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Four routes or pathways have now been identified by which individuals may come within the scope of PSA 16 National Indicator 149, which is concerned with monitoring efforts to achieve settled accommodation for individuals with significant mental health problems. This article focuses on their needs and the identification of those with mental health needs as seen through these four principal routes. An understanding of these four possible pathways can help to identify areas for priority action, local delivery chains and partnerships, and also highlight some of the challenges and risks in and for delivery.

This study aims to explore the opportunities and challenges Self-directed Support policy has presented to Scottish social enterprises, thereby increasing understanding of emerging social care markets arising from international policy-shifts towards empowering social care users to self-direct their care.

This study used guided conversations with a purposive sample of 19 stakeholders sampled from frontline social care social enterprises; social work; third sector; health; and government.

An inconsistent social care market has emerged across Scotland as a result of policy change, providing both opportunities and challenges for social enterprises. Social innovation emerged from a supportive partnership between the local authority and social enterprise in one area, but elsewhere local authorities remained change-resistant, evidencing path dependence. Challenges included the private sector “creaming” clients and geographic areas and social enterprises being scapegoated where the local market was failing.

This study involved a small purposively sampled group of stakeholders specifically interested in social enterprise, and hence the findings are suggestive rather than conclusive.

This paper contributes to currently limited academic understanding of the contribution of social enterprise to emerging social care markets arising from the international policy-shifts. Through an historical institutionalism lens, this study also offers new insight into interactions between public institutions and social enterprise care providers. The insights from this paper will support policymakers and researchers to develop a more equitable, sustainable future for social care provision.

Sustainability and transformation partnerships (STPs) were introduced to England, asking 44 local areas to submit their health and social care plans for the period from October 2016 to March 2021. This study aims to offer a deeper understanding of the complex structure in the local practice, and to discuss the associated challenges and chances.

Documentary analysis, qualitative interviews and questionnaire survey are used for this study. Findings have been compared and analysed thematically.

The study participants reported that apart from pooled budgets, past collaborative experience and local leadership are crucial elements for transforming health and social care integration in Greater Manchester (GM). Also, this study provides policy recommendations to promote effective collaborative partnerships in local practices and mitigate local inequity of funding progress.

The findings of this paper cannot be extrapolated to all stakeholders due to the limited samples. Meanwhile, some of the discussions about the case of GM may not be transferrable to other STPs.

This study argues that the success of pooled budgets is the result, rather than the cause, of effective negotiations between various stakeholders; and therefore, there is no evidence suggesting that pooled budgets can resolve the discoordination of health and social care. Moreover, due to the bottom-up approach adopted by STPs, more effective boroughs tend to receive additional funding, resulting in an increasing gap of development between effective and ineffective boroughs.

To examine a local primary health care infrastructure and the reality of primary health care from the perspective of residents of a small, urban community in the southern United States.

Data were derived from 13 semistructured focus groups, plus three semistructured interviews, and were analyzed inductively consistent with a grounded theory approach.

Structural barriers to the local primary health care infrastructure include transportation, clinic and appointment wait time, and co-payments and health insurance. Hidden barriers consist of knowledge about local health care services, nonphysician gatekeepers, and fear of medical care. Community residents have used home remedies and the emergency department at the local academic medical center to manage these structural and hidden barriers.

Findings might not generalize to primary health care infrastructures in other communities, respondent perspectives can be biased, and the data are subject to various interpretations and conceptual and thematic frameworks. Nevertheless, the structural and hidden barriers to the local primary health care infrastructure have considerably diminished the autonomy community residents have been able to exercise over their decisions about primary health care, ultimately suggesting that efforts concerned with increasing the access of medically underserved groups to primary health care in local communities should recognize the centrality and significance of power.

This study addresses a gap in the sociological literature regarding the impact of specific barriers to primary health care among medically underserved groups.

This paper aims to help public sector managers that are formulating strategies for outsourcing home care from the independent sector.

A review was performed of relevant literature on the outsourcing of home care and its political drivers in the UK. This indicates that the future of home care services, taking into consideration outsourcing and how Best Value will be achieved, has not been researched widely. Therefore, an exploratory approach to research was adopted here using in‐depth analysis of a small number of particularly informative local authorities and private providers selected by purposive/judgemental (extreme and critical case) sampling. Personal contact was deemed necessary in order to perform an intensive investigation to pursue in‐depth information.

The British Government's Best Value regime is driving local authorities towards increasing levels of outsourcing in the provision of home care. A local authority may choose to outsource all of its home care or maintain some in‐house provision based on capacity or capabilities that are complementary to those provided by the independent sector. The 100 per cent outsourcing strategy places enabling demands on the local authority, whereas the alternative strategy requires decisions to be made on what should be outsourced. Across the authorities surveyed, six strategies for creating a mixed economy of care have been identified, with the mix being based on complementary capacity and/or capabilities. With Best Value driving authorities to consider lower‐cost options, the outcome may be a reduction in the amount of complementary capacity provided in‐house, in favour of strategies involving complementary capabilities that deliver the Best Value possible. Re‐enablement is emerging as a common, complementary or core capability that is remaining in‐house. Outsourcing also requires decisions to be made on the number of independent providers to be used and the type of contracts to be employed. This paper considers the decisions that have been made in the local authorities surveyed and critiques the alternative home care outsourcing strategies so derived.

To date, the research has focused on Wales in general plus a few local authorities in England. The next stage will be to survey England in more detail along with other countries that are implementing substantial outsourcing of home care, such as Canada.

This paper provides timely guidance to public sector and health care managers seeking Best Value in home care through outsourcing.

