HOW IS THE FALLING NUMBER OF PEOPLE RECEIVING DIRECT PAYMENTS AFFECTING PERSONALISATION?
According to The King’s Fund’s latest Social Care 360, the number of people using direct payments fell from 118,000 in 2020/21 to 117,000 in 2021/22. Is this decline impacting on the delivery of personalised care and, if so, how?
Empowering choice
According to the Care Act 2014, if an individual’s local authority agrees to fund some or all of their care services subject to a needs and financial assessment, they will be offered a choice of options for this funding to be received.
Typically, one of these options is to receive direct payments from the local authority, which an individual can use to arrange and pay for care services themselves. Individuals can also use direct payments to pay for non-care services such as transport costs to meet eligible needs, short breaks and leisure activities.
Skills for Care states that ‘direct payments are the main mechanism to deliver the personalisation agenda for adult social care in England’.
Falling figures
The King’s Fund reports, ‘The number of people using direct payments is now lower than in 2015/16 and has fallen for each of the past five years. Overall, only 26.7% of people (38.4% of working-age adults and just 15.5% of older people) drawing on adult social care use direct payments, down from 28.1% in 2015/16.’
Guidance from Age UK highlights that when calculating the amount of an individual’s direct payment, a local authority ‘must balance [the individual’s] personal preferences for how [their] care is delivered against its budgetary constraints. In doing so, the local authority must always aim to promote [the individual’s] wellbeing.’ The guidance continues by adding that this ‘can be a difficult balance in practice.’ This balance is likely to be harder to strike given that much-needed central Government funding is falling short of the sector’s expectations.
In April this year, the publication of Government’s policy paper, Next Steps to put People at the Heart of Care, was met by criticism from the adult social care sector and local authorities alike, particularly in response to Government’s plans to reduce the promised financial support for people drawing upon care services.
Professor Vic Rayner OBE, Chief Executive of the National Care Forum, commented, ‘The announcements . . . completely undermine the original vision of person-centred reform.’ While Councillor David Fothergill, Chairman of the Local Government Association’s Community Wellbeing Board, said, ‘Given the well-documented capacity issues and levels of unmet and under-met need, it is hard to see how reducing the funding available to begin to address some of the issues can be justified.’
More call for change
In December 2022, the Adult Social Care Committee, having heard from a range of witnesses, including disabled adults and older people, carers, service providers, local authorities, and academics, published a report, A “Gloriously Ordinary Life’’: Spotlight on Adult Social Care, challenging Government to undertake urgent adult social care reforms.
One of the recommendations outlined in the report was to ensure that people who draw on social care have the same choice and control over their lives as everybody else. The Committee believes that this can be achieved by enabling people to make a genuine choice as to who supports them, simplifying the recruitment of personal assistants, and making access to direct payments easier.
I was disappointed to see in The King’s Fund’s recent Social Care 360 report that direct payment numbers have continued falling. Does this mean that personalisation is stalling? I think the answer to that question is yes.
Whilst direct payments are not a single indicator of personalisation (they aren’t right for everyone), I see no evidence of a natural ceiling being reached. Too many councils make it too hard for people to take and manage a direct payment which suppresses demand. Even the numbers don’t tell the full story, as we know that some councils with respectable figures constrain how budgets are used.
It is also the case that receiving good, personalised care and support shouldn’t be dependent on taking a direct payment; it should be the default for all. Individual Service Funds (ISFs) are a proven alternative when a person doesn’t want to take full control of their budget. The council delegates the budget to a provider who works with the person to tailor their support.
As a recent example, Bexley Council, with support from TLAP, has developed ISFs to transform supported living for people with a learning disability. People now choose their provider and work together to shape their care and support on a day-to-day basis. Demand now outstrips supply, so the council is increasing the number of providers using ISFs.
Returning to direct payments, through a series of reports (two with the Local Government Association), TLAP has shown how councils can improve: through cutting unnecessary process; supporting practitioners; and, above all, by co-producing with people. This is distinctly achievable, as Leicester City Council amongst others has demonstrated.
We are now receiving a growing number of requests to help councils improve their direct payment offer, using TLAP’s Making it Real as a basis for having ‘improvement conversations’. This goes to show that with concerted effort and co-production, change is possible. Councils need to re-commit to improving and increasing direct payments as part of an overall renewal of personalisation. Not only is it possible, it is the right thing to do.
Clenton Farquharson MBE, Chair, Think Local Act Personal (TLAP)
@clentonF
The disabled people’s movement fought hard for direct payments and achieved victory through the Community Care Direct Payments Act 1996. The fight for direct payments was as important as that for civil rights, as it gave disabled people choice and control over how our care and support needs were met. For us, care and support isn’t just about washing, dressing and eating, it’s about the support we need to engage in life and connect with others.
The use of direct payments has been reducing over the past five years. This is a backward step for personalisation and a sign that the drive for equality and self-determination for disabled people is stalling. We have to ask the question, why when the number of working-age disabled people is increasing, would the number receiving direct payments fall?
Making sure that people providing care and support are part of the household and that the times they work, the support they provide and the way they provide it fit personal preferences, are things that direct payments enable. At best, there will be warmth, trust and friendship between disabled people and the personal assistants providing care and support.
So why, when direct payments have so much to offer, are they not being taken up? Social service departments must do a whole lot more to make direct payments a positive option. They need to tell disabled people about the amazing advantages, ensure disabled people’s organisations are funded to provide advice and support on direct payments, reduce ever-rising care charges, increase the pay rate for personal assistants, enable the recruitment and training of personal assistants and reduce bureaucracy.
Over the past decade, disabled people have experienced reductions in public services, inadequate benefit levels, disproportionate deaths and exclusions during COVID-19 and are now being hit by the cost-of-living crisis through energy and food inflation and increasing housing costs. It is vitally important that we have access to high-quality care and support to enable us to live with dignity and independence.
A test of services is whether we would choose them for ourselves, and I strongly suspect that most of us would want to opt for the choice and control over our care and support that direct payments provide.
Fazilet Hadi, Head of Policy, Disability Rights UK
@DisRightsUK