As public service providers strive to improve, a common concern is to ensure that they are operating at an optimal size. Hospitals merge with others to achieve economies of scale. Schools that are perceived to be underperforming federate with more successful neighbours to share management teams. Within the social care sector, care homes link up with others in national chains to reduce costs and increase clout in tendering processes. While these examples demonstrate the perceived advantages of expansion, there are also examples of public services reducing their scale to become better fit for purpose. Social work teams spin out of local authorities to form small mutuals that aim to focus better on the core role. Charities split part of their work into a social enterprise that can operate with more flexible financing. Patterns of preferred sizing may depend on the function of the organisation, but they may also be cyclical over time, shifting from ‘big is efficient’ to ‘small is responsive’ and back again (Pollitt, 2008). Governments often send ambivalent signals about what size of service provider is preferred: small community social enterprises are encouraged at the same time as larger tendering processes reward consortia of providers (McCabe and Phillimore, 2012).

Understanding better the relationship between the size and performance of public service providers is a key element of service improvement, and this book tests that relationship in the distinctive context of care. Organisational size and performance of public service providers has been examined as part of broader studies of public management (for a meta-analysis see Boyne, 2003a). However, much of this literature relates to education and health, or to US welfare studies with limited applicability outside that national context. Writing about the closely related issue of scale, Postma notes, ‘Empirical studies that take scale seriously as an object of study in itself are lacking … Because of the high expectations and the frequent use of (changes in) scale as a governance instrument, empirical studies of the workings of scale in practice are necessary’ (Postma, 2015, pp 23, 25).

This book picks up Postma's challenge, taking size (and scale) seriously as an object of study and focusing particularly on the size of organisations delivering social care.