'They Made an Excellent Start... but After a While, It Started to Die Out', Tensions in Combining Personalisation and Integration in English Adult Social Care

Abstract

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'.