Personalisation in disability policy and practice: an analysis through the lenses of professional actors

ABSTRACT

‘Personalisation’ is nowadays a very popular concept in disability policy and this article – drawing on my PhD research project in the English and Lombardian context of social care services for disabled people – aims to explore the translation of personalisation from policy into practice; hence the ways in which personalisation policy makes its way into disability services. In particular, drawing on street-level-bureaucracy, policy practice and network theories, personalisation is analysed here through the lenses of professional actors. The application of a mix of qualitative research methods brought me to two main conclusions: 1) narrow approaches to personalisation coexist with broader ones, leading to very different roles for professionals charged with translating personalisation policy into practice; 2) power differences and asymmetries are at play among different professional actors, with some having stronger discretional and policy steering capacity compared to others when it comes to informing person-centred care practice.

KEYWORDS:

• Personalisation
• personal budgets
• direct payments
• social work practice
• social policy

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. My PhD thesis is available here: https://dare.uva.nl/search?field1=meta;join=and;field2=meta;smode=advanced;sort-publicationDate-min=2021;sort-publicationDate-max=2021;typeClassification=PhD%20thesis;f1-organisation=Faculty%20of%20Social%20and%20Behavioural%20Sciences%20(FMG);docsPerPage=1;startDoc=78. Some chapters are currently under embargo and will be available after 3 December 2023. Those regarding the aim, focus and methods of my research, however, can already be consulted as pdf documents.

2. England and Lombardy represent contexts where the ‘professional actors lens’ for the study of personalisation has rarely been used. In England, a couple of exceptions are represented by the Personalisation special issue published in 2010 by the Journal of Social Work Practice (Parkinson, 2010) and by the work of Ellis (2015), who applied such lens for the study of personalisation and self-directed-support policies in the context of social work; but no study has actually analysed the role played by other professional actors, such as, for instance, independent consultancy organisations. At most, literature on the topic (Beresford, 2014; Carr, 2010) makes references to their role but without dedicating any specific studies to them. In Lombardy, instead, personalisation has actually never been studied with a specific focus on the role of professionals in translating it, neither within social services nor outside them. As such, professionals’ translation role represents an original lens for the study of personalisation policies and one which, combined with a comparative approach, has the potential to lead – as we shall see – to novel conclusions.

3. In the Method chapter of my PhD thesis (available here: https://pure.uva.nl/ws/files/65588774/Chapter_4.pdf), the rationale for the selection of Lombardy and England as the two units of analysis for comparison is explained in further details, including a section explaining why I decided to compare a country (England) with a region (Lombardy). Such decision might indeed be questioned on different grounds. There are, however, at least three main reasons justifying such comparison: 1) the fact that both England and Lombardy represent relevant examples of the institutionalisation of personalisation through similar ‘choice’ tools; 2) the specific scope of this research and related qualitative approach employed in carrying it out; 3) the different legislative powers of England and Italy in relation to social and health care services. England has a very centralised legislative framework for health and social care policies and services, one which explains the overall uniformity of policy and practice around health and social care I encountered in my fieldwork. Italy, on the contrary, has devolved many legislative powers around social policy to its regions, and Italian regions have the power to further legislate on social care and health matters. In the Methods chapter of my PhD thesis, however, I also clarify an important aspect of the sampling strategy underpinning my work which is worth recalling here too. As it often happens with qualitative research (Cardano, 2011), I had to fine-tune and adapt my methodology to the ‘availability’ of the research contexts and objects I was researching and such adaptation required me to depart, in some cases, from my original research design. This happened, for instance, when I decided to enlarge my original fieldwork contexts (London and Milan) to include different English boroughs (the majority of which in London) and different Lombardian provinces. These choices were carefully considered, however, and only ‘tentatively’ made in the first place. In fact, I proceeded with changes in my sampling strategy only because the initial, ‘tentative’ implementation of these changes proved effective for the wider purposes of my research. For instance, the interviews I carried out with social workers working outside London did not differ substantially from those carried out with social workers employed in different London boroughs. There are organisational differences (including different policy priorities) from one borough/city to the other, but overall social work practice emerged as very similar across areas: similar topics and issues have emerged in all of my interviews, thus allowing a solid comparison. Also, the fact that the same network of actors gravitating around personalisation are found across England (and not just in London) does influence social work practice to similar extents across the country, another element which further convinced me of the suitability of my adapted sample strategy in the English context. A similar point could be made about Lombardy as well. Once I had proceeded to extend my sampling beyond the city of Milan and its province, I indeed encountered a very distinctive feature of Lombardy as compared to England: the extremely wide variety of approaches and practices related to personalisation.

4. The Fondo Nazionale per le Non Autosufficienze (FNA) is a fund established in 2006 for people with severe or critical disabilities while the After Us (Dopo di Noi) funds have been introduced in 2016 with the aim of supporting independent living and domiciliary interventions for people with severe disability who do not have, or are at risk of losing, familial support.

5. The literal translation of Budget di Salute (BdS) would be ‘health budget’. In this article, however, I refer to BdS as ‘combined budget’. My translation choice reflects the fact that the underpinning idea of BdS is precisely that of combining different resources and funding streams into a single integrated budget. Calling it ‘health budget’ would risk creating confusion, erroneously suggesting that this budget is only composed of resources from health care departments.

Additional information

Notes on contributors

Francesca Pozzoli

Francesca Pozzoli is a researcher at the Institute for Social Research (IRS) in Milan. Her main research interests include welfare states’ transformations, social and health care policy and social work. In 2021, she obtained a joint PhD in Sociology and Methodology of Social Research (University of Milan & University of Amsterdam). In her thesis, she examined personalised care practice in the context of two different countries.