Securing quality through contracts? The development of quasi-markets for social care in Britain

This article examines the early development in Britain of quasi-markets for domiciliary care. Initially there were widespread doubts about the appropriateness of market mechanisms for social care because it was regarded as inherently different from other goods and services. We examine these differences and how they are most apparent in domiciliary care - which is provided to the most vulnerable people in the most vulnerable of settings. The study provides a demanding test and illuminating case study of the introduction of competition through quasi-markets. It highlights some potential threats to service quality and demonstrates that to secure such quality for vulnerable users, public sector purchasers need to develop long-term, high-trust relationships with a range of high quality care providers.