Personalisation

Beresford, Peter, Peter Beresford

• Publisher: Policy Press
• Year: 2013
• Print ISBN: 9781447316145
• eBook ISBN: 9781447315933
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Policy
• Index: Social Sciences

Personalisation has become the policy buzz-word of the twenty-first century. Supporters claim it offers service users choice and services attuned to meet their specific needs, moving away from 'one size fits all' state services. In this short form book, part of the Critical and Radical Debates in Social Work series, Peter Beresford, one of Britain's foremost social work academics, challenges the personalisation agenda and its consequences on service users. Although critical of 'one size fits all' services that deny service user voice, Beresford argues that personalisation turns service users into 'consumers' of services within a care market and hence reinforces the commodification of care which sees vast profits made by a small number of providers at the expense of good quality services for those who use them.

PART ONE

Lead essay

Personalisation: from solution to problem?

Peter Beresford

Introduction

‘Personalisation’ is without question the dominating idea and development currently in social work and social care. In England, it has had a high profile since the publication of the government’s Putting people first in 2007 (HM Government, 2007), and the likelihood is that it will remain so in the UK for the foreseeable future. All three mainstream political parties have signed up to the idea of ‘personalisation’. It has become an article of faith for the English Department of Health and numerous consultancies and pressure groups work to advance its implementation.

Yet, ‘personalisation’ is a term that has no clear or agreed meaning and does not have a place in many established dictionaries. Many of its strongest critics have been service users and their organisations, and practitioners and their trade unions, although, ironically, among the major claims made for it are that it will improve service users’ lives and restore professional practice to its original progressive value base.

Whatever we may think of ‘personalisation’, those concerned with social work, social care and health must grapple with it because it is now increasingly shaping both the conceptual frameworks of these fields and their day-to-day professional and occupational practice. So, whether our starting point is as helping professionals, students, managers, educators, researchers, service users or carers, we need to make sense of this development to understand how it may affect us and how we may negotiate and respond to it most helpfully. A key aim of this article is to help readers to do this.

Historical insights

Social work and social care in Britain both have a chequered history. They have been devalued, underfunded, neglected, stigmatised and misunderstood. There has been no golden age for either of them, and the views and experience of service users have often been negative (Harding and Beresford, 1996). ‘Personalisation’ is far from the first instance of a contentious and ambiguous development emerging in social work and social care. Indeed, their history can be seen to be littered with such innovations. One such development was ‘patch’-based or ‘community’ social work. Interestingly, links are now being made between personalisation and community social work. Personalisation has been compared with community social work and is seen as having the potential to offer the same gains (see: http://www.communitycare.co.uk/blogs/adult-care-blog/2011/08/social-care-dependency-and-the-return-of-community-social-work.html [accessed 1 July 2013]).

Patch/community social work

Patch and community social work are most closely associated with the 1982 Barclay Report (Barclay Committee, 1982; Beresford, 1982). These two overlapping ideas were both based on an emphasis on geographic community and decentralisation. While there was some blurring of the two, a key distinction was that the ‘patch’ area tended to be constructed as smaller. Both highlighted the importance of being near to local communities, working closely with them and involving them actively. Pioneering examples of such grassroots ways of working were identified and generated much interest from social workers and others who were already disillusioned with the cumbersome and bureaucratic ‘social services departments’ established in the early 1970s (Hadley and McGrath, 1980). Patch and community social work were sold on:

• challenging and reducing bureaucracy;
• small being beautiful;
• overcoming administrative divisions by having a unified local presence, which was often embodied in a ‘patch’ or ‘neighbourhood office’ (in some areas, decentralisation was across the range of local authority services, all to be accessed in a ‘one-stop shop’); and
• buildings links and relationships with local people, which helped prevent problems arising and made them part of the community (Hadley and McGrath, 1980; Hadley and Hatch, 1981; Hadley et al, 1984).

Interestingly, patch and community social work, like personalisation, emerged at a time of severe economic recession and major political and ideological change. While the developments that were included under the patch/community social work banner were presented as progressive and innovative, they came to be seen as much more heterogeneous and complex. As time went on, it became clear that patch and community social work had regressive as well as progressive implications and associations. Thus, emerging evidence and discussions highlighted their:

• over-reliance on unrealistic and often excluding notions of geographic community (to the exclusion of other ideas and forms of community);
• reliance on the anti-state rhetoric of the political Right;
• limited evidence base;
• reliance on people doing things for themselves in the name of self-help and mutual aid;
• tendency to transfer responsibility rather than power and control;
• association with cuts in paid staff and the substitution of lower-paid for professional staff;
• increasing emphasis and reliance instead on the unpaid work of women, particularly with the emerging idea of ‘informal care’ and ‘informal carers’;
• tendency to misinterpret and appropriate black and minority ethnic community networks;
• difficulties in ensuring a consistent and coherent system of support across localities; and
• association with privatisation (Beresford and Croft, 1984a, 1984b, 1986).

