family carers in England, we undertook a contextual literature review, focusing on parliamentary debates available online from Hansard. We describe the content of debates seeking to amend the law relating to carers and aspirations for the proposed reforms. We highlight the role of parliamentary carer champions, as well as carer-related themes and the lack of controversy over this subject.

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English

The social care reforms of the early 1990s have had profound effects on the domiciliary care system. The adoption of markets and the ‘enabling’ role for local authorities are central features. In contrast to much of the original rhetoric that lay behind these reforms, economic theory emphasises the importance of the institutional arrangements in affecting performance. Given the discretion that local authorities have over the specific form of transactions with providers, questions about contract choices are especially pertinent. This article describes the range of arrangements being used and the different implications of contract choices. In the context of relatively competitive markets and organisations exhibiting a range of business motivations, the evidence supports the hypothesis that for otherwise equivalent providers, prices are significantly affected by contract type. In short, institutional arrangements matter.

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