‘Imposed unknowns’: a qualitative study into the impact of Independent Living Fund closure on users

The Independent Living Fund (ILF) was a non-departmental public body funded by the Department for Work and Pensions. An efficient and popular system of support, the ILF enabled 46,000 people between 1988 and 2015; however, in 2015 the Fund closed and local authorities (LAs) assumed sole responsibility for supporting former ILF users. This paper presents the experiences of 12 former ILF users as they transition from ILF to LA support. We focus on participants’ experiences of ILF and LA support, their transition from ILF to LA support, and the emotional impact of transition. Participants were universally positive about their dealings with the ILF, whilst nearly all were worried about LA provision. For most participants, the process of transfer was not smooth; participants received insufficient information and poor communication from LAs. Participants expressed anxiety and uncertainty over the future and these feelings were exacerbated by the actions of LAs during transfer

Social care managers and care workers’ understandings of personalisation in older people’s services

Purpose: The purpose of this paper is to explore the impact of personalisation policy on the providers of social care services in England, mainly to older people, within the context of austerity and different conceptions of personalisation. Design/methodology/approach: The paper draws on part of a longitudinal study of the care workforce, which involved 188 interviews with managers and staff, undertaken in two rounds. Findings: Four themes were identified: changing understandings and awareness of personalisation; adapting services to fit new requirements; differences in contracting; and the impact on business viability. Research limitations/implications: The paper reflects a second look at the data focussing on a particular theme, which was not the focus of the research study. Furthermore, the data were gathered from self-selecting participants working in services in four contrasting areas, rather than a representative sample. Practical implications: The research raises questions about the impact of a commercial model of “personalised care”, involving personal budgets (PBs) and spot contracts, on the stability of social care markets. Without a pluralistic, well-funded and vibrant social care market, it is hard to increase the consumer choice of services from a range of possible providers and, therefore, fulfil the government’s purposes for personalisation, particularly in a context of falling revenues from local authorities. Originality/value: The research presents an analysis of interviews with care providers and care workers mainly working with older people. Their views on personalisation have not often been considered in contrast to the sizeable literature on PBs recipients and social workers

Developing the knowledge base about carers and personalisation: contributions made by an exploration of carers’ perspectives on personal budgets and the carer–service user relationship

This qualitative study aimed to explore an under-researched issue within the emerging body of research about carers and personalisation – the carer–service user relationship. It was carried out across 11 English local authorities between 2011 and 2012 and focused on the impact of a change in the service user’s social care arrangements to a personal budget on this relationship. Using purposive sampling and explicit inclusion criteria, data were gathered through semi-structured in-depth interviews with 23 carers in long-term dyadic relationships with an adult in receipt of social care who had changed to a personal budget. The interviews explored carers’ perceptions of the carer–service user relationship before and after the advent of the personal budget and changes that had occurred. The findings were thematically analysed and reflect the fact that in addition to the effects of the move to a personal budget on the carer–service user relationship, the interviewees talked at length about a range of other effects of this move. Just over half of those interviewed felt that the personal budget had enhanced the carer–service user relationship. The other effects were both positive and negative. Three quarters reported positive outcomes, such as feeling happier, healthier and having more control over their lives. Although two thirds experienced negative feelings about having less involvement in the service user’s care, these feelings eased over time and if they had confidence in the quality of the care. Over half found administering the personal budget stressful. Further analysis of these findings showed the study contributes not only to existing knowledge about the carer–service user relationship within personalisation but also to knowledge about the effects of personalisation on carers more generally. It therefore simultaneously develops the emergent knowledge base about carers and personalisation. Recommendations based on this analysis are made about future practice and research

The false narrative about personal budgets in England: smoke and mirrors?

Successive governments have supported ‘personal budgets’ as the route to transforming social care. However, this article outlines how the evidence has been constructed in a way that creates a narrative about personal budgets which is misleading. It is a narrative that continues to dominate the national strategy. The consequence is that the care system remains set in a dysfunctional, two-tier state. For the bottom tier, comprising over 90%, we argue there has not been, nor will there be under the current strategy, any transformation

Further lessons from the continuing failure of the national strategy to deliver personal budgets and personalisation

The Government continues to act on the basis that t he model of 'self-directed support' as devised by In Control is working and should be the basis of current and future social care and health strategy. They are sustained in this belief by national surveys of 'personal budget' holders which claim that personal budgets are improving outcomes for people. However, examination of the survey results shows this to be a potentially misleading assertion. It actually suggests that the opposite is more likely to be the case. Whilst political and sector leaders continue to declare their commitment to the model, the legislation has not actually supported it given the way the Care Act has been formulated. This offers the possibility of an alternative future for social work and social care services. However, it will require a refreshed understanding of the widely acknowledged shortcomings of the system that the In Control model had itself been created t o overcome, but which has failed to do

Personalization of health care in England: have the wrong lessons been drawn from the personal health budget pilots?

The Government has introduced personal health budgets in England’s National Health Service (NHS). A three-year programme of pilots has shown that personal health budgets have improved outcomes and are generally cost-effective. They are seen as a key step toward creating a personalized service. However, the Government is attributing the success of the pilots to entirely the wrong factors. It believes that a process similar to the one introduced in social care – where it is called self-directed support – based on the person being given a sum of money ‘up-front’ with which to plan their own care – is responsible for the better outcomes. However, this is not supported by the evidence from the pilots which points to quite different factors being at play. The consequences are potentially very serious. The success of the pilots will not be repeated in roll out. Further, there is the potential to greatly weaken the service by creating confused process and practice, and additional dysfunctional bureaucracy. The practice and process implications from a correct reading of the reasons for success within the pilots centre on replacing the consumerist concepts underpinning self-directed support with what we have called ‘flexibility through partnership’. This will require freeing up the resource base as cash and creating a policy framework to enable decisions about how much resource each person should get within a cash-limited budget that will almost certainly be less than would be required to meet all assessed need

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

This study examines, through the case of Personal Budgets in England, the role of accounting in transforming the subjectivities of social workers through a Foucauldian lens. The findings show how accounting can reshape the subjectivities of social workers serving as intermediaries responsible for the frontline implementation of neoliberal reforms. It does so through an empirical demonstration on how accounting harnesses an individual’s autonomy and responsibility to nurture ‘productive’ relationships between citizens and the state. Furthermore, the findings also highlight the vulnerability of social workers’ subjectivities from the installation of an accounting infrastructure with multiple capabilities. This study contributes to a more nuanced understanding of how neoliberal policies transforms subjectivities in social work and adds to the literature on accounting’s biopolitical role in the reconstitution of such subjectivities. It also addresses the relative neglect of studies examining the role of accounting in neoliberal transformations of social work which, despite its significance for an ageing society and its attendant consequences for public finances, receives far less attention than healthcare reforms