Why have direct payment levels stalled?

By Mithran Samuel, adults' editor, on June 21, 2012 10:21 AM | 2 Comments

If direct payments, generally, deliver better outcomes than council-managed personal budgets, why have numbers of the former stalled over the past two years while numbers of the latter have soared? That is the fascinating question arising from the latest survey of progress on personal budgets from the Association of Directors of Adult Social Services.

[Blog updated 12.20pm - For a good perspective on this read this post from Martin Routledge, programme manager for Think Local Act Personal and head of operations at In Control. He emphasises that there has been some good news around direct payments - a 30% increase in their value from 2011-12 despite the lack of growth in numbers of recipients.]

I don't know but here are a few possible reasons:

1) Many service users prefer managed personal budgets. When the previous government proposed introducing personal budgets in its 2005 social care green paper, one of its justifications was to provide people with an option that offered greater choice and control than traditionally commissioned care without the "potential burdens" of a direct payment i.e. the council-managed budget. This line was developed with older people in mind given their historically low take-up of direct payments and the belief that this was related to a reluctance to take on the responsibilities of a cash payment, such as employing staff. Personal budgets for older people appear to be growing at a faster rate than for other groups, meaning that there could be something in this explanation; but it's clearly not the whole story.

2) Councils are chasing the government's target of having all eligible service users on personal budgets by April 2013. Concerns have been voiced, by Adass among others, that the government's target has had perverse consequences by encouraging councils to get people on to personal budgets without providing them with true choice and control. It is arguably easier to bump up your personal budget take-up rates by getting people on to managed personal budgets than direct payments. This could be because rolling out managed personal budgets may involve less change to councils' IT systems or relationships and contracts with providers, and may well involve less investment with service users in support planning. 

3) Councils are looking to retain control of their finances. With a managed budget, councils keep their hands on the money, something that may appeal to officers at a time of budget cuts. Managed budgets offer the potential to use councils' buying power in the social care market to keep providers' prices down. They could also save councils the bother of working to reshape the social care market in a more creative and diverse direction. However, against this, it is argued that direct payments enable the sort of creative planning and use of resources that can reduce the cost of care packages.

4) Professionals are making risk-averse assumptions. In a report last year, Alzheimer's Society found many people with dementia were not even being offered a personal budget (let alone a direct payment) in part because of risk-averse assumptions from social care professionals. Such risk-aversion may lead professionals to assume managed budgets may be more appropriate for people with dementia and other groups and not discuss the potential benefits of a direct payment.

5) Direct payments offered are not of sufficient value. It could be that people are turning down direct payments because they are not of sufficient value to enable them to purchase the support that they need. There are reported cases of service users not being able to afford to use a direct payment to purchase care from a provider of their choice; this is particularly the case in relation to home care agencies. It could also be the case that councils are cutting back on funding for direct payment support services, often delivered through user-led organisations, that provide an invaluable role in helping people manage the responsibilities of a direct payment. 

There could be any number of other reasons. I'd be interested in hearing your thoughts on this so please comment in the usual way.

 

http://www.communitycare.co.uk/blogs/adult-care-blog/2012/06/why-have-direct-payment-levels-stalled.html