Introduction

Consumerism discourses within adult social care, and the corresponding development of mechanisms to facilitate consumer-type choices by service users, have arguably developed further and faster over recent years than in other public service sectors. In addition to the supplyside mechanisms and incentives put in place by successive government regimes, consumer-related developments in social care have also been energetically advocated by articulate users of social care services.

Voluntary and charitable organisations have always played an active role in the provision of social care. However, since the early 1990s successive governments have consistently promoted a market-based ‘mixed economy’ of social care services, funded by local authorities (and increasingly also by individuals funding their own care entirely from their own private resources) but provided by a range of charitable and for-profit organisations. The promotion of social care markets – with external providers, in contrast to the internal market of the NHS – by the Conservative governments of the 1990s reflected a firm belief in the value of competition in driving down costs and driving up quality within the public sector. There is little to suggest that similar beliefs in the role of markets do not underpin more recent New Labour policies (Glendinning, 2008).

These policy developments have intersected with demands from users of social care services. Since the early 1980s, growing dissatisfaction has been expressed, particularly by disabled people, about the inflexibility and unreliability of local authority-funded social care services. Disabled people have argued for the right to exercise choice and control over their lives by being able to have control over the support they need to live independently. This, they have argued, can be achieved by giving disabled people the cash with which to purchase and organise their own support in place of directly provided services (Glasby and Littlechild, 2006; Morris, 2006).

The current state of consumerism within social care therefore rests upon an uneasy synergy between a highly influential, articulate, ‘bottom-up’ user movement and the ‘top-down’ ambitions of successive governments to increase the penetration of market-related mechanisms into the public sector. This synergy also reflects a convergence between a civil rights or social justice discourse and a neoliberal approach (Askheim, 2005; Glasby and Littlechild, 2006; Postle and Beresford, 2006). In contrast, the more recent discourse of consumerism and choice within the NHS may reflect a greater impact of top-down policy pressures (Rankin, 2005).