PurposeThis paper aims to argue that the inflexible administration and funding silos which characterise a health and social care system focused on uniform provision is no longer working, particularly for those who require some support to live independent and fulfilled lives.Design/methodology/approachThis paper details social care reform policy and the personalisation agenda, particularly self‐directed support and personal budgets. It considers the implications of these developments on personalisation, equity and integration and user‐determined standards and challenges service fragmentation and current commissioning practice.FindingsPersonalisation reforms in adult social care, which are being carried over to health services, are challenging traditional models of uniform or large‐scale care provision. Personalisation means putting people in control of their care and support and giving choices – which in turn means commissioning for local difference and personal preference, as well as bottom‐up pressure for services to integrate in a way that avoids funding or service boundary disputes and ensures individuals can choose and control their support.Originality/valueIt is argued that a focus on equality and fairness now needs to turn to equality of opportunity to exercise choice and control, and to the idea that everyone should expect locally appropriate, good‐quality services and support no matter where they are.