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Integrated care continues to be a central aim within health and social care policy in England. Personal budgets and personal health budgets aim to place service users at the centre of decision-making and are part of a wider long-term initiative working towards personalised and integrated care. Personal budgets began in social care with the national pilot programme of individual budgets, which aimed to incorporate several funding streams into one budget, but in practice local authorities limited these to social care expenditure. Personal budgets then moved into the health care sector with the introduction of a three-year personal health budgets pilot programme that started in 2009. The purpose of the paper is to explore the post-pilot implementation of personal health budgets and explore their role in facilitating service integration. We examine this through the RE-AIM framework.

During 2015 and 2016, eight organisational representatives, 23 personal health budget holders and three service providers were interviewed, 42 personal health budget support plans were collected and 14 service providers completed an online survey.

Overall, personal health budgets continued to be viewed positively but progress in implementation was slower than expected. Effective leadership, clear communication and longer-term implementation were seen as vital ingredients in ensuring personal health budgets are fully embedded and contribute to wider service integration.

The paper highlights the importance of policy implementation over the longer-term, while illustrating how the venture of personal health budgets in England could be a mechanism for implementing service integration. The findings can serve to guide future policy initiatives on person-centred care and service integration.

This paper identifies considerations for managing the risks of abuse during intimate and personal care for people with learning disabilities and complex needs. Drawing on insights gleaned from research involving interviews with staff, policies and procedures in specialist day and residential services, and the development of a staff training resource, the paper identifies a framework for adult protection practice in this critical area of support.

The paper aims to examine changes concerning spending on personal care products and services, and socio‐demographic variations between households.

The data were derived from the Finnish Household Budget Survey from 1998 (n=4,359), 2001 (n=5,495) and 2006 (n=4,007) provided by Statistics Finland. The main analysis of personal care consumption was conducted by examining the purchasing costs of personal care products and appliances, and the amount of spending on personal care services. The differences in expenditure patterns are analysed according to the respondents' gender and age, level of education and income, and type of household.

The results indicate that household spending on personal care products and services has generally increased. However, the share of total consumption has not changed dramatically. The gender of the highest earner of the household along with household income is the key predictor of this type of consumption expenditure across all household types. The effects of these two variables have become stronger.

The data do not make it possible to differentiate between individual level and household level spending decisions across all household types.

Contrary to common belief, gender differences concerning personal care consumption have not diminished.

This study examines actual changes in personal care consumption according to socio‐demographic variables.

The purpose of this paper is to illustrate the potential for service integration by focusing at the level of the individual rather than through structural integration or care coordination. The paper illustrates the potential for integration through the experience of the personal health budgets pilot programme.

This paper is based on a review of the experience of personal health budget pilot sites, drawing on the national evaluation of the pilot programme and the author's experience of working with pilot sites between 2010 and 2013. It also draws on the experience of similar programmes in the USA.

Personal health budgets support integration in two distinct ways. First, they can support the delivery of more holistic, whole‐person care in line with the principles of shared decision making. Second, by bringing personal budgets in social care and personal health budgets together, they can provide a vehicle for integration across health and social care systems. If integration starts from, and responds to, what matters most to individuals rather than with the development of joint structures and processes, the result is more likely to be integrated care.

This is one of only a small number of papers that discusses the scope for personal health budgets to improve the integration of care. Integration between the NHS and social care, in particular, has been identified as a central priority for the NHS.

A central element in the shift to a ‘personalised’ care system in the UK is the opportunity for disabled people to hold and manage budgets for the purchase of care and support, to replace local authority services. The delivery mechanisms of ‘Direct Payments’ and ‘Individual Budgets’ have allowed many disabled people to control their care and support better, and have promoted their social inclusion. However, the particular contexts and issues for people with learning disabilities in holding personal funding have been little considered. The paper sets out the broad themes of the introduction of personalised care, and examines the limited use by people with learning disabilities of Direct Payments and the subsequent development of Individual Budgets. The paper considers the challenges to the nature, spaces and relations of care commonly used by people with learning disabilities that personal budgets present, in particular for those with more severe disabilities. The paper concludes by suggesting ways in which people with learning disabilities can use personal budgets, whilst maintaining the collective relations and spaces of caring desired by many.

The purpose of this paper is to explore the consumption of a personal community and its role in the everyday life of the home‐confined consumer.

Using a Radical Constructivist approach, three cases of home confinement were explored in depth over a period of two years. Ongoing “conversations” captured the consumption experiences with personal communities.

