Juggling and Dealing: The Creative Work of Care Package Purchasing

In conventional diagrams of the new service delivery process, assessment of need is linked to purchase by a single line or arrow; the implication is that purchase follows more or less logically and directly from assessment. This paper focuses on the complex creative work that goes on in the "space" between assessment of need and purchase of service, and the changing influences on that work. "Purchase" is deconstructed to reveal the complex processes and calculations involved, and the ways in which budgets "free" resources and markets influence the final outcome. The paper describes the effects on care package construction and purchase of changing policies, budget arrangements and financial limits; it goes on to outline the difficulties and complications in using information on unit costs in purchasing. Unit costs are only part of a complex equation in which prices are negotiated and total cost juggled in the context of budgets, financial limits, real accessibility and balanced by quality considerations. It is suggested that talk of "playing shops" and use of "off-the-shelf" services underestimates the complexity of care package construction and purchase. Micro-purchase of care services has more in common with dealing and juggling than with lifting standardized, packaged, pre-priced goods off shelves in Sainsbury's.