This article seeks to understand the challenges of combining the distinct aims of personalisation and integration in adult social care. Addressing the local context of service delivery in England through interviews with key stakeholders, we identify how personalisation and integration activities require different, and potentially conflicting, approaches. We observe direct tensions when structural integration with health systems distracts focus from achieving personalised delivery of care or where a focus on clinical outcomes takes precedence over broader wellbeing aspirations. Integration can entail the prioritisation of health over social care and a population rather than personal orientation. We suggest that personalisation and integration are in ‘policy conflict’ (Weible and Heikkila, 2017) and that policy-makers need to acknowledge and address this rather than promise the ‘best of both worlds’.

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.

The marketisation of disability support driven by individualised funding brings new dilemmas for multi-agency collaboration, in particular how to provide personalised supports while remaining commercially viable. This article explores the challenges, risks and adaptations of organisations to navigate the tensions of personalisation and collaboration. Framed by street-level research and using the context of Australia’s National Disability Insurance Scheme (NDIS), this article draws on interviews with twenty-eight organisational managers. Multi-agency challenges are highlighted when several providers are delivering parts of a NDIS participant’s plan, blurring organisational responsibilities and accountabilities. Interviews also revealed the paradox of organisational disconnection and organisational dependence concerning quality support provision and described the collaborative responses organisations implement to ensure their sustainability. There is commitment among organisations to build a trusted ecosystem of providers, but this is largely discretionary and there is a need for further policy mechanisms to enable organisations to negotiate a way through multi-agency dilemmas.

The Care Act 2014 gave English local authorities a duty to ‘shape’ social care markets and encouraged them to work co-productively with stakeholders. Grid-group cultural theory is used here to explain how local authorities have undertaken market shaping, based on a four-part typology of rules and relationships. The four types are: procurement (strong rules, weak relationships); managed market (strong rules, strong relationships); open market (weak rules, weak relationships); and partnership (weak rules, strong relationships). Qualitative data from English local authorities show that they are using different types of market shaping in different parts of the care market (e.g. residential vs home care), and shifting types over time. Challenges to the sustainability of the care system (rising demand, funding cuts, workforce shortages) are pulling local authorities towards the two ‘strong rules’ approaches which run against the co-productive thrust of the Care Act. Some local authorities are experimenting with hybrids of the two ‘weak rules’ approaches but the rival cultural biases of different types mean that hybrid approaches risk antagonising providers and further unsettling an unstable market.

The Care Act 2014 gave local authorities in England broad duties around wellbeing, and responsibility to ensure the availability of good quality, personalised social care and support services for people who need them. These responsibilities are for all people needing support, whether that is publicly or privately funded. In exercising their duties, councils have a responsibility for ‘market-shaping’: that is, understanding the supply and demand for care, and the types of services and support needed now and in the future, and steering the market accordingly. Changes to the implementation of the Care Act removed some of the levers that might have brought self-funders into the mainstream of local authority responsibilities. This article draws on sixty-four qualitative interviews undertaken as part of a larger study on market-shaping and personalisation of care, and reflects on the experience of self-funders and the approach to them adopted by local authorities and provider organisations. The findings indicate that self-funders are still largely bystanders to local authority market shaping strategies, despite being both impacted by those strategies and significantly influencing the markets in which they operate.