Moving beyond direct payments and rethinking the role of commissioning

“Personalisation was never meant to be about just spending a budget; instead it was supposed to focus on building on people’s gifts, talents and desires -not on professional conceptions of ‘need’- and on outcomes that strengthen the spirit and resilience of the person and their family….”.

Dr Simon Duffy, Centre for Welfare Reform & Angela Catley, Community Catalysts

Direct payments were intended to help people have choices and offer flexibility with how they manage their support. The reality is that for many, the extra work involved with having a direct payment does not make them an attractive or easy option and people who receive direct payments can experience them as a burden. There are alternative ways for local authorities to commission support that go beyond such ‘limitations’, according to a new report published today by Dr Simon Duffy and Angela Catley.

In Beyond Direct Payments: making the case for micro-enterprise, Individual Service Funds and new forms of commissioning in health and social care, the authors discuss ways of commissioning support that are a homage to the early days of personalisation with its focus on community and traditional social work practice, and that give people the chance to get flexible support.

Micro-enterprises like those nurtured by Community Catalysts; Local Area Coordination; Social Prescription and the take up of Individual Service Funds are all cited as valuable examples. The authors argue that managers working in health and social care could support and promote these types of commissioning if they are to help create a more diverse market to support people should a direct payment not be the preferred option.

Christopher Watson, Joint Commissioning Manager at Dorset Council, said:

"In practice Individual service funds allow a far greater degree of choice and flexibility than traditional commissioned services and, in some ways, they can be easier to manage with less administration than Direct Payments, In Dorset we have already seen the ISF approach deliver real and tangible benefits for people by helping them to understand their personal budget, which can give them and their chosen provider the flexibility to co-design how their outcomes are best met. Other organisations can deliver elements of support and there is the opportunity to pool some or all the funding with friends, who may be supported by other providers, but have similar identified outcomes."

Rachel Mason, Parent and Direct payment holder, said:

Those of us with Direct Payments are no-longer passive recipients of services commissioned for us, often on block contracts from a provider who won the tender on a procurement framework; we are purchasers and ‘customers’ of local responsive support from one or many different local and visible micro-provider services, whose reputation and transparent accountability, keeps their quality and standards high. This level of self-direction can at last be achieved without having to take on the responsibility of a DP. People can ask for an Individual service fund [ISF], where the provider holds and spends their budget in collaboration with the person.”