Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-20T11:03:40.280Z Has data issue: false hasContentIssue false

Tailored and Seamless: Individualised Budgets and the Dual Forces of Personalisation and Collaboration

Published online by Cambridge University Press:  10 October 2022

Catherine Needham*
Health Services Management Centre, University of Birmingham, Birmingham, United Kingdom
Michele Foster
The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
Karen R. Fisher
Social Policy Research Centre, University of New South Wales, Sydney, New South Wales, Australia
Eloise Hummell
The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
Rights & Permissions [Opens in a new window]


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.

Themed Section on Personalisation and Collaboration: Dual Tensions in Individualised Funding Policy for Older and Disabled Persons
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
© The Author(s), 2022. Published by Cambridge University Press


Individualised funding has come into favour in many social welfare economies as a tool to redesign and reorganise disability support and adult social care. Espoused as a means of breaking down paternalism and standardisation and giving choice and control to users, individualised funding policy is also increasingly synonymous with marketisation of the public sector (Beresford, Reference Beresford2014; Needham and Glasby, Reference Needham and Glasby2014; Carey et al., Reference Carey, Dickinson, Malbon and Reeders2018a, Reference Carey, Malbon, Olney and Reeders2018b). The risk is that the emergence of diverse and competitive markets can be a disincentive for collaboration efforts, a parallel reform objective to deliver holistic and better integrated support. Although personalisation of support and collaboration in provision of support are not necessarily mutually exclusive, their interplay is poorly understood and they can create different sets of incentives and tensions for agencies, organisations and users who are striving to ensure tailored and seamless supports. By drawing on examples from the United Kingdom (UK) and Australia, this state-of-the-art article brings to light how countries facing similar challenges of reconciling personalisation and collaboration design policy solutions and to what effect (Green et al., Reference Green, Malbon, Carey, Dickinson and Reeders2018; Needham et al., Reference Needham, Allen, Burn, Hall, Mangan, Al-Janabi, Tahir, Carr, Glasby, Henwood and McKay2022).

In this article we first outline the historical shift to individualisation in disability support and adult social care and examine the extent to which collaboration and personalisation are complementary or in tension. The article will explore common insights and useful differentials between the UK and Australia. As set out in the Introduction to this themed section, both of these countries have reformed their disability and older persons’ services in recent years, and both have attempted to combine the benefits of more tailored services with a more collaborative and integrated approach (Foster et al., Reference Foster, Hummell, Borg, Fisher and Needham2022 in this themed section). Indeed, there has been explicit policy learning between them in the development of reform initiatives (Needham and Dickinson, Reference Needham and Dickinson2018). However, there are also illuminating differences between them. The Australian approach draws attention to personalisation and collaboration at the individual level for disabled and older people. In the UK, systemic integration (particularly between health and social care systems) has been pursued as a means of strengthening personalised and seamless supports for older and disabled people. The two countries are also on different trajectories in relation to the role of central government: Australian disability and older persons’ services have become more centralised, with reduced discretion for the states, whereas the UK has devolved social care, such that there are increasingly different care systems in England, Scotland, Wales and Northern Ireland. This different trajectory means that the relevant unit of analysis may shift for different aspects of care, as in our discussion of Scotland below and in Rummery et al., Reference Rummery, Lawrence and Russell2022 in this themed section.

Having looked at what the existing literature and policy context tells us about the tensions and synergies between personalisation and collaboration, we consider the question of whether there is scope for reconciling these dual forces. We also identify how future research can take forward academic scholarship and support improved provision for disabled and older people. This includes the importance of continuing to undertake research that involves people with lived experience as co-researchers (as some of the articles in this themed section have done) to co-develop insights. It is also important to understand the long-term impact of Covid-19 as a system shock which is likely to affect the future configuration of individualised funding for disabled and older adults.

Two routes to improving support for disabled and older people

Personalisation and collaboration are arguably two reform agendas, not necessarily in opposition but with inherent tensions, to address systemic failings in support for disabled and older adults. Working age disabled people and frail older people have historically relied on inadequate state services, which have either under-provided services (leaving families alone to address care needs) or over-provided (confining people in long-stay institutions). The carers’ rights movement has drawn attention to the struggles that families face in meeting high level care needs (Rummery, Reference Rummery2022), while disability rights and aged care campaigners have heavily criticised the enforced segregation of disabled people (Fisher et al., Reference Fisher, Lutz, Gadow, Robinson and Gendera2015), and inherent paternalism of traditional systems (Yeandle et al., Reference Yeandle, Kröger and Cass2012). Change is also demographic: the proportion of people who are ageing with a disability, and living a much longer life, is growing, as are the expectations of people about what they might want from the state as they age. Northern Ireland’s Power to People report (Kelly and Kennedy, Reference Kelly and Kennedy2017: 62) into social care reform expresses a sense that state provision has not kept up with social change:

Why, if the population’s needs, expectations and aspirations have changed so much, is the so-called ‘market’ for social care still offering the same services and doing much the same things? If the media was run in this way, we might still be watching the same three channels on a black and white analogue TV!

