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ABSTRACT
This article considers the ethical dimensions of attempts to ‘personalise’ health and social care services in the UK. Personalisation is identified as closely related to efforts to introduce elements of neoliberal marketisation into public service provision, particularly through the introduction of consumer choice for services users. We consider two areas of ethical concern surrounding personalisation: its contribution to social justice agendas and the enhancement of service users’ autonomy. While personalisation in general, and consumer choice in particular, has been presented as positively contributing to both social justice and autonomy, we critically revaluate these claims. We draw on the work of Nancy Fraser and relational theories of autonomy to highlight the ethical complexities of personalisation and the potentially negative effects that the extension of consumer choice may have on promoting social justice and supporting substantive forms of autonomy. We suggest that understanding and negotiating these complexities imposes ethical constraints on the ways in which, and extent to which, health and social care services can be defensibly personalised.
Disclosure Statement
No potential conflict of interest was reported by the authors.
Notes on Contributors
Dr John Owens is Lecturer in Ethics and Public Policy at the Centre for Public Policy Research, King’s College London.
Dr Teodor Mladenov is Leverhulme Early Career Fellow at the Centre for Public Policy Research, King’s College London.
Professor Alan Cribb is Professor of Bioethics and Education, Centre for Public Policy Research, King’s College London.
ORCiD
John Owens http://orcid.org/0000-0001-8978-9025
Teodor Mladenov http://orcid.org/0000-0002-0623-7952
Notes
1 When discussing personal budgets in the UK context, it is important to remember that although healthcare is free-at-the-point-of-use, social care is not. This difference is significant because users of healthcare services know that the NHS will pay for their care, while social care users are used to contributing themselves, both in financial terms, and perhaps also in terms of decision-making. A personal budget thus provides healthcare users with choice where previously it was absent, while social care users are granted some peace of mind that they know what their local authority will pay for concerning at least part of their care needs.
2 The characterisation of ‘choice and voice’ in much of the policy literature is based upon a consumerist motif that either explicitly refers to or implies an atomistic, self-maximising and calculative behaviour on the part of individual services users. This formulation bears little resemblance to more profound, collectively sustained forms of ‘choice and voice’ that have been envisioned by the campaigners for user autonomy (for example, within the disabled people’s movement) in their critique of old-style welfare-state institutions (see Roulstone and Morgan Citation2009).
3 One consequence of introducing a competitive market model that diverts funding directly to service users is that more or less ‘traditional’ health and social care services may face reduction or closure if they prove ‘unpopular’ with holders of personal budgets and in times of austerity such services may not be replaced by alternative forms of support.
4 This argument is based on a distinction that can be drawn between the capacity for autonomous deliberation and the capacity for autonomous action, a distinction that is routinely ignored by those who suggest that greater choice will deliver substantive autonomy to service users (see Owens and Cribb Citation2013).