A view from social work practice

‘It was clear from the start that [SDS] was about a cost cutting agenda.’ Exploring disabled people’s early experiences of the introduction of Self-Directed Support in Scotland

“…This was compounded by the lack of interim support to enable the transition from traditional services to option 1 or 2. Though based on a small study conducted early on in the implementation of SDS, these findings support research into cash for care schemes internationally (Alakeson 2010;Needham and Dickinson 2017), as well as at a UK level (Hart 2014;Manthorpe et al 2015;Fleming, McGilloway and Barry 2016). SDS was still a relatively new approach at the time of interviews for this study, and further research is required to establish whether this is likely to be an ongoing challenge.…”

“…While the most articulate individuals have been able to mobilise assets and social capital to challenge this in some cases, they have not always been successful in doing so. This is an important observation which goes against much of the wider research on personalisation, in which the most articulate service users and those using DPs have been able to achieve significantly better outcomes (Hart 2014;Beresford 2014a;Slasƒberg and Beresford 2017). Again, further research is needed to establish whether this is a more widespread phenomenon.…”

“…As a result the most comprehensive packages of support have tended to be secured by the most articulate and vocal individuals, while those who lacked these assets have had to make do with a more one-size-fits-all model of traditional service provision (Hart 2014). In England, the introduction of Managed Personal Budgets and Individual Service Funds has suggested one mechanism to overcome the issue of risk (Needham and Dickinson 2018).…”

“…Personalisation has come to be described as having represented something of a paradigm shift (Flemming, McGilloway and Barry 2016). However, there has been concern that both personalisation, and policies pioneered by the disabled people's movement such as Direct Payments (DP), have been of benefit to only a small proportion of social care users (Hart 2014;Slasberg and Beresford 2016a). The approach to personalisation in the UK context has been criticised for failing to address wider issues such as the underfunding in social care, limiting potential to deliver significantly improved outcomes for disabled people (Slasberg and Beresford 2016b).…”

Ethical dilemmas: balancing choice and risk with a duty of care in extending personalisation into the care home

“…They are compelled to demonstrate advocacy of a consumerist model presented as synonymous with person centred quality care, despite their own knowledge of the inconsistencies entailed, including overemphasis on the autonomous individual (O'Dwyer 2013). Hart (2014) compares the gains that she has seen for working-age adults fully engaged in the process of organising their own care with the lack of change for older adults with cognitive impairments. Questioning the vastly different ways in which the 'personalisation box is ticked', she contrasts the 'shiny brochures all about user choicelocal leisure centres versus day centres' with her own experience which often came down to 'one shower a day or two baths a week' and highlights that '[i]t is the dishonesty that is difficult to manage as a practitioner' (pp114-115).…”