Social insurance for individualised disability support: implementing the Australian National Disability Insurance Scheme (NDIS)

Australia is implementing an ambitious new approach to individualised disability support based on a social insurance model. In a world first, the National Disability Insurance Scheme (NDIS) is funded through a levy on income and general taxation and gives Australians with disability an entitlement to social service support. This chapter describes the NDIS approach and implementation so far and summarises concerns and challenges about the NDIS discussed in the literature. It uses data from an action research project to inform feasibility questions about how people find out about and receive the individualised support they need. The chapter highlights a basic gap in people’s familiarity with what individualised support is, how it works and how they might benefit from the new approach. A policy implication is that, with the expansion of individualised support, the public is likely to need various opportunities and forms of information sharing, to explore and learn from each other about what the new approach is and what its possibilities are.

Right time, right place? The experiences of rough sleepers and practitioners in the receipt and delivery of personalised budgets

This chapter outlines one way in which personalisation has been implemented within the field of homelessness within the United Kingdom. The chapter draws on research findings from a longitudinal study in Wales, which evaluated the delivery of an approach to allocate ‘individual budgets’ to people experiencing homelessness. The chapter outlines the effectiveness of the approach both in terms of outcomes for those who participated as recipients and its operationalisation by workers. The chapter makes a number of central points. First, individual budgets can be a particularly effective tool in reducing the length of time homelessness is experienced. Second, how such budgets are delivered is as important as the budgets themselves. The skill of workers to work in innovative and creative ways is crucial to their success. Finally, there are inspiring findings arising which point to the pragmatic yet frugal approach by rough sleepers towards the use of individual budgets.

Individualised funding for older people and the ethic of care

This chapter uses an ‘ethic of care’ lens to examine individualised funding as a policy response to the provision of older people’s care. Approaches based on care ethics highlight the necessity of care to the human condition, and offer alternative conceptualisations of autonomy and dependence based in relationality. In the chapter the authors argue that when it comes to the care of older people, the stark ‘line in the sand’ between autonomy and paternalism that the current discourse of rights-based personalisation and individualised funding marks out, is hard to discern and is an inadequate basis for care policy for people in later life. It is not simply a matter of ensuring that personal budgets deliver ‘real choice and control’ for older people, but also one of enabling responsive caring relationships.

Personalised care funding in Norway: a case of gradual co-production

In this chapter, using a case analysis of personal assistance in Norway, the author argues that it is fruitful to combine the concepts of personalisation and co-production. Co-production represents a stronger version of personalisation, but there are also different strengths of coproduction, implying gradual manifestations of user involvement and participation. Through exploring the history of the Norwegian personal assistance model, BPA, the chapter considers different interplays between personalisation and co-production. It concludes that there is the highest level of personalisation where the professionals are no longer directly involved because the users are self-organised. While this obviously is the future policy aim of some users, this will not be an option for others. The right to BPA will provide a future dividing line between those who possibly will be viewed as able to reach this self-organising level, and those for whom the welfare state will still be very important.

Personal health budgets: implementation and outcomes

The main focus of this chapter is to explore personal budgets in health care and the main findings from the national evaluation of the personal health budget pilot programme. This chapter focuses on exploring the initial implementation process during the early stages of the pilot. It goes on to discuss the extent to which the implementation of personal health budgets was in accordance with the policy intentions underlying the initiative (as set by the Department of Health) and how much it had an impact on outcomes and cost-effectiveness for patients with long-term health conditions. The results indicated that implementation adhering to the main underlying principles of personal health budgets had the potential to have a positive impact on outcomes for budget holders and whether they were cost-effective compared to conventional service delivery.

The Troubled Families Programme: in, for and against the state?

This chapter examines the ways in which the Troubled Families Programme has been positioned by central government and by local authorities and practitioners. The reality of the programme is rather different from the runaway success story presented by government, positive outcomes often owing much to local officers’ negotiation and subversion of the programme. Discretion built into the programme has allowed subversion and resistance to occur, these transgressions occur under the radar and do little to trouble the national narrative of an assertive central government policy working successfully with troublesome families. This is significant, as the programme is considered by the Conservatives as a key example of how a smaller, smarter state might function.

‘Progressive’ neo-liberal conservatism and the welfare state: incremental reform or long-term destruction?

This chapter explores the approach of the modern Conservatives towards the welfare state since David Cameron became party leader in 2005. This chapter shows that in shifting the Conservative Party’s narrative to embrace key social justice agendas from a non-egalitarian and more individualist perspective, Cameron has not only allowed the Conservatives to present themselves as being sympathetic to progressive ends but also to move the terms of debate to the efficacy of Labour’s (more statist) means.

Housing policy in the austerity age and beyond

This chapter charts the radical reorientation of housing policy in the UK that was set in motion by the coalition government elected in 2010 and accelerated by the majority Conservative government elected in 2015. There is a strong tendency to favour home-ownership and worsening financial and regulative conditions for those who are not (yet) capable of buying a home. A variety of financial measures has increased the costs of housing for low incomes, whereas safety measures to protect these groups gradually have been abolished. Moreover, legal reforms with regard to tenure security for new tenants have even further worsened the position of low-income newcomers on the housing market. To conclude: the British housing policy redistributes rights away from low-income groups in favour of other groups.

Exploring out-of-work benefit claimants’ attitudes towards welfare reform and conditionality

Chapter 6 explores whether and how far benefit claimants can see a logic for changes to the benefits system. The interviews with out-of-work benefit claimants show that many were angered by the impacts of Cameron’s welfare reforms on their own lives but nonetheless were supportive of the government’s broad agenda. This underlines the depth of a ‘new moral consensus on welfare’ that problematizes out-of-work benefits and those who claim them. In such an environment, it is very difficult for individual claimants to make a positive case for ‘welfare’ in general terms which, in turn, helps further embed the Conservative’s welfare reform narrative.

What counts as ‘counter-conduct’? A governmental analysis of resistance in the face of compulsory community care

In this chapter the findings of an ethnographic study of Community treatment orders (CTOs) in action are reported on, focusing on how individuals made subject to CTOs perceive the role the CTO has in their lives, and their subsequent responses to its imposition. Individuals’ conceptions of self in relation to disciplinary policy interventions can lead to complex, ambiguous and perhaps unexpected responses to compulsion, which are not easily categorised into binary forms of compliance and resistance. The analysis of CTOs underlines the value of a governmentality perspective that eschews simple linear understandings of how ‘target’ groups will respond to policy interventions.