One of the most striking reconfigurations of Irish social care has been the entry of private for-profit companies into a sector previously regarded as outside the market. This article examines the policy context that has given rise to these developments and the impact of marketisation on both the quality of care provision and the employment conditions of the workforce. Whether for-profit provision of care is a positive development is the subject of intense debate, and the arguments for and against are outlined alongside a range of empirical evidence. International research evidence is not convincing about the capacity of markets to deliver on quality or efficiencies. The article concludes with recommendations for further research to enable analysis and debate in the Irish context.
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Anand Carter J. Davidson G. Macdonald G. Kelly B. Clift-Matthews V. Martin A. & Rizzo M. (2012). The transition to personal budgets for people with disabilities: A review of practice in specified jurisdictions [National Disability Authority Working Paper]. Dublin: National Disability Authority.
Bach S. & Bordogna L. (2011). Varieties of new public management or alternative models? The reform of public service employment relations in industrialized democracies. The International Journal of Human Resource Management 22 (11) 2281-94.
Baines D. & Cunningham I. (2015). Care work in the context of austerity. Competition and Change 19 (3) 183-93.
Barry U. (2010). Elderly care in Ireland - Provisions and providers. UCD School of Social Justice Working Papers Series 10 (1) 1-34.
Brennan D. Cass B. Himmelweit S. & Szebehely M. (2012). The marketisation of care: Rationales and consequences in Nordic and liberal care regimes. Journal of European Social Policy 22 (4) 377-81.
Brown T. L. & Potoski M. (2003). Managing contract performance: A transaction costs approach. Journal of Policy Analysis and Management 22 (2) 275-97.
Care Alliance Ireland. (2014). Literature review on the relationship between family carers and home care support workers. Retrieved from http://www.carealliance.ie/userfiles/file/Literaturepercent20Reviewpercent202014percent20Final.pdf [3 April 2016].
Cavendish C. (2013). The Cavendish review. An independent review into healthcare assistants and support workers in the NHS and social care settings. Retrieved from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/236212/Cavendish_Review.pdf [30 May 2016].
Centre for Effective Services. (2015). Commissioning in human social and community services - A rapid evidence review. Retrieved from http://www.effectiveservices.org/updates/article/commissioning-forbetteroutcomes-a-rapid-evidence-review [19 June 2016].
Centre for Health and the Public Interest. (2013). Lessons from the social care market. Retrieved from http://www.chpi.org.uk/wp-content/uploads/2013/10/CHPI-Lessonsfrom-the-social-care-market-October-2013.pdf [10 January 2016].
Clarke J. Smith N. & Vidler E. (2005). Consumerism and the reform of public services: Inequalities and instabilities. In M. Powell L. Bauld & K. Clarke (Eds) Social policy review 17. Bristol: Polity Press.
Cleveland G. (2008). If it don’t make dollars does that mean that it don’t make sense? Commercial non-profit and municipal child care in the city of Toronto. Retrieved from https://www1.toronto.ca/city_of_toronto/childrens_services/files/pdf/cleveland_report_may08.pdf [12 July 2016].
Colton M. Pithouse A. Roberts S. & Ward H. (2004). Review of the purpose and future shape of fostering and residential care services for children in Wales. Cardiff: National Assembly for Wales.
Comondore V. R. Devereaux P. J. Zhou Q. Stone S. B. Busse J. W. Ravindran N. C.… Guyatt G. H. (2009). Quality of care in for-profit and not-for-profit nursing homes: Systematic review and meta-analysis. British Medical Journal 339 b2732.
Considine M. & Dukelow F. (2009). Irish social policy: A critical introduction. Dublin: Gill and Macmillan.
Coulter C. (2013 June 7). There is a conflict between the pursuit of profit and the provision of care. The Irish Times.
Cunningham I. Baines D. & Charlesworth S. (2014). Government funding employment conditions and work organization in non-profit community services: A comparative study. Public Administration 92 (3) 582-98.
Dáil Éireann. (2016). Children in care [Written answer 628 ]. 24 May. Dáil Debates 910 (1).
Department for Education. (2012). Reform of children’s residential care. Report of the Expert Group on the Quality of Children’s Homes. Retrieved from http://cdn.basw.co.uk/upload/basw_341227.pdf [15 December 2015].
Department of Children and Youth Affairs. (2012). Statement of strategy 2011-2014. Retrieved from http://www.dcya.gov.ie/documents/StatementofStrategy2011_2014.pdf [12 January 2016].
Department of Health. (2012). Value for money and policy review of disability services in Ireland. Dublin: Department of Health.
