Making it real of sustaining a fantasy? Personal budgets for older people

The restructuring of English social care services in the last three decades, as services are provided through a shifting collage of state, for-profit and non-profit organisations, exemplifies many of the themes of governance (Bevir, 2013). As well as institutional changes, there have been a new set of elite narratives about citizen behaviours and contributions, undergirded by modernist social science insights into the wellbeing benefits of ‘self-management’ (Mol, 2008). In this article, we particularly focus on the ways in which a narrative of personalisation has been deployed in older people’s social care services. Personalisation is based on an espoused aspiration of empowerment and autonomy through universal implementation to all users of social care (encapsulated in the Making it Real campaign [Think Local, Act Personal (TLAP), no date)], which leaves unproblematised the ever increasing residualisation of older adult social care and the abjection of the frail (Higgs and Gilleard, 2015). In this narrative of universal personalisation, older people are paradoxically positioned as ‘the unexceptional exception’; ‘unexceptional’ in the sense that, as the majority user group, they are rhetorically included in this promised transformation of adult social care; but ‘the exception’ in the sense that frail older adults are persistently placed beyond its reach. It is this paradoxical positioning of older adult social care users as the unexceptional exception and its ideological function that we seek to explain in this article

Peer advocacy in a personalized landscape:The role of peer support in a context of individualized support and austerity

Whilst personalization offers the promise of more choice and control and wider participation in the community, the reality in the United Kingdom has been hampered by local council cuts and a decline in formal services. This has left many people with intellectual disabilities feeling dislocated from collective forms of support (Needham, 2015). What fills this gap and does peer advocacy have a role to play? Drawing on a co-researched study undertaken with and by persons with intellectual disabilities, we examined what role peer advocacy can play in a context of reduced day services, austerity and individualized support. The findings reveal that peer advocacy can help people reconnect in the face of declining services, problem-solve issues and informally learn knowledge and skills needed to participate in the community. We argue that peer advocacy thus offers a vital role in enabling people to take up many of the opportunities afforded by personalization

Making Safeguarding Personal and social work practice with older adults: Findings from Local Authority survey data in England

This article presents the results of a survey of English Local Authorities undertaken in 2016 about the implementation of Making Safeguarding Personal (MSP) in adult social care services. MSP is an approach to adult safeguarding practice that prioritises the needs and outcomes identified by the person being supported. The key findings from a survey of Local Authorities are described, emphasising issues for safeguarding older adults, who are the largest group of people who experience adult safeguarding enquiries. The survey showed that social workers are enthusiastic about MSP and suggests that this approach results in a more efficient use of resources. However, implementation and culture change are affected by different factors, including: austerity; local authority systems and structures; the support of leaders, managers and partners in implementing MSP; service capacity; and input to develop skills and knowledge in local authorities and partner organisations. There are specific challenges for social workers in using MSP with older adults, particularly regarding mental capacity issues for service users, communication skills with older people, family and carers, and the need to combat ageism in service delivery. Organisational blocks affecting local authorities developing this ‘risk enabling’ approach to adult safeguarding are discussed

Towards a contemporary social care ‘prevention narrative’ of principled complexity: An integrative literature review

Prevention has become increasingly central in social care policy and commissioning strategies within the United Kingdom (UK). Commonly there is reliance on understandings borrowed from the sphere of public health, leaning on a prevention discourse characterised by the 'upstream and downstream' metaphor. Whilst framing both structural factors and responses to individual circumstances, the public health approach nonetheless suggests linearity in a cause and effect relationship. Social care and illness follow many trajectories and this conceptualisation of prevention may limit its effectiveness and scope in social care. Undertaken as part of a commissioned evaluation of the Social Services and Wellbeing Act (2014) Wales, a systematic integrative review was conducted to establish the key current debates within prevention work, and how prevention is conceptually framed, implemented and evaluated within the social care context. The databases Scopus, ASSIA, CINAHL and Social Care Online were initially searched in September 2019 resulting in 52 documents being incorporated for analysis. A further re-run of searches was run in March 2021, identifying a further 14 documents, thereby creating a total of 66. Predominantly, these were journal articles or research reports (n = 53), with the remainder guidance or strategy documents, briefings or process evaluations (n = 13). These were categorised by their primary theme and focus, as well as document format and research method before undergoing thematic analysis. This highlighted the continued prominence of three-tiered, linear public health narratives in the framing of prevention for social care, with prevention work often categorised and enacted with inconsistency. Common drivers for prevention activity continue to be cost reduction and reduced dependence on the care system in the future. Through exploring prevention for older people and caregivers, we argue for an approach to prevention aligning with the complexities of the social world surrounding it. Building on developments in complexity theory in social science and healthcare, we offer an alternative view of social care prevention guided by principles rooted in the everyday realities of communities, service users and caregivers

Operationalising desistance through personalisation

This article reports on the early stages of a project to develop a model of offender rehabilitation that operationalises the concept of desistance. The concept of desistance is influential but operationalising it remains a challenge. The aim of this article is to assess whether personalisation of offender rehabilitation has potential as a mechanism for operationalising the concept of desistance. We identify learning from the design and implementation of personalisation in social care, but challenges include the roll out of personal budgets, developing a local market to support consumer choice and the limited evidence base on the effectiveness of personalisation. We specify a project to pilot personalisation in the English probation sector that tests concepts relating both to the design and commissioning of personalised services, including community capacity building to support the supply of personalised services at the local or even micro level. A project evaluation design is also outlined

Strengths-based practice: social care’s latest Elixir or the next false dawn?

There has never been such a consensus that social care is in crisis in England. However, it cannot be assumed this will result in fundamental rethinking of the future. Social care continues to search for a miracle cure that will painlessly transform it into a system both personalised and will cost less. The current ‘elixir’ is ‘strengths based practice’. This article suggests, however, that the current depersonalising and wasteful practices which strengths based practice is meant to replace are a product of the system within which practitioners work. There is unlikely to be significant change until that system has changed. If the current sense of crisis translates only into short-term action to keep the system afloat, the elixir will most likely be the prelude to the next false dawn