The Economics of Self‐Directed Support

Abstract

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.

Neoliberalism, accounting, and the transformation of subjectivities in social work: A study on the implementation of personal budgets

“…Social workers are made to take on board managerial subjectivities for pragmatic reasons, even if they do not necessarily identify with it at a professional and/or emotional level. As the construction of autonomy in PB conflates emancipatory (Duffy, ) with neoliberal (Needham, ) ideals, managers are able to exploit the ambiguity by using accounting to redirect the flow of centrifugal to centripetal power (Munro, ). The ease in which PB can be diverted to alternative uses in adult social care can be credited to the creation of an accounting infrastructure or “bottom line” (e.g., Beresford et al., ; Pearson et al., ).…”

“…To tackle the challenge posed by the seemingly problematic relationship between social workers and clients, the government replaced Direct Payments with PB. Simon Duffy, the key architect of PB in the United Kingdome, argues that a major limitation of Direct Payments is its continued reliance on the professional autonomy of social workers allocating resources to their clients, or what he called the “Professional Gift Model” (Duffy, ; Glasby and Littlechild, ). Instead, Duffy, Waters, and Glasby () propose that subjectivities in the professional–client relationship should be radically transformed.…”

Acquired Brain Injury, Social Work and the Challenges of Personalisation: Table 1

“…The idea is simple: that service users and those who know them well are best able to understand individual needs; that services should be fitted to the needs of each individual; and that each service user should control their own personal budget and, through this, control the support they receive. However, given the reality of reduced local authority budgets and increasing numbers of people needing social care ( CfWI, 2012 ), the outcomes hoped for by advocates of personalisation ( Duffy, 2006 , 2007 ; Glasby and Littlechild, 2009 ) are not always achieved. Research evidence suggested that this way of delivering services has mixed results, with working-aged people with physical impairments likely to benefit most ( IBSEN, 2008 ; Hatton and Waters, 2013 ).…”

The limits of personalisation

“…When this data was aggregated, as is shown in Figure 4, it seemed that people could achieve dramatic improvements in citizenship (Poll et al, 2006). In addition these early experiments also led to significant cost efficiencies (Duffy, 2007).…”