In the previous chapters we discussed the context and mechanisms of social care in the four nations, focusing on Pollitt's (2002) criteria of discursive and decisional convergence. Here we consider the extent to which we are seeing convergence or divergence in relation to outcomes. We draw on what Pollitt calls ‘results convergence’. This is a measure of success: how far has the policy achieved what it set out to achieve? In assessing results convergence we also consider Pollitt's criteria of practice convergence – in other words, how have the discourses (Chapter 2), contexts (Chapter 3) and decisions (Chapter 4) translated into practice?

As we discussed in Chapter 1, perceptions of success depend on attitudes to the original policy. They require a realist willingness to accept that while some aspects of success can be measured, interpretation and perception will play a key role. We start by looking at how each of the four nations has made outcomes a much more explicit part of their social care reform efforts. We then go on to consider what has been achieved in the areas we identified in Chapter 4 as the key reform mechanisms of all four social care systems:

• • redistribute the costs of care

• • personalise support

• • support unpaid carers

• • invest in prevention

• • integrate with health

• • professionalise the workforce.

We look at each of the mechanisms in terms of practice convergence and producing desired outcomes. We then discuss how the reforms have impacted differently, recognising the need to consider success in terms of benefits for different target groups (in this case, people who require support, families, care workers and the broader community). In doing so we also suggest that some of these mechanisms are in tension, meaning that it is unlikely that they can all meet their objectives and desired outcomes at the same time. For example, the introduction of free personal care may be in tension with the prevention agenda and with the move towards more personalisation.

Focus on outcomes

All four nations of the UK have made strong policy commitments to becoming more outcomes-focused, by measuring and funding care on the basis of end goals rather than processes. This has been part of a broader trend to orient public service performance measurement away from activities and outputs and towards outcomes (Bovaird, 2014; Birrell and Gray, 2018).