Abstract
While this is a relatively slim volume, it contains much detail and depth. It is important to remember that the apparently inexorable rise of personalisation and self-directed support has been contested; it has, for example, been accompanied by an increasing volume of literature that either questions or is critical of the developments (Needham, 2011; Beresford, 2014). While the role of disability activists was critical in framing the ideas that have informed the policy, it has progressed a long way from these idealistic formulations, in what are notably difficult economic circumstances. As a result, the policy that is being implemented is substantially different from that which was originally thought up.
This book is written in the full awareness of this, and explores the implementation of personalisation and self-directed support in Scotland. The national context is highly significant, as there is a strong sense in Scotland that it can lead to ‘backdoor privatisation’ (p. 18). Indeed, this is arguably a more powerful current of thought within Scotland than other areas of the United Kingdom. It is given particular force by the acute financial crisis through which we are all living.
From this perspective, the critical chapter in this book is Chapter 5, which poses a key question: to what extent can personalisation and self-directed support be implemented under conditions of austerity? On this, the authors are unequivocal: ‘It is clear that personalisation programmes across the UK and in the rest of Europe are being hit disproportionately by austerity measures’ (p. 70). As a consequence, access to the newly personalised budgets is being severely restricted. It is clear from what the authors write that they consider the principles of self-directed support and personalisation to have been compromised by economic factors. To that extent the analysis is familiar to readers of this journal as it is similar to what has been reported in other papers (see, for example, West, 2013). In common with the above paper, while the text is unflinching as far as the impact of austerity is concerned, it is far from an evidence-free polemic. Indeed, one of its great strengths is the fact that it is grounded in many years of empirical research. When combined with its relative brevity, this renders the text both accessible and authoritative.
This is reinforced by the way in which the book’s chapters are organised. It starts with an exploration of the changing conditions and values of social care, moving on to analyse the impact of the self-directed support pilot sites in Scotland. The book clearly suggests that the ‘success’ of these has drawn self-directed support into the mainstream of social care in Scotland, and has directly affected the ways in which subsequent policy has been devised. In particular, the book comments critically on the way in which support roles have been changed by this, not always in the interests of either users or workers.
As noted above, the meat of the book lies in its exploration of the problems of self-directed support and personalisation in the context of austerity. It functions as a necessary reminder that the adequacy of resources is a material consideration. Many of the respondents to the various research projects that informed the text note that self-directed support has been used as a mechanism to make cuts, thereby compromising its effectiveness. Indeed, in articulating their conclusions the authors highlight the importance of ensuring that funding levels are sufficient to enable good outcomes; an obvious lesson perhaps, but also one that appears to have been officially downplayed.
Overall, therefore, this book comes highly recommended both for an academic and (perhaps particularly) for a professional audience. It is important that anybody involved in the development of social care is able both to accept the need for service users to be enabled to exercise increased levels of choice and control, and to understand the extent to which financial shortfalls might inevitably compromise this. The book’s insistence on this point helps to ensure its significance in the literature.