Of the various proposals to bring services and supports for disabled and older adults ‘up to date’, much attention has focused on how to better tailor these to people’s needs, capabilities and assets. Activism by people living in institutions, making demands for independent living, has combined with abuse scandals in the media to undermine institutional claims to be safe spaces (Morris, Reference Morris1993; Commonwealth of Australia, 2020). Principles of inclusion and involvement in decision-making have become increasingly mainstream (O’Brien and Tyne, Reference O’Brien and Tyne1981), and professional authority has been challenged by user- and family-led initiatives such as person-centred planning (Cambridge and Carnaby, Reference Cambridge and Carnaby2005). Disability rights campaigners highlighted routine human rights violations in many care systems and the need to adopt the social model of disability (Oliver, Reference Oliver2013). At the same time, there was increased recognition that ‘ageing in place’ should be the preferred model for older people’s support, reserving residential care for those with the highest acuity (Day et al., Reference Day, Thorington Taylor, Summons, Van Der Riet, Hunter, Maguire, Dilworth, Bellchambers, Jeong, Haydon, Harris and Higgins2017; Pani-Harreman et al., Reference Pani-Harreman, Bours, Zander, Kempen and van Duren2021). These various forces have coalesced to ensure that support for disabled and older adults has been reimagined in ways that are person-centred and facilitate choice and control by the people using them. In the UK and Australia, new and individualised approaches took hold, along with service models which took some account of user choice and control (Foster et al., Reference Foster, Henman, Fleming, Tilse and Harrington2012; Purcal et al., Reference Purcal, Fisher and Laragy2014; Glasby and Littlechild, Reference Glasby and Littlechild2016; Day et al., Reference Day, Thorington Taylor, Summons, Van Der Riet, Hunter, Maguire, Dilworth, Bellchambers, Jeong, Haydon, Harris and Higgins2017). This was part of a broader international movement, with reforms to individualised funding for disabled and older adults in a range of countries, including Netherlands, France, Belgium, Austria Germany, Canada and USA (for an overview, see Gadsby et al., Reference Gadsby, Segar, Allen, Checkland, Coleman, McDermott and Peckham2013).

The term personalisation as a descriptor for care reforms has been used extensively in England (see e.g. Beresford, Reference Beresford2014; Needham and Glasby, Reference Needham and Glasby2014), Australia (see e.g. Foster et al., Reference Foster, Henman, Fleming, Tilse and Harrington2012; Carey et al., Reference Carey, Malbon, Weier and Duff2022) and Norway (see e.g. Christensen and Pilling, Reference Christensen and Pilling2014). It has been described as starting with the person and their goals rather than the service (Carr, Reference Carr2010), with the aim of moving away from a ‘one size fits all’ service model (Carey et al., Reference Carey, Malbon, Olney and Reeders2018b). Although services can be personalised in a range of different ways (Foster et al., Reference Foster, Henman, Fleming, Tilse and Harrington2012), personalisation has been particularly associated with the individualisation of budgets such that people with eligible needs receive a cash allocation rather than a service. Whereas other forms of ‘person-centredness’ in care services may be more subjective and harder to observe, the transfer of financial control has been seen as giving disabled and older people a tangible lever to bring about change (Hatton and Waters, Reference Hatton and Waters2014). The ‘user’ becomes a commissioner of services and supports in a mixed economy of care (Yeandle et al., Reference Yeandle, Kröger and Cass2012; Carey et al., Reference Carey, Kay and Nevile2019).

The idea of disabled and older people as commissioners of their own support raises potential challenges surrounding individual choices and coordination of multiple service providers and systems (Foster et al., Reference Foster, Henman, Fleming, Tilse and Harrington2012, Reference Foster, Hummell, Fisher, Borg, Needham and Venning2021). There is an awareness that complex social problems cross vertical service demarcations and require a ‘whole person’ approach (Kickbusch and Gleicher, Reference Kickbusch and Gleicher2012; Hudson, Reference Hudson2015). However, services and supports for disabled and older adults remain structurally separated from closely related services such as health, housing, education, and employment (Productivity Commission, 2011a, 2011b; Cooke and Muir, Reference Cooke and Muir2012). By encouraging integration, coordination, or collaboration (the terminology is different in different places), the aim is to deliver services that are less fragmented. This can go from informal linkages between agencies to coordinated efforts where provider agencies and institutions adopt joint planning and management and integrated systems of care and support (see review by Foster et al., Reference Foster, Hummell, Fisher, Borg, Needham and Venning2021).

There are clear overlaps between the personalisation and collaboration agendas. We could argue that both are part of what Hupe (Reference Hupe, Bekkers, Fenger and Scholten2017) calls ‘subject centrism’ in welfare services in which the person receiving services becomes the focus. Nonetheless, personalisation and collaboration offer different routes to person-centredness, and different understandings of when success has been reached. Personalisation is often explained and justified as a way to fragment ‘one size fits all’ provision, breaking down block services and standardised packages so that people can have a pick and mix of options. Choice and control have been key principles here, seen by many as essential to human rights and self-determination – although there are also synergies with neo-liberalism and marketisation (Needham, Reference Needham2011). In contrast, collaboration is about bringing things together, joining up, and is inherently an integrative force. It is part of the ‘joining up’ aspirations that Rhodes (Reference Rhodes2000) found to be replacing both the silos of traditional welfare states and the fragmentation of new public management (see also Davis and Rhodes, Reference Davis, Rhodes and Keating2000). In a context of disability support and older persons’ services, collaboration has particularly focused on how to incentivise inter-organisational cooperation so that people receive holistic support.

