Personalisation of adult social care: self‐directed support and the choice and control agenda

Abstract

Accessible summary This study explores the impact differing ideas about personalisation has on the way in which self‐directed support operates, particularly in the light of cuts to social service budgets. Six participants from a local authority social care transformation team, five from a user‐led organisation and two national experts were interviewed. The findings suggest that whilst generally a positive process, in some cases, self‐directed support has become confusing, and personal budget holders have had less say over how their outcomes are met. The research is useful for people with learning disabilities as it provides an insight into what is happening in local authorities and the impact of the cuts on self‐directed support. Summary In 2007, ‘self‐directed support’ was introduced in adult social care in England to establish choice and control – in the assessment process itself and over service provision – for all service users. The personalisation agenda is underpinned by a range of ideologies, particularly a civil rights empowerment approach and neoliberal market discourses. This research sought to explore how tensions between these discourses are reflected in the operation of self‐directed support, particularly in the light of the changing political and economic climate. The small‐scale study involved semi‐structured interviews with 13 participants: six professionals from a local authority social care transformation team, five from a user‐led organisation and two national experts. The findings suggest that whilst the choice and control agenda may be consistent with market discourses, it is not compatible with neoliberal aspirations of cost‐cutting. To maintain trust and provide as much opportunity for choice and control as possible, the adjustments being made to the personalisation agenda in the light of the current budgetary pressures need to be made explicit to service users.

Perspectives of self-direction: a systematic review of key areas contributing to service users’ engagement and choice-making in self-directed disability services and supports

“…Of the 18 articles, 15 were original research papers from Australia (Dew et al . ), Finland (Eriksson ), New Zealand (Espiner & Hartnett ), Germany (Junne & Huber ), the United Kingdom (Mitchell ,b,c, ,b, Kendall & Cameron ) and the United States of America (Heller et al . , Gross et al .…”

“…Nine of the research papers included the perspectives of carers or stakeholders involved with supporting care services, family members and/or service users (Espiner & Hartnett , Mitchell , ,b, Gross et al . , Eriksson , Junne & Huber , Kendall & Cameron , Swaine et al . ).…”

“…, Dew et al . , Junne & Huber , Kendall & Cameron , Timberlake et al . ) where participants might be exposed to risks (Junne & Huber ).…”

“…). For example, the re‐identification of service users as consumers may result in providers of health and social care providing support of a higher standard (Kendall & Cameron ). While this is encouraging, other literature shows that the personal budgeting approach may have adverse impacts such as lower service quality (Junne & Huber , Sims & Cabrita Gulyurtlu , Swaine et al .…”

‘There’s a lot of places I’d like to go and things I’d like to do’: the daily living experiences of adults with mild to moderate intellectual disabilities during a time of personalised social care reform in the United Kingdom

“…For personalised social care to deliver reduced dependence and enhanced agency for people with intellectual disabilities, however, these barriers need to be acknowledged and addressed. The move away from specialist services under personalised social care reform has led to concern about the potential impact on the social networks of people with intellectual disabilities, particularly people with less severe disabilities who may no longer be eligible for access to statutory care services (Mencap 2012;Kendall and Cameron, 2013). This concern is borne out by the experiences of some participants, illustrated in the two excerpts below:…”