In the past, local authorities have held the monopoly over social care provision. With the introduction of direct payments and therefore choice into the social care market, many people have been able to gain a higher degree of independence than ever before.
These direct payments are initiatives under which local authorities make cash payments to individuals to purchase their own community care services. This has particularly helped many disabled people to choose a career and improved their quality of life.
The advent of the formal direct payments scheme in 1996 has seen new providers enter the market from both the private and voluntary sector offering more flexible services. Since 2001, it has been a duty for local authorities to offer direct payments to those who are eligible and want to receive them. However, take-up is still slow, with an estimated 10,000 users across the UK receiving direct payments in 2002/3 (an increase of over 50 percent in two years) and most authorities operating schemes with less than 50 users.
However, despite many of the obvious benefits the approach is not without problems, especially for those users requiring small amounts of care and those living in rural parts of the country. Schemes operating in Scandinavia have countered this difficulty by allowing users to pool their funds and employ personal assistance collectively. There are also certain user groups who take up direct payments less than others – for example the elderly, those with learning disabilities and those with mental illness. Mechanisms have to be created to ensure that these groups receive all necessary information, advice and support so as not to be excluded.
Nottinghamshire County Council operates one of the bigger direct payments schemes in the UK, with about 340 users. In relation to the total number of eligible disabled people, take up is considered to be very high and the scheme currently grows by ten new users a week. The starting-point for a direct payment scheme is generally the request from someone in receipt of community care to be considered for a direct payment, but increasingly voluntary agencies like Age Concern make people aware that the scheme exists.
Applications are assessed and the user is then referred to an independent advocate, the Nottingham and Nottinghamshire Direct Payment Support Service, who will make the user fully aware of all the benefits and risks associated with accepting a direct payment. If their application is successful a care plan will be agreed with the user and funds are paid weekly into a separate bank account set up by the user.
Users are required to make quarterly returns to the council on how funds are being spent, and they are assessed on an annual basis to ensure that their needs are being met and that choice and independence are being enhanced.
Users of direct payments have welcomed the freedom and independence they have gained through being able to recruit and manage their own personal assistant. Many were able to start a career – a couple have even started university courses.
One user sums it up ‘the scheme gave me flexible, adequate assistance. I became liberated, more fulfilled and light-hearted … I’ve gone from non-involvement to choice’. Another says ‘before I came onto the scheme I felt I was just existing – but now I can chose how to live my own live.’ Through the introduction of direct payments many people have been enabled to work and live independent lives, something that would have not been possible without choice.