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This chapter examines specific areas of conflict and constraint in achieving a ‘modernising’ vision of services that promote independence, well being, and choice, focusing mainly on older people's experiences of social-care services. After summarising what quality of life means from older people's perspectives, it discusses areas of practice in which various facets of the modernisation agenda's managerialism appear to be obstructing the delivery of user-centred services. One is the tension between the need for timely intervention that supports older people's coping strategies and the managerial policies and practices which seek to ration, restrict, and delay service provision. Another is the significance of disjunctions between policy discourses, managerial concerns, and service-user understandings and prioritisations of need. The chapter also assesses the potential of current policy directions, in particular the extension of direct payments and the introduction of individual budgets, to deliver support that is more closely attuned to the needs and preferences of service users.

This chapter draws on textual analysis of ministerial speeches, government documents, so-called grey literature, and interviews to present the key themes of the personalisation narrative. It shows how the narrative deploys the testimonies of social care service users alongside formal evidence of service improvement and claims that the benefits of personalised approaches are self-evident. The chapter highlights five storylines that are embedded in the personalisation narrative: personalisation works, transforming people's lives for the better; personalisation saves money; person-centred approaches reflect the way in which people live their lives; personalisation is applicable to everyone; and people are experts on their own lives. It also explores how the personalisation narrative interacts with the past and constructs the present and future.

This chapter examines a number of reasons for disputing the adequacy of a consumerist frame of reference for understanding the challenge presented to health and social care services by user and carer movements. Not only is the consumer as chooser an inadequate conceptualisation of the relationship between users and producers of welfare services, it is also a flawed strategy for empowerment and does not express the broad significance of the collective action that has developed over the last 40 years among users of welfare services. Collectively, service users have developed alternative ways of understanding disability, mental illness, and caregiving; have claimed the right to construct their own identities; and have unsettled taken-for-granted assumptions about social relations not only between providers and users of welfare services at the point of delivery, but also in the process of deliberation about social policies.

Dependent older people with complex needs often require integrated provision of health and social care services. This chapter shows that the huge number of studies, experimentations and polices carried out, so far, internationally, to pursue this goal have proved that there is no single best recipe to meet integrated care needs. Integrated care needs to become a priority at system level because recognizing its importance on the political agenda is an essential pre-condition to pursuing this goal. Policy-makers, however, should not prescribe how to obtain integrated care: they should, instead, respect the idea that integration is local and there will be differences in how it is pursued across different areas. How to arrange the services and how to involve the different professions in order to obtain integration are choices to make locally, the chapter argues, letting local conditions and opportunities to guide the process

This chapter presents findings from a small piece of research into a neglected area: fathers and social-care services, particularly where there are concerns about the abuse of children. An interesting finding was that women wanted services to engage fathers, although family situations were often complex in relation to who or where the father was, and much more research is required in this area. It would appear that practitioners might not be equipped to deal with the complexities of the relationships they encounter. Many of the men who responded to the research reported considerable anxiety about how much power the mothers of their children had and little belief that services were interested in their needs. Those who had involvement with social workers reported an unreliable and inconsistent service.

In this afterthought, Robert Pinker reflects on the prospects for social policy in the UK after Brexit. On 23 June 2016. the UK electorate voted to leave the European Union. The process of exiting the EU would commence right after the UK Government declared its intention to leave by triggering Article 50 of the Lisbon Treaty. Pinker discusses the debate in the UK regarding the kind of Brexit favoured by those who wanted to leave the EU — a ‘hard’ or a ‘soft’ one. He also considers the legal challenges to a fast-track Brexit, along with the Prime Minister's Lord Mayor's keynote speech promising to adopt a new approach to managing the forces of globalisation and the Chancellor's Autumn Statement on 23 November 2017. Finally, he looks at the funding crisis in UK health and social care services, the government's 12-point Brexit Plan, and the Supreme Court's rulings on Article 50.