The ground-breaking study was led by Dr Anders Bach-Mortensen (Senior Postdoctoral Researcher), co-authored by Dr Benjamin Goodair (Postdoctoral Researcher) and funded by the Nuffield Foundation. It sheds new light on the extent and impact of outsourcing in England’s adult and children’s social care sectors.
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.
“Our analysis reveals a paradox in England’s social care” Anders Bach-Mortensen, lead author
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.
- 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.
Lead author of the report, Anders Bach-Mortensen said of the findings: “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.”
Co-author, Benjamin Goodair 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.”
The full report is available on the project page.
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