I agree with the thrust of the Ferguson/Lavalette analysis of the crisis in adult social care. This response proposes a clearer theoretical framework, challenges the use of some terms and suggests how the way forward can be developed.

Ferguson and Lavalette's article addresses the personalisation, marketisation and privatisation of public services, but does not fully address financialisation, despite it having a key influence on the way neoliberal care policies are designed and implemented. The capitalisation of income streams and securitisation of assets helped to commodify services and assets and extend markets and had a significant role in causing the 2008 financial crisis. A theoretical framework would help to fully understand the scope and scale of the commercialisation of social care and commodification of risk in Britain, and to make valid comparisons with other countries, particularly since public housing and social care were in the forefront of the drive to privatise the welfare state.

Financialisation, personalisation, marketisation and privatisation of public services are four sequential overlapping functions that have a central role in the implementation of neoliberal policies to reduce to role of the welfare state in a capitalist economy. Outright privatisation of many public services is not immediately possible economically or politically feasible, so new pathways had to be created to facilitate the mutation of privatisation via the marketisation of services by outsourcing, joint ventures, public–private partnerships, transfers to arm’s-length companies and ‘commissioning’ of services to spur further competition (Whitfield, 2012a).

This was aided by fragmentation of the public sector into separate business units, trusts and companies, under the guise of increasing user choice and creating a diversity of service providers, but in practice designed to destabilise current provision and increase organisational change and outsourcing. Other key objectives included the transfer of risk and responsibility to individuals, driving down the cost of employment and imposing an austere financial climate by deep cuts in public spending by adopting a rapid deficit reduction strategy.

The mainstreaming of individual budgets, direct payments and vouchers issued to service users who are given a budget or direct payment to spend on defined services instead of being provided with services by the state, new and increased care charges, payment-by-results in which contractors and investors depend on performance-related contracts and profits, in parallel with the growth of a social investment market in bonds and shares, are other examples of the financialisation of health and social care.