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The main focus of this chapter is to explore personal budgets in health care and the main findings from the national evaluation of the personal health budget pilot programme. This chapter focuses on exploring the initial implementation process during the early stages of the pilot. It goes on to discuss the extent to which the implementation of personal health budgets was in accordance with the policy intentions underlying the initiative (as set by the Department of Health) and how much it had an impact on outcomes and cost-effectiveness for patients with long-term health conditions. The results indicated that implementation adhering to the main underlying principles of personal health budgets had the potential to have a positive impact on outcomes for budget holders and whether they were cost-effective compared to conventional service delivery.

This chapter examines how policies transfer from one government department or state to another, exploring how far such moves are evidence-driven and what the mechanisms and channels of transfer are likely to be. Within health and social care, there are a number of initiatives that have been lent or borrowed — some internationally, some between departments. These include policies such as the Patient's Charter, expert patient programmes and individual budgets. An extensive literature has grown up around the concept of policy transfer to explain how transfers such as these occur, offering possible explanations about the how, why and when of transfer. However, this approach relies on a systematic account of the transfer process that has come under increasing attack. As a result, the concept of translation has developed as an alternative approach to explain why and how policies migrate from one setting to another. The chapter considers these two approaches in some depth, and then applies their insights to a case study of personal budgets in social care.

The chapters in this book have addressed transitions in a diverse range of contexts. It is notable that despite the disparate nature of the transitions, there are generic themes that recur, common needs that require similar responses. This final synthesis draws together a number of these common elements. A number of the authors have stressed the need to develop opportunities that allow for gradual transition, providing time for adjustment and adaptation rather than the ‘cliff edge’ of precipitate change. Once individuals become aware of potential routes and alternatives, they can start to consider their options and to select their preferred pathway. For many older people selecting supported living, there should be the presumption of different alternatives from which they can choose; for adults more generally, personal budgets should enhance the opportunities for individual choice and control. For young people seeking asylum, the options may be more uncertain and more constrained. Furthermore, personalisation and the development of self-directed support present opportunities and possibilities not even considered in years past.

This chapter uses an ‘ethic of care’ lens to examine individualised funding as a policy response to the provision of older people’s care. Approaches based on care ethics highlight the necessity of care to the human condition, and offer alternative conceptualisations of autonomy and dependence based in relationality. In the chapter the authors argue that when it comes to the care of older people, the stark ‘line in the sand’ between autonomy and paternalism that the current discourse of rights-based personalisation and individualised funding marks out, is hard to discern and is an inadequate basis for care policy for people in later life. It is not simply a matter of ensuring that personal budgets deliver ‘real choice and control’ for older people, but also one of enabling responsive caring relationships.

This chapter explores the responsibilities of local authorities in relation to the provision of care and support under the Care Act 2014. It discusses how the Act ensures that services are tailored to the needs of the individual, rather than being a set package which is offered regardless of the individual circumstances of the case. The Act serves to protect children and vulnerable adults who are facing abuse. A key theme in the Act’s approaches to adult care is personalization, focusing on the goals and wishes of the individual, who should be involved in determining what their goals are and who should be helped in achieving them. The chapter also examines how the Act requires local authorities to make enquiries if there is an adult who may be at risk of abuse or neglect in their area, and to find out what, if any, action may be needed.

Chapter six examines issues relating to the outcomes of care, bringing in the formal outcomes data from the Adult Social Care Outcomes Toolkit (ASCOT). The chapter sets out the increased privileging of outcomes data, over process and output measures. It also discusses the extent to which outcomes are more elusive than other measures: they are compromised by attribution problems and the absence of counter-factuals. Drawing on pricing data from the organisations in our study and outcomes data from people using those organisations the chapter draws conclusions about value for money. Comparing the hourly rates of care providers in the sample of 27 organisations of different sizes, micro-enterprises were found to be the cheapest. These findings are contextualised within broader debates about how care is financed, and the fit between micro-enterprises and individualised purchasing by personal budget-holders and people who fund their own care (called self-funders).