The marketisation model has a built-in trait towards increasing market share from private companies so within that it serves a commercial purpose to expand public sector provision. If we take the case of individualized care budgets what incentive is there for a private provider to nurture ‘independence, wellbeing and choice’ when if someone is independent and doing rather well they will need less care and therefore you get paid less to provide that care?
It is perverse in every sense to expect private providers to buy into this in a contract environment where we pay a price in terms of the unit cost of care time delivered rather than paying by results – for example a person regaining their independence through recuperative support following say a hip replacement.
When resources are more scarce than ever, marketisation creates expanding demand and consumption at a point where public finances are being squeezed - with a recession increasing demand for public services it creates the perfect storm.
Sadly politicians respond to the storm by suggesting more outsourcing and more marketisation under the accountancy illusion of generating efficiencies. It is like a well written episode of Spooks where the counter-terrorists generate the conflict in order to become viewed as the saviours.
There are alternatives to Ryanair-style public services cut back to a basic low-cost offering, says Charles Leadbeater in the Guardian
http://m.guardian.co.uk/?id=102202&story=http://www.guardian.co.uk/society/joepublic/2009/dec/16/ways-to-protect-public-services