Doyle M. & Timonen V. (2008). Breaking the mould: New trajectories in the domiciliary care of older people in Ireland. International Journal of Social Welfare 17 324-32.
Doyle M. & Timonen V. (2009). The different faces of care work: Understanding the experiences of the multi-cultural care workforce. Ageing and Society 29 (3) 337-50.
England P. (2005). Emerging theories of care work. Annual Review of Sociology 31 381-99.
Eurofound. (2013). More and better jobs in home-care services. Luxembourg: Publications Office of the European Union.
Expert Reference Group on Disability Policy. (2010). Report of the disability policy review. Retrieved from http://health.gov.ie/wpcontent/uploads/2014/08/ERG_Disability_Policy_Review_Final.pdf [9 January 2016].
Fleming P. (2016). How personal budgets are working in Ireland - Evaluating the implementation of four individualised funding initiatives for people with a disability in Ireland. Retrieved from http://www.genio.ie/system/files/publications/PERSONAL_BUDGETS_IRELAND_MAY16.pdf [30 May 2016].
Flynn E. (2010). Direct payments for people with disabilities in Ireland. Human rights. Retrieved from http://humanrights.ie/mental-health-law-anddisabilitylaw/direct-payments-for-people-with-disabilities-in-ireland/ [28 May 2012].
Folbre N. & Nelson J. (2000). For love or money - Or both? Journal of Economic Perspectives 14 (4) 123-40.
Forder J. Knapp M. Hardy B. Kendall J. Matosevic T & Ware P. (2004). Prices contracts and motivations: Institutional arrangements in domiciliary care. Policy and Politics 32 (2) 207-22.
Gadsby E. W. (2013). Personal budgets and health: A review of the evidence. Retrieved from http://blogs.lshtm.ac.uk/prucomm/files/2013/04/Personal-Budgets-reviewofevidence_FINAL-REPORT.pdf [31 May 2016].
Gharabaghi K. (2009). Private service public rights: The private children’s residential group care sector in Ontario Canada. Residential Treatment for Children & Youth 26 3.
Gilbert N. (2002). Transformations of the welfare state. Princeton: Princeton University Press.
Glendinning C. Challis D. Fernandez J. L. Jacobs S. Jones K. Knapp M.… Wilberforce M. (2008). IBSEN: Evaluation of the individual budgets pilot programme final report. Retrieved from http://php.york.ac.uk/inst/spru/research/summs/ibsen.php [23 May 2016].
Hall E. (2011). Shopping for support: Personalisation and the new spaces and relations of commodified care for people with learning disabilities. Social & Cultural Geography 12 (6) 589-603.
Harvey B. (2012). Downsizing the community sector: Changes in employment and services in the voluntary and community sector in Ireland 2008-2012. Dublin: Irish Congress of Trade Unions Community Sector Committee.
Hatton C. & Waters J. (2014). Third national personal budgets survey. Think local act personal in control. Lancaster: University of Lancaster.
Healy K. (2009). A case of mistaken identity: Social welfare professions and new public management. Journal of Sociology 45 401-18.
Himmelweit S. & Land H. (2008). Reducing gender inequalities to create a sustainable care system. York: Joseph Rowntree Foundation.
HIQA. (2016). Annual overview report on the regulation of designated centres for older people - 2015. Retrieved from https://www.hiqa.ie/publications/annual-overview-report-regulation-designated-centres-older-people-2015 [17 June 2016].
Home and Community Care Ireland. (2013) Planning for future demand in the home care sector - Presentation to the Joint Oireachtas Committee on Jobs Enterprise and Innovation. Retrieved from http://www.oireachtas.ie/parliament/media/committees/jobsenterpriseandinnovation/HCCI-presentation.pdf [24 March 2016].
HSE. (2015). Social care division operational plan 2015. Retrieved from http://www.hse.ie/eng/services/publications/corporate/socialcareopplan.pdf [18 March 2016].
HSE. (2016). HSE pay scales. Retrieved from http://www.hse.ie/eng/staff/Benefits_Services/pay/ [13 April 2016].
Hunter N. (2010). Home care regulation urgently needed. Retrieved from http://www.irishhealth.com/article.html?id=18358 [15 March 2016].
Institute of Public Care. (2015). Financial stability cost change and value for money in the children’s residential care market. Oxford: Oxford Brookes University.
Keena C. (2015 June 26). Development of nursing homes needs a helping hand as banks fail to fund sector. The Irish Times.
