Assessing the Role of Increasing Choice in English Social Care Services

Abstract

This article aims to explore the concept of choice in public service policy in England, illustrated through findings of the Individual Budgets (IB) evaluation. The evaluation tested the impact of IBs as a mechanism to increase choice of access to and commissioning of social care services around the individual through a randomised trial and explored the experiences and perspectives of key groups through a large set of interviews. The article presents a reexamination of these interview data, using three 'antagonisms of choice' proposed in the literature -choice and power relations, choice and equity, and choice and the public nature of decisions -as organising themes. The randomised trial found that IB holders perceived they had more control over their lives and appreciated the extra choice over use of services, albeit with variations by user group. However, problems of power relations, equity and the constraints implied by the public nature of decision-making were complicating and limiting factors in producing the benefits envisaged. The focus on choice in policy, especially as implemented by IBs, emphasises an individualistic approach. The findings suggest that addressing broader issues relating to power, equity and an understanding of the public nature of choice will be of value in realising more of the benefits of the policy.

Community Aged Care Case Managers Transitioning to Consumer Directed Care: More Than Procedural Change Required

“…This study demonstrates that there are differing interpretations as to what the principles mean and how they can be implemented. Consistent with other findings (Stevens et al, 2011), our results highlight the need for case managers implementing CDC programs to find a new balance that promotes empowerment and selfdetermination while fulfilling legal obligations to practise a duty of care. Graetz, Rimmer, Lawrence, and Smith (2011, p. 269) argued that successful organisations always have shared core values that mobilise and inspire their staff.…”

Care ‘going market’: Finnish elderly-care policies in transition

“…Countries in the first wave of marketization that adopted new mechanisms to reform public-sector service production represent the liberal welfare regime (Newman, 2001;Stevens et al, 2011;Streek & Thelen, 2005). However, in the second wave the market-related reform movement also reached the Nordic countries, where the state traditionally assumed a wide responsibility for producing and financing social care for its residents.…”

“…Marketization refers first to the increased presence of for-profit providers in providing social care, and, secondly, to the institutionalization of market-like mechanisms in providing care services within the public and third sectors (or civil society). Promotion and implementation of market and quasi-market mechanisms have created space for new operational practices such as 'vouchers', 'personal or independent budgets', and 'payments for informal care', often together with the introduction of purchaser-provider models (Anttonen & Sointu, 2006;Clarke, 2006;Newman, Glendinning & Hughes, 2008;Stevens et al, 2011). Reforms have aimed at targeting society's resources in a more effective way, building up social-care markets, promoting choice, and giving citizens a voice.…”

Self-Directed Care and Individual Budgets for Older People: Lessons from the UK

“…In the US evidence from qualitative interviews suggests that poor older people may see this economic transaction -employing family members -as a reciprocal activity and that they value the enhanced relationship (San Antonio et al, 2006). The social science literature on choice as applied to the subject of personal budgets was summarized by Stevens et al (2011). As they noted, if people with social care needs have sufficient cash to enable them to exercise choices over their care and support, this theoretically alters the power dynamics of relationships between older people, professionals, and the organizations in which they work, in relation to needs and how to meet them.…”

“…On the one hand, personal budgets are likely to intensify consumer behavior and consumer identities among some older people and their families (see Stevens et al, 2011) and consumerism in pensions (Mann, 2006) can be seen as a forerunner of personalization of care and support. Systems of resource allocation will be clarified and this may lead to an increase in numbers of older people and their families feeling that it is worth the 'hassle' or trouble of engaging with public forms of social care.…”