Evidencing the outsourcing of social care provision in England

This project created a centralised, longitudinal data resource of existing datasets to enable  the investigation of the impact of outsourcing social care provision in England.

Why this project is important

Social care services for children and adults in England have been increasingly outsourced to private for-profit and third sector providers over the last 30 years. However, the extent and impact of this marketisation are unclear, even to regulators and commissioners tasked with ensuring sufficient and quality provision. This lack of evidence has been cited as a major barrier to meaningful regulation and reform efforts aimed at addressing the perpetual crises facing both adult and children’s social care sectors in England.

Objectives and methods

The research team aimed to overcome these knowledge gaps by creating a comprehensive, longitudinal data resource on outsourcing trends and their associations with key outcomes in adult and children’s social care provision across England. By harmonising fragmented publicly available administrative data from multiple sources, the project provides insights into three areas:

1. The degree to which adult and children’s social care services have been outsourced to private sector providers over time.
2. Differences in quality outcomes between public, for-profit and third sector social care providers as measured by regulator inspection ratings and enforcement actions.
3. Equity impacts of outsourcing on accessibility and quality by geographical area.

Findings

Analysis of the data resource reveals that outsourcing of residential services like care homes and children’s homes to private providers, especially for-profit companies, has increased substantially over the last 20 years in both sectors. Despite the growth of private provision, the inspection ratings from regulators consistently show that publicly-operated and third sector adult care homes and children’s homes outperform those run by for-profit providers on measures of quality. Involuntary closures and cancellations enforced by CQC and Ofsted are also concentrated among for-profit providers.

For-profit adult care homes also appear increasingly focused on self-funded residents in affluent areas, potentially leaving those in deprived localities with fewer options. In children’s care, for-profit children’s homes concentrate in disadvantaged areas with lower property prices, exacerbating existing issues such as children being placed far outside their local authority areas.

Implications

Overall, the findings reveal a paradox – despite private for-profit provision consistently underperforming public and third sector operators on inspection metrics, outsourcing to for-profit providers has accelerated, especially in residential care settings such as nursing homes and children’s homes. Moreover, the evidence raises concerns about whether the current outsourcing landscape is achieving sufficient quality, equity, and access for adult and children’s social care across England.

Significant data gaps remain on key issues such as provider profits, resident characteristics, and contract details between commissioners and providers. Addressing these gaps in the evidence is crucial for effective regulation and reform.

Next steps

In a second Nuffield funded project, the outsourcing of adult and children social care provision in England will be evaluated.