Thirteen - Individualised funding for older people and the ethic of care

Summary

Introduction

Personal budgets (PBs) have been described as the highest profile strand of the personalisation agenda (Needham and Glasby, 2014: 12). PBs aim to provide service users with control over their care by providing them with choices over the type of care they receive as well as choices over who provides that care. Their introduction was the result of a sustained disability rights campaign, but the extent to which they are appropriate for all social care users has been questioned. Older people, in particular, as a group have been problematically situated in this policy shift to self-directed support. Where older people have money for self-directed support, this is far more likely to be as a budget managed by the local authority (Age UK, 2013). An evaluation of the early implementation of PBs suggested a substantial proportion of older people were likely to experience personal budgets as a burden rather than as leading to improved control over their care (Glendinning et al, 2008: 44) and more recent assessments continue to highlight problems for older service users (Lymbery, 2010; Woolham and Benton, 2013; Moran et al, 2013; Age UK, 2013).

This chapter examines the position of older people in relation to the move to personal budgets for social care from the perspective of the feminist ethic of care as articulated by Gilligan (1982) and Tronto (1993), which emphasises the fundamentally relational and contextual nature of care. Our overarching argument is 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, therefore, an inadequate basis for care policy for people in later life. First, we briefly set out the emergence and intentions of personalisation and personalbudgets. We then contrast the rights-based nature of personalisation, selfdirected support and personal budgets, contrasting this with the ethic of care perspective. We then draw briefly on original research on care relationships in later life to illustrate the unavoidably relational nature of need and care.