New research from the Economic and Social Research Council reveals that direct payments are being operated, and experienced, very differently in England, Scotland, Wales and Northern Ireland.
Direct payments are funds paid by local authorities directly to disabled people, and other community care service users, to buy-in their own support, usually this takes the form of employing personal care assistants.
The payments, first introduced in 1997, have been controversial. Some have seen them as a covert means of privatising the delivery of public sector services, whilst for others they represent an important means of empowering those at the margins, of society by involving them as 'co-producers' of their services.
The research team, led by Professor Sheila Riddell of Edinburgh University, found:
The uptake of direct payments varied greatly between England, Scotland, Wales and Northern Ireland. In 2003-04, they found a total of 18 authorities making no use whatsoever of direct payments - of these, 11 were in Scotland, five in Wales and two in Northern Ireland. In England, all local authorities used direct payments. In some parts of Scotland, on the other hand, union resistance, and the identification of direct payments with 'creeping privatisation', has had a negative effect on their uptake. Throughout the UK, in areas with low take-up of direct payments, there was evidence of professional, managerial and local political resistance.
Local factors play a key role. The local culture of welfare, and the relationship between support organisations and local authorities, are important in either promoting, or inhibiting, the uptake of direct payments. Local authorities in England were far more likely to have designated direct payment officers, compared to those in Scotland, Wales and Northern Ireland.
Support organisations for direct payment users are changing. In England only one quarter of such organisations were seen to be user-led. There was a higher proportion of user-led support organisations in Scotland but many of these saw themselves as having a strong campaigning role and this tended to bring them into conflict with local authorities
The researchers found that questions continue to be raised as to whether direct payments are appropriate for all disabled people and community care groups, or whether some individuals, for example, older people living in socially disadvantaged circumstances, may find them too difficult to manage.
Similarly concerns were raised with the researchers about the supply, pay and conditions of work of the personal care assistants, who are now, to all intents and purposes, employed by those receiving direct payments.
Commenting on the research Professor Sheila Riddell said:
"We need to understand how the modernisation of welfare agenda is playing out in different parts of the UK, so that disabled people and others are confident about having their rights respected irrespective of their country or locality. This research helps to inform the ongoing debate about the best way to empower service users"
A spokesperson for the Department of Health, which oversees the scheme in England, said: 'Direct payments give individuals real choice and control over the services they use. We are committed to extending direct payments to enable greater numbers of people to benefit and we launched a national toolkit in May 2007 to support English local authorities to achieve this.'
A spokesperson for the Scottish government said: "The Scottish government has already addressed many of the issues raised in this report. New national guidance published July 2007 is designed to radically increase uptake of self-directed support (direct payments) in Scotland. Individual budgets are already a reality in some council areas. The guidance sets out good practice for equalising access across Scotland so that more people who wish to can benefit from the flexibility, control and independence self-directed support can bring."