This chapter and the next seek to examine what is in the ‘black box’ of the outcome data – focusing on the process of care as a key element in explaining how good care outcomes are attained. Here research findings are presented about how far the micro-enterprises are more person-centred than larger providers. The main data source for the discussion of personalisation is interviews with the people who use services, family carers and staff.

Interest in the process of public service delivery is coming back into fashion within public management, as the journey from outputs to outcomes has been felt to neglect a focus on the interpersonal aspects of the care process in social and medical settings. The avoidable deaths of hundreds of patients at Mid-Staffordshire NHS Foundation Trust were found to have been in part due to failings at the interpersonal level, with a focus on meeting financial and performance targets eclipsing compassionate care to patients (Francis, 2012). Interpersonal relationships are particularly important in the close and sometimes private settings in which care and support are provided.

Literature that explores care services in the context of an ethic of care is proliferating (for example Barnes, 2012; Lewis and West, 2014; Barnes et al, 2015). In some ways, argue Lewis and West (2014, p 3) this marks a revival of the 1980s feminist literature that:

To better understand the process of care, the relationships that underpinned it and the relevance of organisational size within that, we used the qualitative interview data to analyse the interactions between people who use services and the paid workers who provide their care and support.

Defining personalised support

As discussed in Chapter Two, the term personalisation came to prominence in English social care services around 2007, and has been interpreted in various different ways (Needham, 2011; Needham and Glasby, 2014).