Long Term Care Reform in England: A Long and Unfinished Story

Abstract

After a general description of the structure of the long-term care system as it has historically developed in England, this chapter documents some major changes that have taken place in the organization and delivery of long-term care in England over the past two decades—specifically the introduction of quasimarkets. It also documents the failure over the same period to achieve reform in the critically important area of funding. It shows that one series of policy preoccupations—quasimarkets and choice—has been pursued so consistently and assertively over two decades by Conservative, Labour and Conservative-Liberal Democrat coalition governments alike, when all have found more fundamental funding reforms much harder to achieve. Furthermore, this chapter describes the changes introduced in the institutional setting of the system in order to improve its efficiency, by supporting better collaboration between services, by introducing intermediate care services and by improving new approaches to home care. Finally, a review of the role played by diverse social and institutional actors in the revision of the system is presented as well as an interpretation of the mechanisms of change and the impact of the reforms.