The Myth of the Market in the Organisation of Community Care

Abstract

This chapter argues that ‘the market’ for health and social care is best understood as a metaphorical device. Metaphors refer by virtue of ‘social and intersubjective’ mechanisms (Boyd 1993: 524), so they do not simply refer to or describe reality: they create or influence it by conditioning understandings of the social realities to which they apparently refer. Because ‘the market’ is used metaphorically without referents, its use requires and allows it to be mythologised as an autonomous and powerful social agent. Using research evidence from mental health services, this chapter is intended to demonstrate how this myth has distinct effects on organisations where managers and others lack any agreement of what a market should look like. The first section of the chapter examines the variety of available interpretations of ‘the market’, and aims to show how ‘the market’ is an over-burdened metaphor. Next, the chapter examines the nature of care as a unique commodity. Then, using empirical illustrations, the chapter examines the implications of using this metaphor in defining organisational purposes and in creating organisational identity through the establishment and negotiation of boundaries. Finally there will be a discussion conserning the dilemmas resulting from adopting competitive or collaborative strategies in relation to other parts of the service that have acquired a separate status.