Social Policy Research Unit, University of York, Heslington, York, UK.
Health Soc Care Community. 2012 May;20(3):292-9. doi: 10.1111/j.1365-2524.2012.01059.x. Epub 2012 Feb 24.
This paper traces developments in English home care services over two decades from the early 1990s. This longer-term perspective is used to show how factors shaping the broader restructuring of the English welfare state have impacted on home care services in particular. The two most salient features of these policies have been public sector funding constraints and extensive marketisation. Despite demographic trends, home care services have been deeply affected by the structural underfunding of long-term care services in general. The sector has been further shaped by the creation first of a 'mixed economy' of supply, with local authorities purchasing services from external providers instead of their own in-house services; and by the more recent introduction of a 'mixed economy' of purchasing, as greater emphasis is placed on individual choice and personalisation. The outcomes of these dual pressures are an increasingly residual publicly funded home care service and a growing role for private funding and supply. These outcomes have potentially damaging consequences for the quality of both public and private home care.
本文追溯了 20 多年来英国家庭护理服务的发展情况，时间跨度从 20 世纪 90 年代初开始。这一长期视角用于展示塑造英国福利制度更广泛重构的因素是如何特别影响家庭护理服务的。这些政策的两个最显著特点是公共部门资金限制和广泛的市场化。尽管存在人口趋势，但家庭护理服务还是受到了长期护理服务整体结构性资金不足的严重影响。该行业还受到以下因素的进一步塑造：首先是供应的“混合经济”的建立，地方当局从外部供应商那里购买服务，而不是从自己的内部服务中购买；其次是最近引入了“混合经济”的采购模式，因为更加注重个人选择和个性化。这双重压力的结果是公共资助的家庭护理服务日益减少，而私人资金和供应的作用越来越大。这些结果可能对公共和私人家庭护理的质量都产生潜在的破坏性影响。