Below we trace the development of these two reform agendas in the distinctive policy contexts of the UK and Australia, and in relation to individualised funding for disabled and older adults. We then go on to discuss where this leaves our understandings of personalisation and collaboration and where a future research agenda might helpfully be focused.

The UK: personalise and integrate

Individualised funding for disabled people in the UK dates back to the creation of the Independent Living Fund in the mid-1980s and to experiments in direct payment allocations, which were passed into law in the Community Care (Direct Payments) Act 1996 (Glasby and Littlechild, Reference Glasby and Littlechild2016). Initially limited in its scope and influence, over time this has evolved into a duty for all people in the UK with an assessed care need to have access to individualised funding. This can be in the form of a direct payment, or be a notional budget held by the state or a third party. Expectations relating to personalisation are set out in statutory guidance that accompanies the English Care Act (DHSC, 2017, section 4.46):

Local authorities should facilitate the personalisation of care and support services, encouraging services (including small, local, specialised and personal assistant services that are highly tailored), to enable people to make meaningful choices and to take control of their support arrangements, regardless of service setting or how their personal budget is managed.

Although direct payments are UK wide, devolution of powers to new governments in Scotland, Wales and Northern Ireland in 1998 has led to the evolution of somewhat different care systems. Scotland has developed Self-Directed Support as a principle of care services and both Wales and Northern Ireland increasingly also use the term self-directed support rather than personalisation. This vocabulary differentiates their approach from what is seen as the more market focused approach in England (Pearson et al., Reference Pearson, Watson and Manji2018). Despite differences of rhetoric and emphasis, the broad strand of policies relating to individualised funding are similar in the four nations. It is also the case that all four nations have made relatively slow progress on the individualisation of funding, particularly in terms of direct payments. Direct payment spend as a proportion of total care spend remains less than 10 per cent in all of the nations of the UK, and is lowest in Scotland at around 3 per cent (Atkins et al., Reference Atkins, Dalton, Phillips and Stojanovic2021: 44). There is a frustration among advocates of personalisation and self-directed support that take up appears to be falling rather than rising (Kings Fund, 2021).

Collaboration as a principle of reform is usually referred to as integration in the UK and is particularly focused on improving links between the health and care systems. It is universally accepted that there is an overlap between people’s health and care needs, and that a lack of integration between these two systems (and associated services such as housing or employment) must be addressed. Insufficient collaboration leads to delays in hospital discharge, insufficient data sharing and uncertainty about where responsibility lies for paying for certain services (Miller et al., Reference Miller, Glasby and Dickinson2021). All four nations now have some structural integration between health and care services and plan to increase this further (Atkins et al., Reference Atkins, Dalton, Phillips and Stojanovic2021). Northern Ireland is the furthest ahead on structural integration having had combined health and care services since the 1970s, although this has not translated into better support for the person using care services (Dayan and Heenan, Reference Dayan and Heenan2019).

Miller and colleagues (Reference Miller, Glasby and Dickinson2021) argue that integration efforts tend to be focused on ‘macro’ level integration rather than the micro and meso forms of integration in which services collaborate around the person. Reviewing ten years of integration efforts in England, Miller and colleagues (Reference Miller, Glasby and Dickinson2021: 3) contend:

[S]uccessive English governments had been unduly focused on the ‘structural’ elements of partnership working, which failed to acknowledge the reality of the ways that organisations and professionals develop relationships and trust in order to be able to work together.

Similarly Audit Scotland (2018) found that progress towards integration has been slow. A Scottish government consultation on reform of the care system noted the limits in what had been achieved on integration to date:

The aim of integration was to improve people’s experience of social care, and to focus on early intervention and preventative approaches, rather than only intervening when people reach a crisis. This has not worked as well as it should have done, particularly due to a lack of collaborative leadership in some areas (Scottish Government, 2021: 51).

Progress on integration in Wales has similarly been slow, with the Wales Audit Office’s (2019) review of the Integrated Care Fund finding little evidence of improved service outcomes. In all the nations, problems of structural complexity and lack of parity of esteem between health and care have become incorporated into integrated structures rather than resolved by them. In England and Wales, where public spending on care is lower than in Scotland (Charlesworth and Watt, Reference Charlesworth and Watt2019), local authorities are under intense pressures with rising demand and shrinking capacity to respond. Workforce shortages are acute and providers are fragile in terms of financial viability. These factors have been magnified by Covid-19 (Daly, Reference Daly2020).