Kendall J. Matosevic T. Forder J. Knapp M. Hardy B. & Ware P. (2003). The motivations of domiciliary care providers in England: New concepts new findings. Journal of Social Policy 32 (4) 489-511.
King D. (2007). Rethinking care-market relationships in care provider organisations. Australian Journal of Social Issues 42 (2).
Kirkpatrick I. Kitchener M. & Whipp R. (2001). ‘Out of sight out of mind’: Assessing the impact of markets for children’s residential care. Public Administration 79 (1) 49-71.
Krachler N. & Greer I. (2015). When does marketisation lead to privatisation? Profit making in English health care after the 2012 Health and Social Care Act. Social Science and Medicine 124 215-23.
LeGrand J. (1998). Ownership and social policy. The Political Quarterly 69 (4) 415-21.
Linehan C. O’Doherty S. Tatlow-Golden M. Craig S. Kerr M. Lynch C. McConkey R. & Staines A. (2014). Mapping the national disability policy landscape. Dublin: School of Social Work and Social Policy Trinity College Dublin.
Lynch K. Grummell B. & Devine D. (2012). New managerialism in education: Commercialization carelessness and gender. Basingstoke: Macmillan Publishers.
Martin B. (2005). Residential aged care facilities and their workers: How staffing patterns and work experience vary with facility characteristics. Australia: National Institute of Labour Studies Flinders University.
Matosevic T. Knapp M. Kendall J. Henderson C. & Fernandez J.-L. (2007). Care-home providers as professionals: Understanding the motivations of care-home providers in England. Ageing & Society 27 103-26.
McInerney C. & Finn C. (2015). Caring - At what cost? Rebuilding and refinancing the community and voluntary sector. Dublin: IMPACT.
Meagher G. (2006). What can we expect from paid carers? Politics and Society 34 (1) 33-54.
Meagher G. & Cortis N. (2008). The political economy of for-profit paid care: Theory and evidence. In D. King & G. Meagher (Eds) Paid care in Australia: Profits purpose practices (pp. 13-36). Sydney: Sydney University Press.
Meagher G. Lundström T. Sallnäs M. & Wiklund S. (2015). Big business in a thin market: Understanding the privatization of residential care for children and youth in Sweden. Social Policy & Administration. Advance online publication. doi:
Meagher, G., Lundström, T., Sallnäs M., & Wiklund, S. (2015). Big business in a thin market: Understanding the privatization of residential care for children and youth in Sweden. Social Policy & Administration. Advance online publication. doi: 10.1111/spol.12172)| false
Meagher G. & Szebehely M. (2013). Marketisation in Nordic eldercare. A research report on legislation oversight extent and consequences. Retrieved from http://www.normacare.net/wp-content/uploads/2013/09/Marketisation-innordiceldercare-webbversion-med-omslag1.pdf [1 June 2016].
Migrant Rights Centre Ireland. (2015). Migrant workers in the home care sector: Preparing for the elder boom in Ireland. Retrieved from http://www.mrci.ie/wp-content/uploads/2015/09/Migrant-Workersinthe-Home-Care-Sector-Preparing-for-the-Elder-Boom-in-Ireland.pdf [24 March 2016].
Morris J. & Helburn S. (2000). Child care centre quality differences: The role of profit status client preferences and trust. Non-profit and Voluntary Sector Quarterly 29 377-99.
National Audit Office. (2011). Oversight of user choice and provider competition in care markets. London: National Audit Office.
National Children’s Bureau. (2015). Training and developing staff in children’s homes. Research report. Retrieved from http://www.ncb.org.uk [17 February 2016].
Nelson J. & England P. (2002). Feminist philosophies of love and work. Hypatia 17 (2) 1- 18.
Ní Lochlainn A. & Collins M. L. (2015). Outsourcing in the public sector: A value-for-money perspective [NERI WP 2015/No 22]. Retrieved from http://www.nerinstitute.net/download/pdf/20150120104204.pdf [19 June 2016].
O’Brien C. (2014 22 April). Vacant beds for children in care cost taxpayer €20m. The Irish Times.
Office of the Ombudsman for Children. (2015). Children’s Ombudsman highlights gaps in the oversight of children’s residential centres. Retrieved from http://www.oco.ie/2015/08/childrens-ombudsman-highlights-gaps-intheoversightofchildrens-residential-centres/ [10 September 2015].
Oireachtas Committee on Health and Children. (2015). From survival to sustainability. Opening statement by Gordon Jeyes Chief Executive Child and Family Agency to the Health and Children Committee. Retrieved from www.oireachtas.ie [9 September 2015].