Little has been found in the literature on strategies for outsourcing home care, yet such strategies are needed urgently in the UK to achieve Best Value. The World Health Organization stresses that strategies should be drawn up for providing support to patients and carers at community level in order to avoid costly institutional care.

This paper seeks to address the question, “How can private home care providers compete and drive their businesses forward to deliver best value to the community?” Public sector managers in local authorities need this question answered so that they can provide their part of the solution, facilitating best value.

A review was performed of relevant literature on the commissioning (outsourcing) of home care and of best value. This indicates that the future of home care services, taking into consideration commissioning and how best value will be achieved, has not been researched widely. Therefore, an exploratory approach to research was adopted here using in‐depth analysis of a small number of particularly informative local authorities and private providers selected by purposive/judgemental (extreme and critical case) sampling. Personal contact was deemed necessary in order to perform an intensive investigation to pursue in‐depth information.

To improve value one can cut costs and/or increase quality. It is argued here that there is little immediate opportunity for private home care providers to cut costs and with fixed pricing substantial improvements in quality cannot be funded by increased prices or cost cutting elsewhere. To address this impasse, two solutions have been identified; increased economies of scale through consolidation in the marketplace and radical improvements in efficiency through the exploitation of information and communication technology (ICT). Both of these strategies have major ramifications for the “enabling local authority” taking actions to see best value delivered to its community.

This paper presents the findings of exploratory research. A more detailed study covering many more local authorities, private care providers and an international prospective will be conducted over the next two years.

This paper provides timely guidance to public sector managers in local authorities and private home care providers seeking best value in home care through commissioning.

Little has been found in the literature on strategies by which private home care providers can deliver best value, yet such strategies are needed urgently to achieve best value. This paper is a timely contribution to addressing this need.

This paper is the sequel to the authors' earlier paper in this journal and aims to present the “future research” outlined in that paper.

The approaches being employed by Welsh local authorities in commissioning home care from the independent sector are surveyed to see how a mixed economy of care is being implemented. The observed differences are analysed to see what can be learnt for the benefit of public sector managers concerned with the development of commissioning practices. Semi‐structured interviews have been performed with home care managers and commissioning officers in 13 (60 per cent) of the local, unitary authorities in Wales. Managers at independent home care providers have been interviewed also. The study has been ongoing since September 2004. For comparison, Barnet in England has been included because, unlike any Welsh authority, it has implemented 100 per cent outsourcing of home care. Croydon has been included as it has a good practice brokerage that has helped it to expand its provision from the independent sector.

Great diversity is seen in the approaches adopted by the Welsh local authorities when commissioning home care from the independent sector. They differ in the proportion of home care that is commissioned from the independent sector, what is commissioned, the number of independent providers and the contractual arrangements. These features are used to develop a taxonomy of home care strategies that reveals high levels of diversity. It is seen that in Wales there has been less political drive and compulsion to outsource home care than in England, but the natural desire to reduce costs in the face of a growing need for home care is now driving outsourcing in Wales.

This paper provides guidance to public sector managers in local authorities seeking best practice in the commissioning of home care from the independent sector.

The existing literature contains little research into good practice in the commissioning of home care by local authorities from the independent sector. This paper is a timely contribution to addressing this shortfall.

It is a longstanding commitment of government in the UK that health and social care services be brought together despite the separate legislative and organisational arrangements which were put in place in the 1940s when the welfare state was established. However, frequent government‐generated re‐organisations have disrupted the building of shared health and social care agendas and services. With the General Election in 2010, and a new or revitalised government to be elected, more change is likely. However, there may now be opportunities to concentrate on creating shared health and social care provider organisations and local government leadership of the public health agenda, alongside local council areas as the building blocks for the commissioning of health and social care services.

The purpose of this paper is to examine the changes in local childcare policy that have taken place between the years 2008 and 2016 in the city of Jyväskylä, Finland, and to study how the local gender contract for women is being reshaped via these transformations in local policy.

Case study was applied as a research strategy. Local and national level statistics were used to explore the use of childcare services. Documents regarding the decision-making and administration of childcare in the city were analysed to distinguish the local policy changes during the time period. These documents include city budgets and records from the two municipal boards that have held the administrative responsibility of local childcare policy. The analysis of the data was conducted by using document analysis and feminist content analysis as a methodological framework.

The results show that the overall development in local childcare policy has been towards cutbacks in childcare services and benefits, and towards the marketisation of childcare services. The city has also implemented new, locally specific childcare policies, which constitute a hybrid form of marketisation and neofamilism. Together these developments are creating a new local gender contract, which goes beyond the past previous traditional or modern models. This new local gender contract for women is defined as that of “entrepreneurial homemaker”.

This paper contributes to the research on local social policy by identifying the role of local childcare policy in reshaping the gender contract in a Nordic context. This paper advances the theorisation of the concept of gender contract by introducing the “entrepreneurial homemaker” model of gender contract.

The purpose of this paper is to analyse the changes that have taken place in the central regulation of social care in Finland since the 1970s. The changes in vertical central‐local relations are discussed in the context of economic and welfare state development.

The paper is a case study, applying the concept of “the Nordic welfare municipality” to the case of Finland. With this concept, the author refers to the inherently contradictory character of the Nordic model of welfare governance: to a system that emphasises local self‐government but that, at the same time, perceives regional harmonisation as imperative.

After strong central control during the most intensive construction period of the Finnish welfare state in the 1970s and 1980s, a radical decentralisation reform was implemented in 1993. However, since the early 2000s pressure for centralisation has increased again as emerging regional inequalities in care service provisions came under criticism.

The paper identifies a cycle of decentralisation and recentralisation that reflects the fundamental discrepancy between the maxims of local autonomy and regional equality that are both formative elements of local governance within the Nordic welfare model.