In relation to the home‐confined context, the ability to attain individuality, empowerment and creativity are all heightened as a result of personal community construction. An underlying concern for home‐confined consumers is their removal from independent living to institutionalized living, and, as a result the need to construct, manage and maintain a personal community is of major concern.

Although the study addresses a home‐confined context, it is nevertheless reflective of concerns that are significant to all consumers, namely the attainment of individuality and independence irrespective of marginalization or not.

The importance of a personal community in terms of both self‐empowerment and self‐identity with respect to marginalized groups and vulnerable individuals should not be underestimated. The supporting role of a personal community provides, in times of uncertainty, a framework to maintain self‐identity and independence.

This paper provides a better understanding of the role of a personal community in the consumption experiences of those consumers marginalized and vulnerable as a consequence of context. Home‐confined consumers are “invisible” in the marketplace and the personal community is a means of redressing this imbalance by empowering such individuals.

Older people are often perceived to be a drain on health care resources. This ignores their caring contribution to the health care sector. The purpose of this paper is to address this imbalance and highlight the role of older people as carers.

The study uses a unique data set supplied by a charity. It covers 1,985 caregivers, their characteristics, type and amount of care provided and the characteristics and needs of those cared-for. Binary and ordered logistic regression is used to examine determinates of the supply of care. Fairlie-Oaxaca-Blinder decompositions are used to disentangle the extent to which differences in the supply of care by age are due to observable endowment effects or coefficient effects. Nationally representative British Household Panel Survey data provide contextualization.

Older caregivers are more intensive carers, caring for longer hours, providing more co-residential and personal care. They are therefore more likely to be in greater need of assistance. The decompositions show that their more intensive caring contribution is partly explained by the largely exogenous characteristics and needs of the people they care for.

The data are regional and constrained by the supplier's design.

Older carers make a significant contribution to health care provision. Their allocation of time to caregiving is not a free choice, it is constrained by the needs of those cared-for.

If the burden of care and caring contribution are measured by hours supplied and provision of intimate personal care, then a case is made that older carers experience the greatest burden and contribute the most to the community.

The purpose of this paper is to examine the current policy of extending personal budgets to older people.

In developing this explanation, the paper draws upon a species of de-centred, post-foundationalist theory which draws attention to the way in which certain narratives can sustain a longing for the implementation of policies that are ultimately unachievable. The paper also draws upon original data from an evaluation of a national ageing charity’s project to increase take-up of personal budgets.

The paper draws attention to, and seeks to explain, the paradoxical discursive positioning of older adults as “the unexceptional exception” within the general narrative of universal personalisation.

This analytical approach can secure a different vantage point in this debate by paying closer attention to the ideological and ethical dimensions of personalisation than has been the case until now.

The paper contributes to the critical interrogation of the personalisation agenda, in which debate (both in academic and practitioner circles) has become highly polarised.

The paper contributes to discussions in critical social gerontology which point to a bifurcation of later life into, on the one hand, an ageless third age and a frailed fourth age, on the other.

The paper makes clear that the discursive positioning of older people as “the unexceptional exception” risks an inadvertent ageism.

The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011.

Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St George's, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users’ experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life.

xService users (n=7 older people and carers; n=7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its administration complex. Older people in particular were reluctant to assume full control and responsibility for managing their own personal budget in the form of a Direct Payment. Participants in both groups reported their continued reliance on traditional home care or day care services. These findings were reported back to the LA to help staff review the implementation of personal budgets for these two user groups.

Study participant numbers are low due to difficulties recruiting. Several potential participants were not interviewed due to their frailty.

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

Studies of this type are important for constructing local knowledge about national policies such as the implementation of personal budgets in social care.

A cursory look at the contemporary social scientific literature shows that the concept of ambivalence has gained prominence in analyses of contemporary societies and identities, and in analyses of interpersonal relationships and interactions. With respect to societal analyses, for example, Bauman has argued that the postmodern habitat “is a territory subjected to rival and contradictory meaning-bestowing claims and hence perpetually ambivalent” (Bauman, 1992, p. 193). “To live with ambivalence,” Varga suggests (Varga, 2001), is the postmodern pronouncement. By using ambivalence as an “interpretive category” rather than as a “research construct” (Lüscher, this volume Chaps 2 and 7), however, sociologists often leave unspecified whether this way of living entails different things for different social actors.