Abstract
This edited collection brings together a range of perspectives on the policy development, implementation and impact of personalisation and provides a view of the many layers and facets that make this policy so difficult to implement. The editors sought both critics and advocates of the personalisation agenda to put forward their views in one publication so that readers can decide for themselves which argument they consider the most convincing. The editors achieve their aim of providing a detailed discussion of ambiguous concepts using a clear and accessible style and avoiding opaque language or jargon.
The book is divided into five parts offering an overview of the topic and the challenges that have arisen since the development of personal budgets. There are contributions from those involved in policy development and service delivery as well as service users and academics. Needham and Glasby begin with the definition of personalisation which is acknowledged as having different meanings to different people. As the different contributors set out their own understanding of personalisation it becomes clear that for all of them it is about independence, choice and control. Each contributor evaluates the extent to which the policy is achieving one or more of these objectives. It has been widely recognised that personalisation has not achieved its original aims and the authors suggest three possible reasons for this failure: that personalisation is a ‘Trojan horse’ for neoliberalism; that it is a well-meaning policy derailed by budget cuts since 2010; or that personalisation has not yet had time to establish itself as a mainstream approach to adult social care.
Part Two of the book looks at the challenges of personalisation. The section begins with an examination of the resource allocation systems used by local authorities to arrive at an indicative amount for personal budgets. It questions whether these systems have succeeded in reducing bureaucracy or replacing the subjective judgements of social care practitioners as was originally intended. The difficulty in balancing personal choice with concerns about safeguarding service users is also discussed before moving on to consider the position of specific groups: older people, carers and self-funders. Concerns about the involvement of older people in the roll-out of personal budgets are discussed and it is suggested that putting an emphasis on increasing the uptake of these budgets is a distraction from the wider concerns regarding care for older people. Whilst personalisation seeks to ensure that disabled and older people have choice and control over care services, it appears to ignore the realities of their lives which are often embedded in networks of support from close kin and friends. The current and future rights of carers are discussed. The final contribution in this section provides the important perspective of those who self-fund their care who have largely been absent from the discourse around social care.
The third part looks at the front line of personal budgets. It includes a first-hand account from a service user with experience of a personal budget and a positive perspective on how the annual process allows her to adjust her care and keep making it better. She describes the benefits and challenges of becoming an employer, leading to the next contribution which discusses the development of local social care enterprises. These organisations provide service users with support and information on employment and other issues. Moving to the concerns of those working within social care, the lack of support for those working as personal assistants is highlighted. The contribution from a social worker describes the early days of personal budgets as liberating and exciting and counters the criticism that the failures in the implementation of personalisation lie with disgruntled social workers.
Part Four discusses personal health budgets. The difference between health and social care becomes apparent when evaluating the pilot project of personal health budgets and the difficulties of being unable to conduct a randomised control trial. The final part offers an overview as well as the editors’ final thoughts.
This book is highly recommended for an overview of the debate in a clear, accessible form. It posits personalisation as evolutionary rather than revolutionary by acknowledging its history and highlighting its successes since the Seebohm report of 1968 and the introduction of direct payments in the late 1990s. It makes an important contribution to critical social policy by emphasising that person-centred care is not about individual responsibility, it is about choice and control, and stressing that these are only possible if they go hand in hand with support delivered through trusting and meaningful relationships.