What is perhaps most interesting about patch and community social work is how limited their lives were. Advanced with enthusiasm in the early 1980s, schemes were already being dismantled by the latter part of the decade. East Sussex, a high-profile pioneer of patch-based social work, just as quickly closed its neighbourhood offices and moved back to a traditional system of specialist social work. By the beginning of the 1990s, the government had switched its attention and interest to ‘care’ or ‘case management’, which has been the dominant approach to local authority social work, particularly adult social work, up until the introduction of personalisation.

There are some significant lessons to be learned from this history when considering personalisation. First is the ambiguity of patch and community social work. While they gained much support from progressive commentators and practitioners and pioneering examples, like the patch teams in the London Borough of Hammersmith and Fulham, really seemed to break new ground, for example, in relation to the emergence of HIV/AIDS (Beresford and Harding, 1993), strong concerns were also expressed about the negative potential of this social work approach, especially from feminist and radical social work commentators (Finch and Groves, 1980, 1983; Langan and Lee, 1989). Second, patch and community social work offer a powerful reminder of the vulnerability and tenuousness of major changes and innovations in social work and social care, even when they gain high-level political, policy and professional support. Their actual shelf lives were very short and they seem to have left little legacy, except perhaps in the consciousness of those practitioners and service users who valued and benefitted from them. We will do well to remember both these points as we turn to personalisation in order to minimise the risk of repeating past mistakes.

The emergence of personalisation

SLK Training and Consultancy, one of many such consultancies set up in the wake of the government’s commitment to roll out personalisation, offers a helpful face-value definition of the term, which reflects much of the conventional wisdom and prevailing thinking about it:

Personalisation, often referred to as the complete transformation of adult social care, also means making universal services such as transport, housing and education accessible to all citizens. Personalisation is about putting individuals firmly in the driving seat of building a system of care and support that is designed with their full involvement and tailored to meet their own unique needs. This is a completely different approach to an historic ‘one size fits all’ system of individuals having to access, and fit into, care and support services that already exist which have been designed and commissioned on their behalf by Local Authorities for example. Individuals will receive their own budget and can decide how, who with and where they wish to spend that budget in order to meet their needs and achieve their desired outcomes. Whilst there is initial focus on social care and support services, the principles of personalisation are being embedded into a range of other public service areas such as health and education. (From: www.slk-consultancy.org.uk/viewnews.php?id=34 [accessed 1 September 2011]).

As this statement suggests, the term ‘personalisation’ was originally used to describe people accessing a cash budget (personal or individual budget) to spend on their support, to put together what help and services they wanted. However, more recently, there has been a shift in the term’s official usage. It is now also used by the government to mean people having more choice and control and a more customised service, regardless of what service or form of support they receive and however it is provided. No clear reason has been offered for this change, although it does, of course, result in a much vaguer definition. At the same time, official measures of progress towards the ‘transformation’ of social care have still tended to be presented in terms of the numbers and proportion of service users who have moved to personal budgets. Thus, personalisation is still closely, but not solely, associated with budgets, although there is now some ambiguity about the idea.

The presentation of personalisation

Personalisation in social care represents a major shift in public policy, with strong ministerial support, the allocation of more than £500 million by government to take it forward – an unusually large amount in the usually cash-strapped field of social care – and an official emphasis on its radical structural and transformative nature (Boxall et al, 2009). Yet, despite the scale of the change, it was publicly presented and significantly constructed in terms of a number of personal stories. These were stories of service users who were beneficiaries of the new arrangements for support through personal budgets. Often, new policies or initiatives are presented in terms of particular pioneering examples (as happened, for instance, with patch) or through spotlighting specific programmes or innovating organisations. Certainly, with personalisation and personal budgets, some particular local authorities, like Essex and Oldham, have also been highlighted.

However, in the case of personalisation, the story was primarily told through a series of personal stories. A significant exception has been the helpful resources produced by the Social Care Institute for Excellence (eg Carr, 2010a, 2010b). These high-profile and frequently repeated stories featured regularly in the media and at conferences and were cited by policymakers and politicians. Notable examples include those of personal budget users Gavin Croft and Julia Winter. As these were reported:

Gavin Croft … spent £375 of care money from Oldham council on a season ticket for Rochdale FC for a fellow fan to accompany him to home matches and commentate on the action on the pitch. Croft, who suffers from multiple sclerosis and whose vision is impaired by a degenerative condition, recruited his companion from the supporters’ internet site. Croft’s wife said that allowing her husband to spend his care money in this way gave her a much-needed break. ‘It has been great. It gives me the only time I get off all week and I don’t have to watch football in the wet and the cold,’ she told the Manchester Evening News. Croft said he also enjoyed going to the pub after the match with his Saturday afternoon ‘carer’….

In Essex, for example, a personal budget-holder [Julia Winter] with serious respiratory problems that kep...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Notes on contributors
• Series editors’ introduction
• Part One: Lead essay
• Part Two: Responses
• Part Three: Concluding remarks
• References