Australia: individualise and coordinate

In the last decade, Australia’s predominantly block-funded approaches for disabled and older people have been progressively replaced by individualised funding to provide more user choice and control and create a competitive assemblage of diverse markets. This includes the National Disability Insurance Scheme (NDIS) for children and working age disabled people (Olney and Dickinson, Reference Olney and Dickinson2019) and the Consumer Directed Care (CDC) initiative for older Australians (Hodgkin et al., Reference Hodgkin, Savy, Clune and Mahoney2020). As in the UK, these reforms have sought to address inadequacies in social services and supports for disabled and older people. As a backdrop, the Productivity Commission (2011a) cited chronic underfunding, fragmentation and inefficiency as longstanding problems of the disability support system in Australia, giving disabled people little choice, no certainty of access to appropriate supports and limited scope to participate in the community. Similarly, limited user choice, market failures and increasing expectations of older people for independent living were strong drivers for recommending shifts to consumer directed support for older Australians (Productivity Commission, 2011b).

Whereas the UK is travelling in the direction of more devolution to its component parts, in Australia the reforms have led to greater national mandating of provision (Purcal et al., Reference Purcal, Fisher and Laragy2014). While individualised funding was evident in some states before the NDIS (see Fisher et al., Reference Fisher, Gleeson, Edwards, Purcal, Sitek, Dinning, Laragy, D’Aegher and Thompson2010), funding was usually paid directly to organisations rather than to individuals (Chenoweth and Clements, Reference Chenoweth and Clements2009; Purcal et al., Reference Purcal, Fisher and Laragy2014). The NDIS (legislated in 2013, with gradual roll-out completed in 2020) is based on a universal approach to individualised funding support, which therefore represents a radical departure (Purcal et al., Reference Purcal, Fisher, Meltzer, Fenger, Hudson and Needham2016). It provides non-means tested access to individualised funding to purchase support services for citizens who acquire a disability before the age of sixty-five years, have a high level of needs and meet the eligibility requirements. Supporting approximately 484,000 Australians with a disability (NDIS, 2021), NDIS funded packages are un-capped and calculated based on what is ‘reasonable and necessary’. NDIS participants can purchase their supports from various service providers they choose (either NDIS-registered and/or unregistered depending on their plan management arrangements) with capped prices for individual services.

A potentially positive aspect of the NDIS design for personalisation and collaboration is the option for users to self-manage their NDIS plan and flexibly choose providers and/or employ their own support staff. Self-managed plans allow greater control over personalising and coordinating supports and sometimes leads to innovative packages to overcome market limitations (Purcal et al., Reference Purcal, Savage and Fisher2021). Yet, the option to self-manage is not always appealing and concerns remain that disabled people with the most complex needs are more disadvantaged in adopting this option and exercising the accompanying choice and control (Malbon et al., Reference Malbon, Carey and Meltzer2019). The rapid roll-out of the scheme has outpaced the capacity of the disability market to evolve, leaving participants with potentially nothing to buy particularly in areas with ‘thin markets’ and unresolved questions about the government’s role to steward new markets (Carey et al., Reference Carey, Dickinson, Malbon and Reeders2018a). Moreover, interface issues, particularly between the NDIS and health system, pose a risk to NDIS sustainability and quality of funded supports if major responsibility disputes are not resolved (Productivity Commission, 2017). At the organisational level, research from Foster et al. (Reference Foster, Hummell, Fisher, Borg, Needham and Venning2021) shows the struggle with personalisation where there is stronger marketisation. Specifically, the shift in financial control has simultaneously created a heightened sense of disconnection and a greater need for collaboration between providers.

Whereas the UK combines disability and aged care in a single adult social care system, these are dealt with separately in Australia, with the latter comprising multiple funding models and programs. Consumer Directed Care (CDC) has its origins in The Aged Care (Living Longer Living Better) Act 2013, and Home Care Packages Program created in 2013, which aimed to support older people to live at home and have choice of services and supports through a sustainable market-based system (Jorgensen and Haddock, Reference Jorgensen and Haddock2018). Further legislative amendments in 2016 transferred financial control from providers to consumers, ensuring that by 2018 all home care packages were consumer-directed (for further information see Hodgkin et al., Reference Hodgkin, Savy, Clune and Mahoney2020; Moore, Reference Moore2021). Described as a ’tiered system that provides greater levels of support according to an individual’s assessed care needs’ (Hodgkin et al., Reference Hodgkin, Savy, Clune and Mahoney2020: 378), home care is means tested (unlike the NDIS), and sometimes may require co-contributions (My Aged Care, n.d.). Not only are there budget caps, but the overall number of home care packages available Australia-wide for eligible older people is capped (Australian Government, 2021), both of which present persistent and contentious problems (see Moore, Reference Moore2021) due to long wait times and increased vulnerability of older Australians. Once in receipt of a home care package, consumers can choose from a list of government approved providers only.

Like the NDIS, market limitations are also challenging for older people. The Royal Commission into Aged Care (Commonwealth of Australia, 2021b: 201) reported ‘a clear absence of market management by the Australian Government’, with a drift towards very large providers and an over-concentration in big cities. The recommendations highlighted the centrality of personalisation and collaboration to the future vision of improved aged care in Australia: ‘Based on assessed need, it should provide an entitlement to care at home with a personalised budget which allows for a coordinated and integrated range of care and supports’ (Commonwealth of Australia, 2021a: 100). However, unlike the UK where there are forms of structural integration between health and social care, this is less the case in Australia despite care coordination being the focus of many reforms.

