Dr Anders Bach-Mortensen, Dr Ben Goodair and Isabelle Kelly argue the NHS 10 year plan risks repeating past privatisation failures.👇
https://ow.ly/Sv1e50YKhRM

The NHS 10-year plan suggests solving low capital expenditure and long waiting times through greater use of the private sector...

...but doesn't state how to avoid previous failures of NHS privatisation.

www.bmj.com/content/393/...

Is privatised health and social care serving those most in need? I LSE Research Postdoctoral Fellow Benjamin Goodair investigates the realities of privatisation in health and social care, revealing how ownership — especially in children’s homes — shapes access, quality and equity...

"Who benefits from the privatisation of health and social care?" @bengoodair.bsky.social explores how privatisation has panned out in practice, and who benefits the most, and suggests two possible paths for policymakers.
#LSEResearchForTheWorld
www.lse.ac.uk/research/res...

Funding gratefully received from @nuffieldfoundation.org.

cc. @jessasatomp.bsky.social @joshmacalistermp.bsky.social @becomecharity.org.uk @nataliegreenpeer.bsky.social @lse-sticerd-case.bsky.social @blavatnikschool.bsky.social @lsepress.bsky.social

Commercialisation and care sufficiency: the privatisation of children's homes in England Although the commercialisation of care services is intended to produce markets that respond to care need, it is still unclear whether profit incentives align with population need. In this Health Polic...

We conclude:

Our study "reveals a system either inherently unsuited to commercial interests, or too poorly resourced to effectively regulate private sector behaviour."

www.thelancet.com/journals/lan...

We argue that this matters, for children in children's home, and for all users of health and care services.

The more care services are commercialised, the more we can expect them to respond to financial incentives.

Financial incentives for providers are usually not aligned to care need.

Bigger firms and investment-backed firms are more likely to run children's homes in areas with lower need for homes.

Charities and councils are most likely to open homes in areas with high need

But is this problem linked to commercialisation?

Our results suggest so.

There is a clear association between the location of children homes and ownership type.

There is a known problem in sufficient children's home places. E.g. this from the HoC education committee:

"There are severe shortages of appropriate placements"

"The children’s social care market is not delivering for
children or for local authorities"

committees.parliament.uk/publications...

The most common type of children's home provider has been investment ownership.

In the past 10 years, the number of for-profit homes has more than doubled and there has been a decrease or plateau in the number of third sector and publicly owned homes.

We test this by analysing the commercialisation of children's homes in England.

We analyse the ultimate ownership of children's homes, linking them to charities, councils, individual-owned companies, corporate-owned companies (chains) and investment-owned companies (often private equity).

There are two competing theories we wanted to test:

1) Commercial entities are more responsive to need because their financial survival relies on it.

or

2) Commercial entities are selective in their provision of services - only providing the most financially lucrative care.

Commercialisation and care sufficiency: the privatisation of children's homes in England Although the commercialisation of care services is intended to produce markets that respond to care need, it is still unclear whether profit incentives align with population need. In this Health Polic...

New paper out today in @thelancetph.bsky.social with François Schoenberger and @andersb-m.bsky.social :

Do commercial markets deliver public services where we need them?

www.thelancet.com/journals/lan...

Ny forskning viser, at særligt de nyeste private sociale tilbud leverer dårligere kvalitet for sårbare børn og voksne sammenlignet med både de kommunale og selvejende steder.

Forskning: Private sociale tilbud har lavere kvalitet end de offentlige

New paper, showing inequalities in social care.

"The poorest areas have far fewer outstanding rated care homes, despite those areas having higher care needs."

@lse-sticerd-case.bsky.social @nuffieldfoundation.org @blavatnikschool.bsky.social @ageuk.bsky.social @carers-uk.bsky.social @scie.org.uk

Many thanks to great co-authors @andersb-m.bsky.social @catherineneedham.bsky.social and Michelle Degli Esposti

And many thanks to our funders @nuffieldfoundation.org

All feedback welcome :)

Our case for change is quite simple: the system doesn't function well for anyone.

A different funding model can simultaneously provide more equitable outcomes whilst preventing extortionate costs for people self-funding.

We argue that

"Beyond these statistics lies a profound human impact: those who cannot afford to self-fund from the outset will have often have no choice but to live in struggling homes simply because they cannot afford to pay."

We also show that state-funded residents live in worse quality care homes across the board - with largest inequalities in the richest areas.

We show that in England the best homes open in the richest places...

... It's almost exactly the opposite for the worst quality homes.

England’s two tier care system deepens social care inequalities Anders Bach-Mortensen and colleagues examine how increasing reliance on out-of-pocket payments for adult social care has created a quality divide In July 2024, the UK government abandoned long awaite...

Out today in @bmj.com

What happens in a two-tier system of care where some people pay and others don't?

- Care homes end up providing better care for the richest;

- They open in the richest areas;

- Something people discover when their personal savings run out...

bmj.com/cgi/content/...

Funded PhD available to work with @mjwdemography.bsky.social and team answering: "are international migrants living longer lives in worse health than non-migrants in the U.K. are?"

And happy to share my experiences working with Anders for anyone thinking of applying.

Postdoc position in Social Care Policy and Outsourcing The Department of Social Sciences at Roskilde University invites applications for a postdoctoral researcher as part of the Carlsberg Foundation Semper Ardens Ac

New Postdoc job!!! Esp for Danish-speaking researchers. To work with @andersb-m.bsky.social at RUC.

Answering the 🔥 topic: Why is Denmark outsourcing it's care services... when the for-profit sector are worse?

Please share with colleagues!

Due: 1st June

candidate.hr-manager.net/ApplicationI...

Full paper available open access here: academic.oup.com/ageing/artic...

cc: @weownit.org.uk

Let down by the care system: state-funded patients Residents in state-funded private facilities more likely to receive below standard treatment, according to Oxford University study

Brand new research reported by @tomwall.bsky.social this weekend:

Our new article, funded by @nuffieldfoundation.org describes the extent of inequalities in care homes - with better care going to those that can pay for it.

For-profit homes delivering poorest care for state-funded residents:

Evidencing the outsourcing of social care provision in England - Nuffield Foundation New research funded by the Nuffield Foundation will enable investigation of the impact of outsourcing social care provision in England.

With many thanks to @nuffieldfoundation.org for funding the study.

You can read more of our studies on our previous project page:

www.nuffieldfoundation.org/project/evid...

Published with @andersb-m.bsky.social + Michelle Degli Esposti + Christine Corlet Walker

At @blavatnikschool.bsky.social + @lse-sticerd-case.bsky.social

cc: @camille-oung.bsky.social , @gerisoc.bsky.social , @nataliegreenpeer.bsky.social , @skinnock.bsky.social

We conclude that the combined system of:

1) Two-tiered funding
2) Under resourcing of state-funded services
3) Outsourcing of care provision

Means that care is unequally provided between people and areas with wealth vs without.

The Casey Commission should consider all three of these features.

Secondly, we show that the "ownership gap" in care quality - a widely shown phenomenon of for-profit care homes being worse quality than other kinds - is only true in England when care homes are providing care for state-funded residents.