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Social care actors' motivations and attitudes play a central role in the delivery of services. This thesis examines the underlying motivations for providing care home services for older people, drawing data from private, voluntary and local authority homes in eight areas of England. The study explores care home owners'/managers' motivations. The majority of respondents were found to be primarily motivated by meeting the needs of older people and professional achievements. With regards to professional motivations, interviewees reported high levels of job satisfaction. Care home owners/managers were satisfied with their career choice and felt that, through their work, they were contributing to society as a whole. The study identified a range of personal and external factors that could influence owners'/managers' intrinsic motivations and professional aspirations. Local authority commissioners' perceptions of care-home owners'/managers' motivations are also identified as playing an important role. Commissioners' views of care home owners'/managers' motivations, their perceived strengths and weaknesses, and their motivations will have a bearing on commissioning decisions. The results indicate that owners/managers are generally perceived by commissioners as highly altruistic, but also relatively financially motivated individuals. Further analysis revealed significantly different views towards profit maximising, which commissioners perceive as very important, while providers consider it to be of little motivational value. Private sector care home owners/managers are described by commissioners as significantly more motivated by personal income. Associations are found between commissioners' perceptions of motivations and the nature of their relationships with providers. The study also examined changes in owners'/managers' motivations between 1994 and 2003. The findings indicated that, overall, care home owners'/managers' main motivations remained unchanged over time. The policy implications of the main findings are discussed with a specific focus on care home owners'/managers' intrinsic motivations, commissioner- provider relationships, and the role of motivations in social care markets.

The Chinese group is the fastest growing ethnic group in the UK; this group is ageing fast, with the number of older Chinese doubling in 8 years. The majority of older Chinese immigrants in the UK have low education levels and limited English proficiency, and were reported to have low service use rate, lack of social support, and poor emotional status. This suggests that they may have difficult ageing experiences. This research set out to understand the UK older Chinese immigrants’ ageing experiences and coping strategies with the challenges of ageing, with a focus on the formal service use in their later life. The research adopted grounded theory as methodology, and used semi-structured interviews for data collection. The research had two phases. The first phase was exploratory using, mainly, focus groups to investigate perceptions of ageing, and for orientation to the field. Based on the contextual data provided by the phase one study, the phase two study was more focused on the support network and its influences on services use. Here individual interviews with follow-ups were used to gain in-depth understanding. Together, 58 participants, including older Chinese immigrants (n=44), family members of older Chinese (n=9), staff from organizations that work with Chinese people (n=3), and acquaintance who provided support for older Chinese (n=2), were interviewed. During phase two of the study, a group of key support providers who facilitated access to formal services for older Chinese were identified, and named as Bridge People. The outcomes of this research revealed that older Chinese immigrants used Bridge People, consisting of people from family, public sectors, Chinese community, and personal social network, to communicate with formal service providers. Older Chinese immigrants also rely on Bridge People to bridge other gaps in service delivery, such as lack of transportation, informational support, emotional support, and other cultural issues. In return, Bridge People gained trust and incurred power with older Chinese immigrants. Properties of Bridge People were identified as bilingual, bicultural, accessible, costless, and no social debt. Within the concept of Bridge People, each category provides a different combination of support, and older Chinese immigrants used this range of support in different combinations. In this study new theory and knowledge were generated about older Chinese and their key support providers. The Bridge People network model highlights the importance of interactions between Bridge People and older Chinese immigrants in accessing and using formal services. As many factors, including limited information resources, availability, role, emotional attachment, confined the performance of Bridge People, there are implications for policy makers; namely the role and importance of Bridge People should be recognized across health, social care and housing provision for older people. To promote engagement and optimise service use by older Chinese, relevant support should also be provided to Bridge People.

This thesis is concerned with strategic (economic) organisation, as applied to the long-term care system in England. This work adopts a transaction cost perspective. The main hypotheses are: first, that the transaction costs generated by (public sector) hierarchies in social care are lower than those generated in quasi-markets. Second, that production costs in hierarchies are greater than in markets. Third, that contingent contract use is associated with comparatively higher prices and mark-up rates, and greater net transaction costs. The motivation for this work is first to address perceived limitations of the theory in a comparative public sector application. Second, to inform the empirical and policy debate on social care reform. Following an account of the historical policy and institutional context, a multi-period, comparative theoretical model was developed, building on the contract theory literature. It underpins a systematic empirical analysis of care home services - at local authority and care home level - for older people in 1998 and 1999. Various estimation techniques addressed the skewed nature of the data and the panel design. The estimation results supported the theoretical hypotheses. Point estimates of marginal and average transaction costs were £6 and £21 per place per week respectively for hierarchies and £41 and £56 for placements under the market governance archetype, statistically significant differences. For production costs, a significant difference was found in the other direction: £89 for hierarchy and £55 for markets at the margin. Overall, the total (production + transaction) costs were not significantly different. Contingent contract use was associated with higher prices relative to average variable costs of 8% of average price compared with non-contingent contracts. The analysis pointed to low profitability rates and that providers are not solely motivated by profit (only taking 55% of potential profit). Policy implications were explored for both the markets-hierarchies and contracts analyses.