Making it personal
November 4, 2010 Leave a comment
[Originally posted on The Policy Press Blog, 04/11/10]
Personalisation is squarely at the heart of current policy debate around adult social care. For the last 10 years the British government has been experimenting with moving away from assisting users through providing services drawn from a relatively short menu of possibilities. Personalisation gives users personal or individual budgets and allows them discretion to determine how they think the money should be best spent to meet their own understanding of their needs.
From a policymaking perspective it is a fascinating development because stakeholders from very different perspectives feel able to support it. The market liberals see it as a means of introducing competition and choice into public service provision, while those more concerned with autonomy and dignity see it as a means of empowering service users. Those concerned about the size of the welfare budget see it as a more efficient way of achieving positive outcomes for those receiving assistance. With such diverse constituencies lined up behind it, it is perhaps not surprising that the personalisation agenda has momentum.
And this is the case despite the need for several notes of caution. First, there is the tension between the individualisation of welfare and society’s collective responsibility for meeting the needs of its members. Second, there are concerns that personalisation may be great for some but it is not necessarily beneficial for all recipients of social care – older people in particular. Third, the evidence that personalisation delivers cost savings and enhanced outcomes is promising, but by no means overwhelming. Some would contest it vigorously.
Debate about personalisation can also occur at a more conceptual level. Precisely what type of state intervention does it represent? It is not the sort of direct service that much of social care provision has traditionally been based upon, but at the same time it isn’t a pure income transfer of the type so beloved by economists. In a paper in the current issue of Policy & Politics Simon Duffy and his colleagues offer a framework for thinking about personal budgets as conditional resource entitlements (CRE). The characteristics of such entitlements can be examined in relation to five dimensions: autonomy, flexibility, targeting, support and conditionality. The authors argue that the nature of the conditionality associated with personal budgets differentiates it from other types of CRE: the focus is less on how resources are spent and more upon outcomes.
Perhaps the most interesting aspect of this issue is what personal budgets might tell us about future directions for welfare. Here Duffy et al offer a brief discussion of three possible scenarios. First, personal budgets are a transition in the move towards pure income transfers. Second, personal budgets represent an optimal state – they represent the best of both worlds. Third, personal budgets represent a stage in the process of shifting greater responsibility for meeting need away from the state and towards the individual. These are all plausible futures. Which one is realised will depend in part on how we make sense of the agenda and how we narrate it. Whether we embrace it uncritically or whether we contest it. There is much still to play for.
Duffy, S., Waters, J. and Glasby, J. (2010) ‘Personalisation and adult social care: future options for the reform of public services’, Policy & Politics, Volume 38, Number 4, October 2010*