The purchaser-provider split and the mixed economy of provision: the case of home care for elderly people in Kent

<p>Kent Social Services is one of the first authorities to introduce a purchaser-provider split and a mixed economy of provision as a result of the Community Care White Paper (1989). Since the PSSRU was already undertaking a study of Kent Home Care for the Authority, it seemed a good idea to extend this, using Department of Health funding, to study how Kent is organising and managing the change to the mixed economy, from both the Authority's point of view, and that of the indpendent provider organisations involved. The study was undertaken in collaboration with Cherry Rowlings, David Challis and Bleddyn Davies.

<p><p><p>The aim of the study was to follow and analyse the process and content of change in introducing the purchaser-provider split, and the mixed economy of provision in relation to home care services, and paying particular attention to:

<p><p><li> what new structures, systems, procedures, skills and aptitudes are required both within the SSD, and within independent providers of different types?</li><p><p><li>what means and level of intervention in the market are necessary to achieve the aims of the Community Care White Paper? Are the Government's expectations of the split and mixed economy well-founded, or in what circumstances are they well-founded?</li><p><p><li>what are the values and motivations of key people in the SSD and independent providers which determine and explain their decisions viz a viz the above changes?</li><p><p><li>what issues deserve further study?</li>

<p><p><p>Fieldwork, involving interviews and documentary collection, was conducted in summer 1990, and change was monitored up to April 1991. The report is in four sections. Section 1 is an introduction. Section 2 describes progress in implementing the purchaser-provider split and the mixed economy of home care provision. Section 3 covers the provider perspective, giving details of the independent providers participating in the study and a brief history of their involvement, and describing particular issues raised by them during interviews. Section 4 discusses the implications of Kent's approach to a mixed economy, and outlines a number of issues to be studied in future.