Over recent years, a preventative approach has been promoted within adult social care policy and practice in England. However, progress has been somewhat inconsistent, in part due to issues around conceptualising what exactly prevention means within this context. Particularly since the financial crisis, there have emerged tensions between seeing prevention as a positive strategy to build assets and capability; as part of a neo-liberal project to roll back expectations for state support; or simply as a technocratic strategy to increase efficiency by deploying resources ‘upstream’ where they might have greater impact. This paper provides a critical perspective on how policy has unfolded over the last 15 years, which provides the context for an analysis of findings from a national survey of English local authorities and interviews with key stakeholders. These findings demonstrate a substantial commitment to preventative activity, but also some serious confusions and contradictions in how this agenda may be taken forward in the current policy environment.

This article reviews the design and delivery features of individualised budgets for disabled and older adults to understand the mechanisms for disaggregation and collaboration in the way support is organised and delivered. Individualised funding is often assumed to be a fragmenting force, breaking down mass provision into personalised and tailored support and stimulating diverse provider markets. However, disability campaigners and policy makers are keen that it also be an integrative force, to stimulate collaboration such that a person receives a ‘seamless’ service. The article brings out these tensions within the individualisation of funding and support for older and disabled people in the United Kingdom and Australia, and considers whether there is scope for reconciling these dual forces.

Drawing on a 2010 analysis of the reform and costs of adult social care commissioned by Downing Street and the UK Department of Health, this paper sets out projected future costs under different reform scenarios, reviews what happened in practice from 2010-19, explores the impact of the growing gap between need and funding, and explores the relationship between future spending and economic growth. In the process, it identifies a ‘lost decade’ in which policy makers failed to act on the warnings which they received in 2010, draws attention to the disproportionate impact of cuts on older people (compared to services for people of working age) and calls for urgent action before the current system becomes unsustainable.

Direct payments – cash for people eligible for adult social care and spent by them on care and support – are claimed to enable care to better reflect user preferences and goals which improve outcomes. This paper compares outcomes of older direct payment users and those receiving care via a managed personal budget (where the budget is spent on the recipients behalf by a third party). The study adopted a retrospective, comparative design using a postal questionnaire in three English councils with adult social care responsibilities in 2012–13. Included in the study were 1,341 budget users aged 75+, living in ordinary community settings. The overall response rate was 27.1 per cent (339 respondents). Three validated scales measured outcomes: EQ-5D-3L (health status), the Sheldon–Cohen Perceived Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related quality of life). The study found that direct payment users appreciated the control conferred by budget ownership, but in practice, for many it did not ‘translate’ into improved living arrangements. It also found no statistically significant difference in outcomes between direct payment and managed personal budget users. The paper argues that despite policy and other guidance and research evidence about effective implementation of direct payments for older people, the absence of evidence for better outcomes may at least in part be attributable to values underpinning policies relating to personalisation and personal budgets.

Despite the long-term strategic shift to personalisation, with its emphasis on choice and control for those who use public services, there has been relatively little policy consideration of family carers’ choice within personalisation. The relationship between carers and personalisation also remains under-researched. This article is based on a review of existing knowledge around personalisation. It shows that carer choice is highly complex, not least because of the multifaceted and paradoxical nature of the concept of choice itself. The review demonstrates that choice for carers within personalisation is no less complex and is subject to new and overlapping variables which do not necessarily lead to improved choice for carers. In light of the limited empirical evidence about carers, choice and personalisation, the introduction of the Care Act 2014, and the importance of frontline practice in securing choice for carers, recommendations are made for future research and social work policy and practice.