Abstract
This excellent contribution critiques the prevailing hegemony around ‘personalisation’ in adult social care. The book opens with an extended essay by Professor Peter Beresford, who starts by noting the similarities between ‘personalisation’ and earlier short-lived reform movements such as ‘patch’-based or ‘community’ social work, which also ‘emerged at a time of severe economic recession and major political and ideological change’ (p. 75), before moving on to consider the process by which ‘personalisation’ developed – noting both shifts in the use of language and the reliance on personal anecdote, rather than independent research evidence, to support policy implementation. Beresford also demonstrates how personal budgets have become synonymous with the practice of personalisation and argues that, far from being the invention of Simon Duffy and colleagues, these are in fact a (watered down) form of direct payments as developed by the disabled people’s movement many years earlier.
The contributions which follow provide further compelling arguments against ‘personalisation’, as presently being implemented, from the perspectives of service users, researchers, practitioners and trade unionists. These demonstrate how personalisation has been stolen away from its roots in the disabled people’s movement and re-imagined to fit the neoliberal agenda. Sarah Carr explains the confluence of political and ideological forces which enabled personalisation to achieve its rapid rise to prominence; Jim Main gives a vivid description of the negative impacts, on both service users and the social care workforce, of the implementation of ‘personalisation’ in Glasgow; whilst Alan Roulstone provides a timely reminder that the present, bureaucratic, top-down implementation of ‘personalisation’ is not the only way that personalisation could be designed. In shorter pieces, Pat Stack, Helga Pile and Roddy Slorach highlight the move away from personalisation as a bottom-up/service-user led movement towards ‘personalisation’ as a top-down, bureaucratic process; critique the ways in which ‘personalisation’ has become about process rather than outcomes; and link this to wider attacks on benefits and services for disabled people. Finally, Colin Slasberg methodically sets out evidence to debunk the myths that advocates of neoliberal ‘personalisation’ peddle: personalisation has not brought transparency to the resource allocation process; bureaucracy has increased rather than decreased; and service user control is not apparent.
What unified this at times disparate set of critiques was the clear consensus that (i) ‘personalisation’ as currently being implemented is not the same as the personalisation long demanded by service users; and (ii) ‘personalisation’ is being used as a mechanism for cutting social care budgets. This is occurring because of the way in which neoliberal conceptions of personalisation emphasise individuality at the expense of collectivism. This makes implementing cuts to public services easier: cut collective service provision and you risk a collective protest; cut an individual’s personal budget and the chances are that they will lack the power to fight back.
My one disappointment with this volume was that none of the authors directly addressed the issue of mental capacity and personalisation. Whilst they deftly expose the neoliberal, consumerist version of ‘personalisation’ that has been promoted by successive UK governments, none of the authors explicitly consider the needs of the many adult social care service users who are cognitively impaired – including people with dementia, people with severe learning disabilities and people experiencing extreme forms of mental distress. Personalisation was developed by the disabled people’s movement, which is led largely by cognitively able people with physical or sensory impairments; now, however, greater consideration needs to be given to how existing service-user led models of personalisation can be adapted to meet the needs of people with cognitive impairments, who may struggle to manage direct payments and for whom considerations of vulnerability may be necessary.
Overall, however, this slim volume will prove an invaluable resource to anyone who has found themselves uneasy with the march of neoliberal ‘personalisation’ within social care services, but has felt afraid to speak out for fear that they will be perceived as wishing to return to earlier, paternalistic patterns of support provision. This group of authors, individually and collectively, make it very clear that personalisation – as seen in person-centred approaches to the assessment of need and delivery of support – is the best way of meeting people’s social care needs. However, ‘personalisation’ as presently being implemented top-down across UK social care services is often a different beast altogether: bureaucratic, impersonal and a threat to the well-being of both service users and the social care workforce.