When promises fade: the changing landscape of direct payments

The introduction of direct payments in the late 90’s marked a real step towards enabling disabled people to establish real choice, control and independence in their care environment, and in their lives as a whole.  As initial caution and apprehension began to give way to confidence and innovation it really began to feel like giant steps forward were being made. 

Yet there is a real feeling in the last few years that progress has been halted and even reversed in many places. This is perhaps reflected in the fall in take-up of direct payments nationally. 

From idealistic and optimistic beginnings, it feels in many places like we have drifted into a world: 

• where direct payments cease to be a route to independence, and rather have become just one alternative way of ‘delivering care’; 

• where direct payments have been used as money saving devices, with costings restricted in completely different ways to those of commissioned care; 

• where improvisation and flexibility have been replaced by narrow rules and restrictions; 

• where light touch has been replaced by deeply intrusive monitoring, and local authority direct payment teams are expected to be judged on how much money they have reclaimed from direct payment recipients’ budgets. 

I believe one of the factors that lies at the heart of both the fall off in take-up and the drift I have described above has been the lack of resourcing for, and drift in the role of direct payment support services. 

I entered the world of direct payments in 2000 as initially the one direct payment support worker in Camden and then manager of a team of direct payment workers with the local disabled peoples led organisation. 

Because the team worked solely around direct payments unlike, say, social workers who had a much wider remit, they developed an expertise around direct payments that nobody else in the council had. As a result, they became a resource for social workers and indeed senior management. 

Advice was sought, collaboration the norm, we were involved in helping to draw up forms, monitoring procedures, I was even one of a three-person team that recommended the rates annually. 

My experience was of maybe a very good model, but it was far from unique. Attending the forerunner of the National Direct Payment Forum of the time it was clear that this was the approach many local authorities were taking. 

It was of course vital as we were the conduit between those receiving or wishing to receive direct payments and the local social services. Precisely because we were independent direct payment recipients trusted us, felt we were on their side. Although we were not formally advocates, we would often be the go between, making the case for how the recipient wished to use the payment, or why they felt they needed more support. 

Gradually down the years that relationship drifted in many areas, and was ruptured in many more. The support services were often no longer seen as collaborators and innovators, but rather as commissioned guns hired first and foremost to do the bidding of the council rather than their clients. Disabled peoples led organisations were no longer gaining the contracts, missing out initially to large organisations operating nationally replacing local organisations as a result of tendering based on price and tightly defined specifications. These latter bodies almost always sold themselves, as cheaper, and promised more cost-efficient delivery of the entire process. Often the staff members would want to continue delivering highly tailored support only to be given ‘one size fits all’ instructions. They also found they were being asked to police rather than support their client. 

Of course, there are still some very fine services, but they are often battling due to lack of resource and lack of empathy from those who have commissioned them. 

Worse though at the extreme end are providers who don’t want their (often poorly paid) staff to do home visits, are not available in person or on the phone, only on websites. Who specialise in one size fits all, believing frequently asked questions are a replacement for one-to-one support, rather than an addition to it. They have no real notion of personalisation insisting that everyone must have the same budget, the same contract of employment, and the same computer skills. They increasingly police direct payment recipients and offer no advice or encouragement for flexible use of direct payments. 

Why does all this matter? Right at the beginning of direct payments it was recognised that for many people taking them, it would be a first step to independence, and could be very daunting.  The number of people who would start a conversation with ‘I can’t handle being an employer’ who would end up being some of the most confident personal assistant employers, greatest peer advisers, was amazing. 

They did so because they found they were not alone in facing what looked daunting. Support workers would (if requested) come to their home, help them with every step of recruitment; drawing up adverts, helping to place them, offering to sit in on interviews, assisting with short listing. 

They would draw up budgets, contracts of employment and job descriptions all tailor-made to the individual’s needs. They would give advice on employment law, personal assistant employment status, contingency plans. Crucially they were then a phone call away for ongoing support. 

Where people didn’t want to employ, the support service would help locate agencies and services. Most exciting of all was exploring and discovering unique and exciting ways to flexibly use the direct payment, and take those ideas back to often very receptive social workers. 

I believe the large-scale disappearance of that level of support has had a real impact on both the take-up of direct payments and the quality of life and stress levels of direct payment recipients. Therefore, any talk about the reinvigoration of direct payments must be accompanied by the proper resourcing of direct payments support services, and a proper understanding of their function and priorities. 

 

To learn more about direct payments and check out extensive resources on the subject, visit TLAP’s Direct Payments page.