The issue about who is in control of care support has been developed by the government through a policy known as 'personalisation' or 'self-directed support'. This policy agenda has two main principles:
- The first is that how a person is supported needs to be in their control and provide what is important to them. This is called being 'person centred' and, while it may seem obvious, it can be said to represent a 'cultural shift' for many professionals in health and social care. For many years the training and education for health and social care staff tended to reinforce an attitude that the view of the professional was paramount and that 'caring' involved taking over and doing for people, not working with them.
- The second principle of personalisation is that rather than providing or organising support services directly, local authorities can now allocate a budget to individuals. This budget can then be used by a person to employ their own staff in the way they want and consequently to take all the responsibilities of being an employer. The idea of a personal budget started out primarily for people with physical disabilities but now the principle has been extended to many groups of people who may need additional support e.g. people with mental health conditions, older people, people with learning disabilities, children and families.
Some writers have begun to suggest that the principle of allocating a budget to provide control over the support does not work equally well for all groups. For example, for many people, managing the employer responsibilities does not fall to the person themselves, but to their family carers or relatives. If a person has dementia, or a learning disability, it is unlikely they will be able to manage the complexity of wages, tax and national insurance etc. Similarly, there are suggestions that a principle of 'ethics of care' is more relevant to some groups, including older people. This suggests that ideas of control and autonomy are not always appropriate and that there are times in the life course where dependence and reliance on others is a more person-centred approach. There is also concern amongst some professionals that some individuals are vulnerable and there is the potential to be exploited by the people who are supposed to be working for them.
While the personalisation agenda provides a positive strategy for providing person-centred support for many people, there have also been concerns about the position of the workers within this policy. High-handed and controlling attitudes amongst some professional groups can be seen to be unacceptable, but such professionals have a body of knowledge and experience that can inform what they do and why they do it. They have standards and regulatory bodies that register and monitor the way they work affording some protections to the people they support. They are often linked to larger organisations that will keep them informed of new techniques and approaches and provide ongoing training. Few of these supports and protections are in place for the individual employee or employer. Trade Unions such as Unison (2011), while embracing the positive principles of personalisation, point out the importance of establishing an approach to protection of the pay and conditions of individual worker in a social care workforce that is based on thousands of individual employers paying for care in a flexible way.