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Living on a knife edge: The responses of people with physical health conditions to changes in disability benefits. Disability and Society.

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Care management is a central part of the current health and social care system, but the development of Self‐Directed Support raises significant questions about the future of this function. Moreover, if the current design of the care management function is to change, then this will raise significant challenges and opportunities for those professionals who currently act as care managers. These changes may even allow social workers to return to a way of working that fits better with their professional ethos.

This article reviews the social care evidence concerning direct payments/personal budgets, before arguing for an extension of these concepts to the National Health Service (NHS). Despite a commitment to inter-agency health and social care, direct payments/personal budgets have only been available for the ‘social care’ part of people's lives. Moreover, many of the challenges faced by the NHS are precisely those which social care has turned to more individualised funding to help resolve. Against this background, the article speculates as to how such a system might work and seeks to address some popular misconceptions and potential objections.

Purpose -The paper's aim is to explain the development of the concept of personalisation and its dependence upon prior innovations such as independent living, person-centred planning and individual budgets and explore its meaning, limitations and future prospects.Design/methodology/approach -The paper takes the form of an analytical and historical review of ideas that have been important in the recent history of public policy for people with learning disabilities.Findings -People with learning disabilities, along with other disabled people, have been engaged in a struggle to achieve full citizenship. The recent reforms that go by the name of ''personalisation'' may mark an important stage in the development of a fairer system, but on their own they will be insufficient to achieve that objective.Originality/value -Personalisation is placed, with all its strengths and limitations, within the wider context of the development of policies for people with learning disabilities.

This paper argues that human services should move towards self‐directed support. If people have more control over their own individual support, they will be better able to control the quality of the support and to participate in community life. This hypothesis is being tested by the In Control programme.

If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service information about how to choose which publication to write for and submission guidelines are available for all. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.comEmerald is a global publisher linking research and practice to the benefit of society. The company manages a portfolio of more than 290 journals and over 2,350 books and book series volumes, as well as providing an extensive range of online products and additional customer resources and services.Emerald is both COUNTER 4 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. ABSTRACTThere has been growing international interest in the idea that social care would be better organised as a system of self-directed support, where people control their own budgets for their own support. While there is significant evidence that this approach brings benefits to disabled people and those older people who need support, there is still an active debate about the efficiency and affordability of this approach. In Control has led work in England on piloting this approach, and has gathered some early evidence on the economic sustainability of selfdirected support. This article outlines the economic case for self-directed support and some of the practical issues that will need to be confronted in order to implement self-directed support successfully in the UK. In particular, it argues that the current service-focused system of social care is structurally inefficient, and that self-directed support makes much better use of the resources committed through public taxation. Finally, it contends that a rethink of the health and social care boundary will inevitably follow.