This document discusses personalization and choice in social care. It outlines the history and evolution of direct payments, individual budgets, and personal budgets. While these aim to give users more choice and control, there are also risks, such as uncertainty, lack of information, cultural and legal constraints, and increased responsibility being placed on users and carers. About half of total spending on social care for older people comes from private contributions rather than the local authority, showing that social care is already quite privatized in many ways.

1. ‘Personalisation’ and choice
in social care
Professor Caroline Glendinning
Social Policy Research Unit
University of York

2. Background
 1997 direct payments
 In Control
 2005 Improving the Life Chances of Disabled
People
 13 Individual Budget pilots – 2005-7
 December 2007 Putting People First
commitment to personal budgets in social
care

3. Direct payments … individual budgets …
personal budgets … what’s the difference?
 Direct payments
 traditional assessment; convert ‘hours’ of care
into £; typically used to employ personal assistant
 Individual budgets
 multiple funding streams (AtW, ILF, ICES, DFGs,
SP); transparency; (?entitlement); deployment
options; flexible use
 Personal budgets
 social care only; transparency; (?entitlement);
deployment options; flexible use

4. Why choice in social care?
Choice and control fundamental to …
 Citizenship
 Independence
 Redressing power inequalities
 As outcome of social care
 As vehicle for remaking citizenship (Demos)

5. But … conditions for exercising choice
and control
 Stability/certainty
 Information, brokerage
 ‘information asymmetry’
 Awareness of options
 Supply
 purchasing leverage
 specialist needs
 opportunities for ‘exit’

6. Other risks and challenges
 Legal constraints
 Cultural constraints
 Professionals
 Users
 Choice not to choose
 Transferring risk to users
 Impact on carers
 New management tasks
 New obligations
 Risks to equity
 Information/access
 Transparency

7. Social care – already privatised?
 Rising eligibility thresholds
 substantial/critical needs only
 Assets test for residential care
 118,000 fund own care home place
 Charges for community services
 1 in 4 pay means tested charges
 ‘Topping up’ LA-funded care
 1 in 4 ‘top up’ insufficient local authority care
 ‘Self-funders’ – ineligible/choose not to use LA care
 150,000 older people
About half total spending on personal social care for older
people comes from private contributions – total £5.9bn
Unpaid care from carers valued at £87bn a year – more than
total cost of NHS