A lack of willingness to adopt more integrated cross-sectoral funding models continues to thwart attempts to coordinate services and supports for older Australians (Mann et al., Reference Mann, Devine and McDermott2019) and for Australians with disability (Productivity Commission, 2017). We can see therefore that for both older and disabled people in Australia, personalisation and collaboration remain key aspirations but that progress to date has been very limited.

Discussion and conclusion

Reviewing the literature on personalisation and collaboration in Australia and the UK, it is clear that in both countries these twin initiatives remain at the heart of long-term ambitions. Progress towards both of them is incomplete, and this is of course no surprise given the implementation challenges of reforming complex systems (Carey et al., Reference Carey, Kay and Nevile2019; Needham et al., Reference Needham, Allen, Burn, Hall, Mangan, Al-Janabi, Tahir, Carr, Glasby, Henwood and McKay2022). Covid-19 has been a further disruptive factor with devastating consequences for many people living with disability or age-related frailty (see e.g. Daly, Reference Daly2020; Kavanagh et al., Reference Kavanagh, Dickinson, Carey, Llewellyn, Emerson, Disney and Hatton2021). The collaboration agenda may have been advanced through the pandemic as local stakeholders worked closely together to ensure continuity of support (Comas-Herrera et al., Reference Comas-Herrera, Fernandez, Hancock, Hatton, Knapp, McDaid, Malley, Wistow and Wittenberg2020). However, personalisation and flexibility of provision may have become less of a feature given the limits on service access associated with recurrent lockdowns and shielding by many disabled people (Yates et al., Reference Yates, Dickinson, Smith and Tani2021). The extent to which Covid-19 will have reconfigured care services in the long-term remains to be seen.

We could therefore apply a temporal lens and argue that collaboration and personalisation need longer to embed and mature (on the other side of the pandemic). Providers require time to develop the skills and networks in order to join-up services around the person in a way that delivers both personalisation and collaboration. However, a second explanation is that these agendas, although pursued in tandem, contain contradictory impulses that will continue to undermine each other (see Allen et al., Reference Allen, Burn, Hall, Mangan and Needham2022 in this themed section). More collaboration between organisations risks closing down choice and control for the person using services; alternatively, the move to individualised funding fragments care markets in such a way that collaboration is harder than ever.

Future research could usefully explore the extent to which some types of collaboration and of personalisation are easier to combine than others. It may be that the structural integration attempted in the UK is particularly ill-suited to fostering the kinds of choice and control that personalised care necessitates. The approach taken in the NDIS to collaborate around the person offers scope for support that is both tailored and seamless. However, Foster et al.’s article in this themed section highlights that there are aspects of the current design that militate against this, particularly in heavily privatised care markets. Future research could also move beyond care and support services to consider how far the same fragmenting versus integrating conflicts are evident in other welfare services. For example, ‘welfare to work’ arrangements often promise to deliver support that is both tailored and holistic (Considine et al., Reference Considine, Lewis and O’Sullivan2011; Rees et al., Reference Rees, Whitworth and Carter2014), usually with disappointing results on both elements. There are broader questions here about the primacy of choice and markets as a goal in welfare systems over alternative dynamics of relational and holistic support (Cottam, Reference Cottam2018). Is the most important aim of a welfare system to maximise the choice and control of the people using services, or to join up services around them in a way that improves efficiency and outcomes? Such value conflicts and ambivalences are not unusual in welfare systems, as Hoggett (Reference Hoggett2006: 179) argues. Rather than being resolved he suggests that they must be ‘lived out’ at the frontline:

[I]t is often at the level of ‘operations’ that unresolved value conflicts are most sharply enacted, public officials and local representatives finding themselves ‘living out’ rather than ‘acting upon’ the contradictions of the complex and diverse society in which they live.

Missing from Hoggett’s account of public officials and local representatives are the people with lived experience of using social services. They in particular must ‘live out’ the value conflicts within the welfare state. Services that are either tailored or seamless remain well beyond many people’s experiences as closed residential institutions endure or are remade in overly controlling and functional community support systems (Fox, Reference Fox2018). Finding a way to advance personalisation and collaboration, and understanding which to prioritise when they are in tension, must be a co-productive endeavour with the people who have most at stake.


The broader project is funded by an Australian Research Council (ARC) Discovery Project (ARCDP190102711) grant.