Petersen O. H. & Hjelmer U. (2013). Marketization of welfare services in Scandinavia: A review of Swedish and Danish experiences. Scandinavian Journal of Public Administration 17 (4) 3-20.
Rees P. (2010). State dilemmas in the provision of alternative care for children: Relative efficacy of public sector and independent sector foster placements. International Journal of Public Administration 33 (6) 325-34.
Ricucci N. & Meyers M. (2008). Comparing welfare service delivery among public non-profit and for-profit work agencies. International Journal of Public Administration 12 (31) 1441-54.
Rodriques R. & Glendinning C. (2015). Choice competition and caredevelopments in english social care and the impacts on providers and older users of home care services. Social Policy and Administration 49 (5) 649-64.
Rostgaard T. with Glendinning C. Gori C. Kroger T. Osterle A. Szebehely M. Thoebald H. Timonen V. & Vabo M. (2011) Livindhome: Living independently at home: Reforms in home care in 9 European countries. Copenhagen: SFI - Danish National Centre for Social Research.
RTÉ. (2010 December 15). Prime Time investigates: The shocking standards of home care. Retrieved from http://www.rte.ie/news/2010/1213/295483-care/ [21 March 2016].
Ryan P. (2013). Public sector outsourcing in Ireland: A journey from Croke Park to Haddington Road and beyond. Retrieved from http://www.arthurcox.com/wp-content/uploads/2014/01/Public-Sector-Outsourcingin-Ireland-Pearse-Ryan-July-2013.pdf [18 June 2016].
Scott C. (2014 November 18). Welfare regulation and democracy. Retrieved from http://researchrepository.ucd.ie/bitstream/handle/10197/6840/WelfareRegulationDemocracy.pdf?sequence=2 [1 April 2016].
Scourfield P. (2007). Are there reasons to be worried about caretelisation in residential care? Critical Social Policy 27 (2) 155-80.
Simonazzi A. (2009). Care regimes and national employment models. Cambridge Journal of Economics 33 (2) 211-32.
Skills for Care. (2015). The state of the adult social care sector and workforce in England 2015. Retrieved from http://www.skillsforcare.org.uk/Documentlibrary/NMDS-SC-workforceintelligence-and-innovation/NMDSSC/State-of-2014-ENGLANDWEB-FINAL.pdf [10 April 2016].
Slasberg C. Beresford P. & Schofield P. (2012). Can personal budgets really deliver better outcome for all at no cost? Reviewing the evidence costs and quality. Disability and Society 27 (7) 1029-34.
Slasberg C. Beresford P. & Schofield P. (2013). The increasing evidence of how self-directed support is failing to deliver personal budgets and personalisation. Research Policy and Planning 30 (2) 91-105.
Social Services Inspectorate. (1999 11 March). Retrieved from www.irishtimes.com/opinion/social-services-inspectoratehttp://www.irishtimes.com/opinion/social-services-inspectorate-1.161738%5b191.161738 [19 March 2016].
Stone D. (2005). For love nor money: The commodification of care. In M. Ertman & J. Williams (Eds) Rethinking commodification: Cases and readings in law and culture. New York: New York University Press.
Sweeney J. (2010). Attitudes of Catholic religious orders towards children and adults with an intellectual disability in post-colonial Ireland. Nursing Inquiry 17 (2) 95-110.
The Wheel & Crowe Horwarth. (2014). A portrait of Ireland’s non-profit sector. Retrieved from http://www.wheel.ie/portrait [3 March 2016].
Timonen V. Doyle M. & O’Dwyer C. (2012). Expanded but not regulated: Ambiguity in home care policy in Ireland. Health and Social Care in the Community 20 (3) 310-18.
Tusla. (2013). National guidance and local implementation. Child and Family Agency commissioning guide. Retrieved from http://www.tusla.ie/uploads/content/Tusla_Commissioning_Guidance.pdf [8 January 2016].
Vabø M. Christensen K. Jacobsen F. F. & Trætteberg H. D. (2013). Marketisation in Norwegian eldercare: Preconditions trends and resistance. In G. Meagher & M. Szebehely (Eds) Marketisation in Nordic eldercare. A research report on legislation oversight extent and consequences. Retrieved from http://www.normacare.net/wpcontent/uploads/2013/09/Marketisation-in-nordiceldercare-webbversion-medomslag1.pdf [1 June 2016].
Wilson K. Sinclair I. Taylor C. Pithouse A. & Sellick C. (2004). Fostering success: An exploration of the research literature in foster care. London: Social Care Institute for Excellence.