Bach-Mortensen Anders Malthe, Goodair Benjamin, Barlow Jane
Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
Lancet. 2022 Nov;400 Suppl 1:S14. doi: 10.1016/S0140-6736(22)02224-3. Epub 2022 Nov 24.
Most children's social care services in England are operated by for-profit companies, but the implications of this development are not well understood. We aimed to evaluate the associations between for-profit outsourcing and quality of service provision among local authorities and children's home providers in England, UK.
We did an observational longitudinal analysis of inspection outcomes among English children's homes and local authorities. We created and analysed a novel, longitudinal dataset of inspections from Ofsted (ie, the independent regulator of children's social care in England) over a period of 7 years (2014-21; n=13 452). We also analysed the association between Ofsted local authority ratings (n=147) and the use of for-profit outsourcing.
We found that for-profit children's home providers are significantly more likely to be rated of lower quality than both public and third sector services across all provider level Ofsted inspection domains. For example, for-profit providers have 33·7% lower odds (odds ratio [OR] 0·663; 95% CI 0·522-0·842) than local authority providers of being rated "Outstanding", "Good", or "Requires Improvement", as opposed to "Inadequate" in the main "Overall Experiences" Ofsted category. For-profit services also violate more legal requirements (OR 0·380 [95% CI 0·186-0·575]) and receive more recommendations (0·391 [0·242-0·540]) than local authority providers. These findings are robust to model specification and consistent over the full analysed period. Further, we found provisional evidence that local authority Ofsted ratings are negatively correlated with the percentage of for-profit outsourcing, suggesting that poorly performing local authorities tend to outsource a greater amount of their services than well performing local authorities.
Our findings are of considerable concern given the focus of these services on society's most vulnerable service users. However, caution is needed in terms of regulating the sector going forward, as the role of for-profit providers cannot be replaced without substantial coordination and long-term planning.
The John Fell Fund and the Carlsberg Foundation.
英国英格兰地区的大多数儿童社会护理服务由营利性公司运营，但这一发展趋势的影响尚未得到充分理解。我们旨在评估英国英格兰地区地方当局和儿童之家提供者中营利性外包与服务提供质量之间的关联。
我们对英国英格兰地区儿童之家和地方当局的检查结果进行了观察性纵向分析。我们创建并分析了一个来自英国教育标准局（即英国英格兰地区儿童社会护理的独立监管机构）的新颖纵向检查数据集，时间跨度为7年（2014 - 2021年；n = 13452）。我们还分析了英国教育标准局对地方当局的评级（n = 147）与营利性外包使用之间的关联。
我们发现，在所有提供者层面的英国教育标准局检查领域中，营利性儿童之家提供者被评为质量较低的可能性显著高于公共部门和第三部门服务。例如，在主要的“总体体验”英国教育标准局类别中，营利性提供者被评为“优秀”“良好”或“需要改进”而非“不合格”的几率比地方当局提供者低33.7%（优势比[OR] 0.663；95%置信区间0.522 - 0.842）。营利性服务也比地方当局提供者违反更多法律要求（OR 0.380 [95%置信区间0.186 - 0.575]）且收到更多改进建议（0.391 [0.242 - 0.540]）。这些发现对于模型设定具有稳健性，并且在整个分析期内保持一致。此外，我们发现初步证据表明，英国教育标准局对地方当局的评级与营利性外包的百分比呈负相关，这表明表现不佳的地方当局往往比表现良好的地方当局外包更多服务。
鉴于这些服务关注社会上最弱势的服务使用者，我们的发现令人深感担忧。然而，鉴于在没有大量协调和长期规划的情况下，营利性提供者的角色无法被取代，未来在监管该部门时需要谨慎行事。
约翰·费尔基金和嘉士伯基金会。
