Home 5 Topic hubs 5 Choice and control topic hub 5 About choice and control 5 The history of self-directed support

Making choice and control a reality for people who draw upon care and support isn’t something that just happens overnight. The progress made so far has been the result of decades of committed people campaigning for change. Even so, there’s still more to do.

Today, people drawing on care and support have legal rights to shape their own lives. But not so long ago, it was widely-agreed that decisions should be made for people, not with them.
Understanding this history helps us see how far we’ve come – and why it’s so important to keep moving forward.

“In this pivotal era of personalised care and support, we have an exciting opportunity to advance the agenda of self-directed support … Central to this vision is the empowerment of individuals to organise their own care and support, reflecting the ethos of choice and control.”

Clenton Farquharson

Associate Director, Think Local Act Personal

From institutional care to personalisation

For much of the 20th century, many disabled people, older people and people with mental health conditions lived in large institutions or residential services. Professionals and services decided:

Where people lived
Who supported them
How they spent their time

People often had little say, and many experienced isolation and loss of independence.

From the 1960s onwards, disabled people and their allies began demanding more say in their own lives. This led to growing pressure to close institutions and develop support in community settings instead.

In the 1980s and 1990s, councils started to give or started trials of giving people Direct Payments so they could employ their own personal assistants rather than rely on services arranged on their behalf by the council.

“Nothing about us without us.”

– Slogan of the disabled people’s movement

The independent living movement

A powerful force behind self-directed support has been the independent living movement. This was led by disabled people who wanted the same rights and choices as everyone else: to live in their own homes, study, work, and participate in community life.

Key messages of the movement included:

Disabled people are the experts in their own lives
Support should help people live ordinary, fulfilling lives
Systems and services should remove barriers, not create them

Organisations like the British Council of Disabled People, Centres for Independent Living, and later Disability Rights UK – amongst others – played a big part in campaigning for change.

Personalisation and policy changes

The early 2000s saw personalisation become a central aim in UK social care policy. This meant:

Putting people at the centre of their care and support
Offering personal budgets so people could choose how money was spent
Planning support with the person, not just for them

However, while the policy direction was clear, putting personalisation into practice has been uneven.

Some councils and services took bold steps to change how support was delivered. Others were more cautious, facing practical challenges like systems not set up for individual choice, staff needing new skills, and limited resources.

Key milestones:

1996 – Community Care (Direct Payments) Act introduced legal right to cash payments in place of services.
2007 – Putting People First policy launched, making personalisation a stated national goal.
2014 – Care Act 2014 made personal budgets a legal right for those eligible for care and support.
2014 onwards – Children and Families Act introduced personal budgets for some disabled children and families.