Personalisation in disability services and healthcare: a critical comparative analysis (Critical Social Policy, 2015) (original) (raw)
Related papers
Scandinavian Journal of Disability Research, 2020
Personalisation has dominated social care across OECD countries over the past 20 years. UK policy evolved from the efforts of disabled peoples' organisations (DPOs) to secure the availability of cash payments as part of a wider drive to enable independent living. Implementation of personalisation across the UK has seen significant divergence in how governments have developed their own responses, but in each country the DPOs' role and impact has shifted from campaigning and promoting the voices of disabled people to a more muted focus on service provision and limited policy engagement. This article draws on a series of interviews with DPOs and leading disabled activists. It highlights concerns raised related to themes around austerity, changing relationships with local government and the role of co-production in developing policy. We conclude the article by discussing the future directions for personalisation and developments in light of the COVID-19 pandemic.
Personalisation schemes in social care: are they growing social and health inequalities
Background: The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes.
As part of the international trend towards personalisation, in 2013 Australia launched a major disability scheme aiming to give participants greater choice and control over services. The scheme aims to cover a wide diversity of disabilities, services and significant geographical arearesulting in a highly complex system of local overlapping markets. At four years into implementation a range of challenges have emerged. In this paper we firstly describe the Australian National Disability Insurance Scheme, then explore a range of implementation challenges it currently faces as a large-scale personalisation scheme. Based on these experiences we pose a range of questions for similar schemes internationally.
INKLUSI: Journal of Disability Studies, 2020
Person-centred funding models are replacing block-funding models in the disability services sector. Australia is part of this international trend. Concerns have been raised by service providers, suggesting that people with disabilities are not benefiting from this system. This paper evaluates the views of service providers from a large non-government organization in South Australia, responsible for leading the transition from a block-funded model of support to a person-centred model of support. Two focus groups were conducted. Two themes emerged from these focus group discussions: customers with disabilities are vulnerable in the market, and marketizing disability services compromises quality. Neoliberal ideologies and market-based values frame the challenges and opportunities for not-for-profit organizations when transitioning to person-centred funding for disability support. This research both enlivens and confirms the existing research literature. Although person-centred funding models offer a socially just model, there is evidence that unintended consequences emerge in an open and competitive quasi-market. This study reveals that the competitive market design had stopped trans-sector collaboration.
Critically assess the impact of relevant social policies regarding Disability in the public domain in the UK. This essay will look at the theories and definitions of disability and how the theories have informed the discourse, legislation and policies relating to disability discrimination. The essay will also critically analyse UK legislation and policies in the areas of education, employment and access to services. The treatment of disabled people in the UK can be divided into three broadly distinct phases: the moral model of disability which can be traced from the early 17 th century to the introduction of the medical model; the period of the medical model from 1952 onwards; and the recent history where the social model of disability has gained impetus from 1983. The search for equality for all has led to the propositioning of different policy frameworks in order to achieve equal opportunities in the UK. This has dominated UK policy since the 1970 ¶s, producing legislation such as the Equal Pay Act, 1970; Sex Discrimination Act 1975, and Race Relations Act 1975 and Smith (2011) argue that equal treatment does not produce equal outcomes and still leaves groups of people discriminated against. Ross and Schneider (1992) argued that the equal opportunities agenda focused on groups rather than individuals and hence created tokenistic policies which generated changes to individuals with diverse needs. Oliver (1990) argued that equal opportunities implied that everybody should be treated the same and failed to address inequalities and sustained disabling barriers. This essay will look at how or whether legislation has embraced diversity.
Journal of Social Policy, 2014
Personalisation has now become centre-stage in adult social care and continues to have an enduring level of political commitment and on-going appeal for many disabled people. And yet its roll-out has taken place during a time of austerity where central governments in many neo-liberal countries are re-imagining (read: shrinking) their role in social care provision. This paper reports on findings from an empirical study of relevant government officials from different countries which have advanced personalisation: Canada, England and the US. It reports on their views on personalisation and the remaking of adult social care, and managing expectations for change. Despite the relative success of personalisation, the findings reveal a tempered, cautious account, with respondents aware of the pitfalls and risks inherent in self-led support, government limitations in changing systems and an end to the primary involvement by the state in the creation of a social care market. With this in mind, the study’s findings make a strong case for forms of ‘progressive localism’, as imagined by Featherstone et al. (2012), in galvanising local community resources alongside more radical politics in order to make self-led support achieve its desired outcomes on the ground.
Critical Social Policy, 2021
Social care provision across high-income countries has been transformed over the last ten years by personalisation – a policy agenda to give people with eligible support needs more choice and control over their support. Yet the ideological underpinnings of this transformation remain highly mutable, particularly in the context of reduced welfare provision that has unfolded in many nations advancing personalisation. How the policy has manifested itself has led to an expectation for people to self-build a life as individual consumers within a care market. This article draws on a study exploring how people with learning disabilities in England and Scotland are responding to the everyday realities of personalisation as it is enacted where they live and show the relationality inherent in their practices. We propose that the personalisation agenda as it currently stands (as an individualising movement involving an increasing responsibilisation of individuals and their families) ignores the...
INKLUSI
Person-centered funding models are replacing block-funding models in the disability services sector. Australia is part of this international trend. Concerns have been raised by service providers, suggesting that people with disabilities are not benefiting from this system. This paper evaluates the views of service providers from a large non-government organization in South Australia, responsible for leading the transition from a block-funded model of support to a person-centered model of support. Two focus groups were conducted. Two themes emerged from these focus group discussions: customers with disabilities are vulnerable in the market, and marketizing disability services compromises quality. Neoliberal ideologies and market-based values frame the challenges and opportunities for not-for-profit organizations when transitioning to person-centered funding for disability support. This research both enlivens and confirms the existing research literature. Although person-cente...
Personalisation schemes in social care and inequality: review of the evidence and early theorising
Background: Personalisation is a growing international policy paradigm that aims to create both improved outcomes for individuals, and reduce fiscal pressures on government, by giving greater choice and control to citizens accessing social services. In personalisation schemes, individuals purchase services from a 'service market' using individual budgets or vouchers given to them by governments. Personalisation schemes have grown in areas such as disability and aged care across Europe, the UK and Australia. There is a wealth of evidence in public health and health care that demonstrates that practically all forms of social services, programs and interventions produce unequal benefit depending on socioeconomic position. Research has found that skills required to successfully negotiate service systems leads to disproportionate benefit to the 'middle class. With an unprecedented emphasis on individual skills, personalisation has even greater potential to widen and entrench social inequalities. Despite the increase in numbers of people now accessing services through such schemes, there has been no examination of how different social groups benefit from these schemes, how this widens and entrenches social inequities, and-in turn-what can be done to mitigate this. Methods: This article presents a meta-review of the evidence on personalisation and inequality. A qualitative meta-analysis was undertaking of existing research into personalisation schemes in social services to identify whether and how such schemes are impacting different socioeconomic groups.