Allen, K., Burn, E., Hall, K., Mangan, C. and Needham, C. (2022) ‘“They made an excellent start – after a while it started to die out.” Tensions in combining personalisation and integration in English adult social care’, Social Policy and Society, this themed section.CrossRefGoogle Scholar
Atkins, G., Dalton, G., Phillips, A. and Stojanovic, A. (2021) Devolved Public Services, London: Institute for Government, [accessed 07.02.2022].Google Scholar
Audit Scotland (2018) Health and Social Care Integration, Edinburgh: Audit Scotland, [accessed 07.02.2022].Google Scholar
Australian Government (2021) Home Care Packages Program, Data Report 1st Quarter 2021, 1 July–30 September 2021, Department of Health, [accessed 07.02.2022].Google Scholar
Beresford, P. (ed.) (2014) Personalisation, Bristol: Policy Press.Google Scholar
Cambridge, P. and Carnaby, S. (2005) (eds.) Person Centred Planning and Care Management with People with Learning Disabilities, London: Jessica Kingsley.Google Scholar
Carey, G., Dickinson, H., Malbon, E. and Reeders, D. (2018a) ‘The vexed question of market stewardship in the public sector: examining equity and the social contract through the Australian National Disability Insurance Scheme’, Social Policy and Administration, 52, 1, 387407.CrossRefGoogle Scholar
Carey, G., Kay, A. and Nevile, A. (2019) ‘Institutional legacies and “sticky layers”: what happens in cases of transformative policy change?’, Administration and Society, 51, 3, 491509.CrossRefGoogle Scholar
Carey, G., Malbon, E., Olney, S. and Reeders, D. (2018b) 'The personalisation agenda: the case of the Australian National Disability Insurance Scheme', International Review of Sociology, 28, 1, 2034.CrossRefGoogle Scholar
Carey, G., Malbon, E., Weier, M. and Duff, G. (2022) ‘Balancing stability and change: lessons on policy responsiveness and turbulence in the disability care sector’, Health and Social Care in the Community, 30, 4, 1307–14.CrossRefGoogle ScholarPubMed
Carr, S. (2010) Personalisation: A Rough Guide, revised 2nd edn, London: Social Care Institute for Excellence.Google Scholar
Charlesworth, A. and Watt, T. (2019) ‘The real cost of a fair adult social care system’, blog, The Health Foundation, [accessed 07.02.2022].Google Scholar
Chenoweth, L. and Clements, N. (2009) Funding and Service Options for People with Disabilities: Final Report, Brisbane: Griffith University.Google Scholar
Christensen, K. and Pilling, D. (2014) ‘Policies of personalisation in Norway and England: on the impact of political context’, Journal of Social Policy, 43, 3, 479–96.CrossRefGoogle Scholar
Comas-Herrera, A., Fernandez, J. -L., Hancock, R., Hatton, C., Knapp, M., McDaid, D., Malley, J., Wistow, G. and Wittenberg, R. (2020) ‘COVID-19: implications for the support of people with social care needs in England’, Journal of Aging and Social Policy, 32, 45, 365–72.CrossRefGoogle ScholarPubMed
Commonwealth of Australia (2020) Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability: Interim Report, [accessed 07.02.2022].Google Scholar
Commonwealth of Australia (2021a) Royal Commission into Aged Care Quality and Safety. Final Report: Care, Dignity and Respect, Volume 1, Summary and Recommendations, [online] Commonwealth of Australia, [accessed 07.02.2022].Google Scholar
Commonwealth of Australia (2021b) Royal Commission into Aged Care Quality and Safety Final Report: Care, Dignity and Respect, Volume 2, The Current System, [online] Commonwealth of Australia, [accessed 07.02.2022].Google Scholar
Considine, M., Lewis, J. M., and O’Sullivan, S. (2011) ‘Quasi-markets and service delivery flexibility following a decade of employment assistance reform in Australia’, Journal of Social Policy, 40, 4, 811–33.CrossRefGoogle Scholar
Cooke, G. and Muir, R. (2012) The Relational State, London: Institute for Public Policy Research, [accessed 11.07.2022].Google Scholar
Cottam, H. (2018) Radical Help: How We Can Remake the Relationships Between Us and Revolutionise the Welfare State, London: Virago.Google Scholar
Daly, M. (2020) ‘COVID-19 and care homes in England: what happened and why?’, Social Policy and Administration, 54, 7, 985–98.CrossRefGoogle ScholarPubMed
Davis, G. and Rhodes, R. A. (2000) ‘From hierarchy to contracts and back again: reforming the Australian public service’, in Keating, M. (ed.), Institutions on the Edge?: Capacity for Governance, London: Routledge, 7498.Google Scholar
Day, J., Thorington Taylor, A. C., Summons, P., Van Der Riet, P., Hunter, S., Maguire, J., Dilworth, S., Bellchambers, H., Jeong, S., Haydon, G., Harris, M. and Higgins, I. (2017) ‘Home care packages: insights into the experiences of older people leading up to the introduction of consumer directed care in Australia’, Australian Journal of Primary Health, 23, 2, 162–69.CrossRefGoogle Scholar
Dayan, M. and Heenan, D. (2019) Change or Collapse: Lessons from the Drive to Reform Health and Social Care in Northern Ireland, London: Nuffield Trust, [accessed 07.07.2022].Google ScholarPubMed
