AbstractThe objective of this paper is to map out the changes in the public, private and voluntary provision of long‐stay care for elderly people and younger people with a physical handicap, people with a mental handicap and people with a mental illness in Britain over the period 1970–1990. It is also designed to bring together in a convenient form all the relevant data which are not readily available because they are published in several disparate sources. The effects on the social security budget of the expansion of private residential and nursing homes are described.National trends in provision show a marked increase in private residential and nursing homes and indicate how private provision has taken up an increasing number of people aged 65 years or over and has substituted for public provision with the closure of the hospitals for people with a mental illness or a mental handicap. The income support payments to people in independent homes increased, at 1990 prices, from $33 million in 1980 to $1390 million in 1990.The implications of this changing balance of care in terms of choice, efficiency and equity are examined in the concluding section. There is some evidence that the growth of the independent sector has increased consumer choice and improved efficiency in the provision of long‐stay care but at some cost to those people who would have been provided with free NHS facilities but now have to contribute to the costs of their