Personalisation in rural areas

How have individual budgets fared in country areas? Academic Jill Manthorpe summarises the lessons from her recent study of the views of social care staff involved in implementation

Research title: The personalisation of adult social care in rural areas, 2008

Authors: Jill Manthorpe and Martin Stevens

Affiliations: Commission for Rural Communities, Gloucester. Available from the CRC website


The study sought the views of lead officers, mainly social services managers, from rural local authorities where individual budgets (IBs) were piloted. The study also included the views of providers and service users in rural areas of England.

The focus was on lead officers involved with older people, particularly those aged 75 years and over, although the study will be relevant to other age groups and carers. The study took place earlier this year and its observations are still valid despite recent developments in personal budgets. The study was funded by the Commission for Rural Communities.

This study is one of the first to consider rural issues and the personalisation agenda. Council staff who were responsible for implementing the IB schemes (called IB leads) in the pilots in rural local authorities had more than two years’ experience of developing services in the vanguard of personalisation. Many had long experiences of working in rural areas and were local residents.


IB leads reported that one of the positive aspects of personalisation for rural communities was enabling the service user to pay for support that fits their needs. People without friends and families can pay local people to work for them or they can make use of community facilities and undertake activities by choosing to pay for transport.

Negative aspects included the still vexed questions of finding people to work as personal assistants or people’s ability to pay for sufficient levels of support because local wages may be high and it may be necessary to pay for a worker’s travel costs or travel time. If there is high employment locally it can be hard to find a personal assistant or their availability might change in the holiday season if people go off to work in the leisure and hospitality industry. Reasonable public transport could make recruitment easier but is uncommon in rural areas.

Factors that seemed to help make the desired outcomes of personalisation (choice, control and flexibility) more likely to be realised in rural areas included the availability of advice and support for people planning their support or considering changes. Agencies offering advice and support in rural communities were spread unevenly. Much depended on whether the local voluntary and community sector had a tradition of providing advice and information. Some advice agencies were reported to subsidise rural provision from other more urban services and this might not be sustainable.

IB leads emphasised the changes to rural populations. People move to rural areas on retirement, or were searching for a better quality of life, or people may have lived there all of their lives. But other rural communities may have substantial populations of people who work away, or mainly only live there at the weekends.

The IB leads believed this resulted in different commitments to and involvement with the local community. They were aware that people moving into small communities in later life might become isolated, particularly if health problems or disability arose, because of a lack of local friends and support.

Likewise, the IB leads commented on the multifaceted and changing nature of rural communities. Many small communities have lost facilities such as a shop, pub, post office, church and so on. Some hamlets have fewer focal points and so much less community cohesion. Bigger villages were felt to retain community identity for example, there were several comments about how it would be more likely for people to be quickly aware of an older person who was seriously ill or who had died at home. It was believed this was more unlikely in large towns and cities.

Revitalised hubs

In some areas, market towns are being revitalised and health and social care service hubs developed. This could be part of the personalisation reforms. Local newsletters and papers are useful as sources for communication between councils and local communities, and can be a means of publicising sources of support, such as help with repairs.

Service provision was variable for example, there could be several care homes in one village while other areas of the county could have none. This would affect the rollout of personalisation and the choices on offer.

Some older people were keen to manage the greater flexibility of IBs, particularly to engage in social activities. But many existing service users were reported to be fearful of losing what they had and particularly of managing the budget and hiring processes. In contrast, people with unsatisfactory or poor experiences of using services were said to be particularly enthusiastic about the potential to have greater choices over their support. However, some IB leads regarded the current high levels of eligibility criteria as restricting the development of support but did not believe this was any worse in rural areas than in others.

Transport costs

The study found that some IB leads believed certain rural characteristics were very relevant to IBs and might be key in other rural areas. The IB leads raised the necessity of being careful about contingency planning because alternative resources may not be readily available. They recognised that meeting transport costs was a problem for people accessing support but also for home care and personal assistant staff. In some areas, service users might find it difficult to recruit and their choices would be restricted. Such factors might make the support planning process longer.

The IB leads gave views about what new forms of social care might be fostered by personalised support. These included the paying of neighbours, friends or care workers to stay in older people’s homes and provide respite care, lunch clubs run in pubs, or individuals becoming involved as care workers through informal recruitment routes.

The possibilities for local social enterprises were seen as greater in rural areas than in urban and of more importance, given a possible decline in bulk contracts with larger social care agencies.


Generally, rural areas have older populations than their urban equivalents. This means they are an important part of rural communities, being key resources as carers, volunteers, good neighbours and community activists (as well as local politicians).

There was a lack of comparative information on older people’s needs for social care support in urban and rural areas. It is often suspected that rural areas may have different patterns of provision and that their populations may experience greater difficulty getting the help that they require. Local networks may be fragile if certain supports, such as subsidised transport or buildings, are removed.

This study supports the idea that the local context of personalisation is important and there may be specific rural issues to consider. But it also underlines the great variety of rural areas and the diversity of older people living in them. Also there is a need to consider other service users and carers in rural areas such as some younger people, who may be more isolated, stigmatised or have fewer resources on which to draw.

Policies that argue for greater choice, control and flexibility, such as personalisation, may be welcome in both rural and urban communities.

The rural impact of these new nationally driven models of service delivery is unclear and there is a risk that it may be over-generalised. This makes it timely to collect information at several levels, using the information from service providers and community representatives as well as other harder or quantitative data. The views and experiences of those helping to implement change in rural communities are also valuable, since they may have much to tell others about change and system re-engineering.


Personalisation goes beyond personal budgets and it will be important for social care in England to be aware of the transformation agenda’s impact on rural communities.

This will require greater attention to what we mean by rural and possibly more sophisticated definitions, using terms such as remote to better define areas where populations are sparse and settlements are few.

Rural social care services may benefit from personalisation and the impacts may well differ between rural communities. But to know who benefits and at what cost we must look at the importance of context on local outcomes.

Social work practitioners in rural areas can contribute to this evidence base and use it to develop their practice.


For practitioners

What resources do rural areas have that may help personalisation?

For older people’s groups

Local councillors have contacts and networks beyond social care interests and may be useful conduits for information from social care and to social care commissioners and providers. Are they being well informed?

For community workers

Local councillors have contacts and networks beyond social care interests and may be useful conduits for information from social care and to social care commissioners and providers. Are they being well informed?

For local government members

Local councillors have contacts and networks beyond social care interests and may be useful conduits for information from social care and to social care commissioners and providers. Are they being well informed?

For researchers

Rural and remote communities’ particular circumstances have not always been taken account of in social care studies.

Jill Manthorpe is professor of social work and director of the Social Care Workforce Research Unit, King’s College London

Published in the 23 October 2008 edition of Community Care magazine with the headline Rural Areas and Personalisation

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