Department of Health and Social Care (DHSC) (2017) Care and Support Statutory Guidance, London: DHSC [accessed 07.02.2022].Google Scholar
Fisher, K. R., Gleeson, R., Edwards, R., Purcal, C., Sitek, T., Dinning, B., Laragy, C., D’Aegher, L. and Thompson, D. (2010) Effectiveness of Individual Funding Approaches for Disability Support, Occasional Paper 29, Canberra: Australian Government Department of Families, Housing, Community Services and Indigenous Affairs.CrossRefGoogle Scholar
Fisher, K. R., Lutz, D., Gadow, F., Robinson, S. and Gendera, S. (2015) ‘A transformative framework for deinstitutionalisation’, Research and Practice in Intellectual and Developmental Disabilities, 2, 1, 6072.CrossRefGoogle Scholar
Foster, M., Henman, P., Fleming, J., Tilse, C. and Harrington, R. (2012) ‘The politics of entitlement and personalisation: perspectives on a proposed national disability long-term care and support scheme in Australia’, Social Policy and Society, 11, 3, 331–43.CrossRefGoogle Scholar
Foster, M., Hummell, E., Borg, S., Fisher, K. and Needham, C. (2022) ‘Breaking up is risky business: personalisation and collaboration in a marketised disability sector’, Social Policy and Society, this themed section.CrossRefGoogle Scholar
Foster, M., Hummell, E., Fisher, K., Borg, S. J., Needham, C. and Venning, A. (2021) ‘Organisations adapting to dual aspirations of individualisation and collaboration in the National Disability Insurance Scheme (NDIS) market’, Australian Journal of Public Administration, DOI: 10.1111/1467-8500.12497 CrossRefGoogle Scholar
Fox, A. (2018) A New Health and Care System: Escaping the Invisible Asylum, Bristol: Policy Press.Google Scholar
Gadsby, W. E., Segar, J., Allen, P., Checkland, K., Coleman, A., McDermott, I. and Peckham, S. (2013) ‘Personal budgets, choice, and health: a review of international evidence from 11 OECD countries’, International Journal of Public and Private Healthcare Management and Economics, 3, 34, 15–28.CrossRefGoogle Scholar
Glasby, J. and Littlechild, R. (2016) Direct Payments and Personal Budgets: Putting Personalisation into Practice, Bristol: Polity Press.CrossRefGoogle Scholar
Green, C., Malbon, E., Carey, G., Dickinson, H. and Reeders, D. (2018) Competition and Collaboration between Service Providers in the NDIS, Centre for Social Impact, UNSW Sydney.Google Scholar
Hatton, C. and Waters, J. (2014) Third National Personal Budget Survey, London: Think Local, Act Personal, [accessed 07.02.2022].Google Scholar
Hodgkin, S., Savy, P., Clune, S. and Mahoney, A. M. (2020) ‘Navigating the marketisation of community aged care services in rural Australia’, International Journal of Care and Caring, 4, 3, 377–93.CrossRefGoogle Scholar
Hoggett, P. (2006) ‘Conflict, ambivalence, and the contested purpose of public organizations’, Human Relations, 59, 2, 175–94.CrossRefGoogle Scholar
Hudson, B. (2015) ‘Can GPs coordinate “whole person care”?’, Journal of Integrated Care, 23, 1, 1016.CrossRefGoogle Scholar
Hupe, P. L. (2017) ‘Capturing what happens after a bill became a law: the ongoing quest of implementation research’, Valedictory lecture and first chapter in liber amicorum for Peter Hupe, in Bekkers, V. J. J. M., Fenger, H. J. M. and Scholten, P. W. A. (eds), Public Service as Practice, Erasmus University Rotterdam: Erasmus School of Social and Behavioural Sciences, 1129.Google Scholar
Jorgensen, M. and Haddock, R. (2018) ‘The impact of the home care reforms on the older person, the aged care workforce and the wider health system’, Deeble Institute Issues Brief, No. 27, Australian Healthcare and Hospitals Association, [accessed 07.02.2022].Google Scholar
Kavanagh, A., Dickinson, H., Carey, G., Llewellyn, G., Emerson, E., Disney, G. and Hatton, C. (2021) ‘Improving health care for disabled people in COVID-19 and beyond: lessons from Australia and England’, Disability and Health Journal, 14, 2, 101050, 2–7.CrossRefGoogle ScholarPubMed
Kelly, D. and Kennedy, J. (2017) Power to People: Proposal to Reboot Adult Care and Support in Northern Ireland, Expert Advisory Panel on Adult Care and Support, Northern Ireland Department of Health.Google Scholar
Kickbusch, I. and Gleicher, D. (2012) Governance for Health in the 21st Century, Denmark: WHO Regional Office for Europe.Google Scholar
Kings Fund (2021) Social Care 360, London: Kings Fund, [accessed 07.02.2022].Google Scholar
Malbon, E., Carey, G. and Meltzer, A. (2019) ‘Personalisation schemes in social care: are they growing social and health inequalities?’, BMC Public Health, 19, 805, 212.CrossRefGoogle ScholarPubMed
Mann, J., Devine, S. and McDermott, R. (2019) ‘Integrated care for community dwelling older Australians’, Journal of Integrated Care, 27, 2, 173–87.CrossRefGoogle Scholar
Miller, R., Glasby, J. and Dickinson, H. (2021) ‘Integrated health and social care in England: ten years on’, International Journal of Integrated Care, 21, 4, 19.CrossRefGoogle Scholar
Moore, C. (2021) ‘Consumer directed care aged care reforms in Australia since 2009: a retrospective policy analysis’, Health Policy, 125, 5, 577–81.CrossRefGoogle Scholar
Morris, J. (1993) Independent Lives? Community Care and Disabled People, Basingstoke: Macmillan.CrossRefGoogle Scholar
My Aged Care (n.d.) ‘Home care packages costs and fees’, [accessed 07.02.2022].Google Scholar
National Disability Insurance Scheme (NDIS) (2021) September 2021 NDIS Quarterly Report to Disability Ministers,, [accessed 07.02.2022].Google Scholar
Needham, C. (2011) Personalising Public Services: Understanding the Personalisation Narrative, Bristol: Policy Press.Google Scholar
Needham, C., Allen, K., Burn, E., Hall, K., Mangan, C., Al-Janabi, H., Tahir, W., Carr, S., Glasby, J., Henwood, M. and McKay, S. (2022) ‘How do you shape a market? Explaining local state practices in adult social care’, Journal of Social Policy, DOI: 10.1017/S0047279421000805 CrossRefGoogle Scholar
Needham, C. and Dickinson, H. (2018) “Any one of us could be among that number’: comparing the policy narratives for individualized disability funding in Australia and England’, Social Policy and Administration, 52, 3, 731–49.CrossRefGoogle Scholar
Needham, C. and Glasby, J. (eds.) (2014) Debates in Personalisation, Bristol: Policy Press.CrossRefGoogle Scholar
O’Brien, J. and Tyne, A. (1981) The Principle of Normalisation: A Foundation for Effective Services, London: CMH.Google Scholar
Oliver, M. (2013) ‘The social model of disability: thirty years on’, Disability and Society, 28, 7, 1024–6.CrossRefGoogle Scholar
Olney, S. and Dickinson, H. (2019) ‘Australia’s new National Disability Insurance Scheme: implications for policy and practice’, Policy Design and Practice, 2, 3, 275–90.CrossRefGoogle Scholar
Pani-Harreman, K. E., Bours, G. J., Zander, I., Kempen, G. I. and van Duren, J. M. (2021) ‘Definitions, key themes and aspects of ‘ageing in place’: a scoping review’, Ageing and Society, 41, 9, 2026–59.CrossRefGoogle Scholar
Pearson, C., Watson, N. and Manji, K. (2018) ‘Changing the culture of social care in Scotland: has a shift to personalization brought about transformative change?’, Social Policy and Administration, 52, 3, 662–76.CrossRefGoogle Scholar
Productivity Commission (2011a) Disability Care and Support, Report No. 54, Canberra, [accessed 07.02.2022].Google Scholar
Productivity Commission (2011b) Caring for Older Australians, Report No. 53, Final Inquiry Report, Canberra, [accessed 07.02.2022].Google Scholar
Productivity Commission (2017) National Disability Insurance Scheme (NDIS) Costs, Study Report, Canberra, [accessed 07.02.2022].Google Scholar
Purcal, C., Fisher, K. R. and Laragy, C. (2014) ‘Analysing choice in Australian individual funding disability policies’, Australian Journal of Public Administration, 731, 88102.CrossRefGoogle Scholar
Purcal, C., Fisher, K. R. and Meltzer, A. (2016) ‘Social insurance for individualised disability support –implementing the Australian National Disability Insurance Scheme (NDIS)’, in Fenger, M., Hudson, J. and Needham, C. (eds.), Social Policy Review 28: Analysis and Debate in Social Policy, Bristol: Policy Press, 173–90.Google Scholar
Purcal, C., Savage, L. and Fisher, K. R. (2021) National Disability Insurance Scheme Self-Managed Plans Family Advocacy Survey, Sydney: Social Policy Research Centre, UNSW Sydney, [accessed 04.07.2022].Google Scholar
Rees, J., Whitworth, A. and Carter, E. (2014) ‘Support for all in the UK Work Programme? Differential payments, same old problem’, Social Policy and Administration. 48: 221239, doi: 10.1111/spol.12058, ScholarPubMed
Rhodes, R. A. (2000) ‘New Labour’s civil service: summing-up joining-up’, The Political Quarterly, 71, 2, 151–66.CrossRefGoogle Scholar
Rummery, K. (2022) ‘The right to care? Social citizenship and care poverty in developed welfare states’, International Journal of Sociology and Social Policy, DOI: 10.1108/IJSSP-09-2021-0229 CrossRefGoogle Scholar
Rummery, K., Lawrence, J. and Russell, S. (2022) ‘Partnership and personalisation in personal care: conflicts and compromises’, Social Policy and Society, DOI: 10.1017/S1474746422000525 Google Scholar
Scottish Government (2021) A National Care Service for Scotland: Consultation, Edinburgh: Scottish Government, [accessed 07.02.2022].Google Scholar
Wales Audit Office (2019) Integrated Care Fund, Cardiff: Auditor General for Wales, [accessed 07.02.2022].Google Scholar
Yates, S., Dickinson, H., Smith, C. and Tani, M. (2021) ‘Flexibility in individual funding schemes: how well did Australia’s National Disability Insurance Scheme support remote learning for students with disability during COVID-19?’, Social Policy and Administration, 55, 5, 906–20.CrossRefGoogle ScholarPubMed
Yeandle, S., Kröger, T. and Cass, B. (2012) ‘Voice and choice for consumers and carers: developments in patterns of care for older people in Australia, England and Finland’, Journal of European Social Policy, 22, 4, 432–45.CrossRefGoogle Scholar