Direct Payments – Chapter One


Direct Payments is the system of, basically, rather than giving a direct service, providing money to the user of the service to ‘buy’ the care that they need directly.

‘Direct Payments were introduced in the UK

– for adults with a disability in 1997

– for older people in 2000

– for carers, parents of disabled children and for 16 and 17 year olds in 2001

Since 2003, councils have been required to make Direct Payments available to those who are able to choose to have them and who wish to have them’

(Source : Direct Payments for people with mental health problems: A guide to action)

I have worked with Direct Payments a few times although it isn’t something that comes up with any great regularity in the field that I am currently working in – mostly because, I imagine, my work is focused on a combination for the two groups of service users who have found the system of direct payments least accessible – older people and people with mental illnesses.

So working in a team for older people with mental health problems seems to be possibly the least likely place for direct payments to be accessed.

I have instigated a few direct payments packages but not a many. One of the things that I have found the most frustrating is the time-lag between going in to someone and identifying a support need – offering and explaining direct payments alongside an explanation of the direct provision of services.

On meeting potential interest, the boxes get ticked but in the meantime the service is needed immediately – it can and  has taken months to get a direct payment service up and running but in the meantime a direct service is needed to meet the need that still exists – sometimes a carer is employed in the meantime with whom the patient gets on very well – seeing no need to change to direct payments after a few months of building up a relationship.

Sometimes the  delay between setting up a ‘new’ system leads to a complacency to fall back to the ‘default’ system.

But sometimes, occasionally, it has followed through.

I have two reasons for bringing this up at the moment

Firstly, I am starting the process of referring someone for direct payments and her daughter for carers direct payments.

I thought it would be a useful illustration of the time it between someone deciding they need a service to its eventual ‘fruition’ if I can follow it here by indicating the different points in the process as they arise.

I hope I will be proved wrong and that we can get things up and running quickly. I really do.

Bit of brief background, service user and potential user of direct payments has an Alzheimer’s type dementia. She has had this diagnosis for a couple of years and can function fairly well. On meeting her, you probably wouldn’t realise she has dementia until you’ve been talking to her for at least about half an hour when some of the conversation begins to repeat itself. She would certainly have the capacity at present to make decisions about her own care and support packages.

She has been receiving a directly provided care package for a while but some of the elements have proved to be less than satisfactory. She doesn’t enjoy the day services on offer and would probably get more from community activities such as tai chi classes at the local leisure centre. One of the ideas of the direct payments is to look at someone to take her to these kinds of activities rather than her going to the local community day centre.

Image via Wikipedia

Outdoor practice in Beijing's Temple of Heaven.

Her daughter is her main carer and lives locally but not walking distance. Her daughter has a young family and provides a substantial amount of emotional support to her mother, visiting most days and taking her mother to stay with her family many weekends.

I’m hoping that Carers Direct Payments will be able to address some of her needs regarding travel costs between the two houses and possibly some of the domestic care.

It’s been a while since I referred a Direct Payment care package so I called the Direct Payment lead (who I get on well with anyway and always find it easy to talk to) to confirm the procedure to refer.

I sent her an initial care schedule with costings and times attached.

Meanwhile, on the ‘Carer’s’ front, I need still (and hope to today) update the most recent Carers Assessment and Carers Care Plan to include the conversation I had with daughter to include Direct Payments for Carers as an outcome.

Anyway, lets see together how long it takes to get these things up and running..

7 thoughts on “Direct Payments – Chapter One

  1. I have used direct paymenst a bit….quite a lot in a previous job and not so much now, although I am in the process of setting two up at the moment………..they certainly aren’t things to use in a crisis!

    I have found that they can work well with people who don’t easily fit into existing services; although it does require an amount of goodwill and commitment from carers that isn’t always there.

    Working in learning disabilities, I find, like you, that few on my caseload have the ability to manage a direct payment, so not many get offered; they do allow for a bit of creativity though.

    I have been told, just this week, by a parent, to stick my direct payment where the monkey stuck the nuts…………..it’s my job to sort out services and I should stop passing the buck. The gentleman will not be shifted from this position.

    Another problem, which didn’t apply in my previous authority is that there is a strict cap on the hourly rate that we will pay, which comes nowhere near the cost of agency rates, so if the family do not know people who are willing to take the job on, the whole thing gets scuppered, so there’s your chance of innovation and creativity gone straight through the window.

    On the whole though, I think they are a good thing.

  2. I generally like direct payments. I definitely like the idea and the sentiment. I just think some of the details need to be worked out and some of the worries I have about personalisation are basically from experiences of working with direct payments. I’ve found they can be arranged very quickly if.. as you say, there is someone around that has been identified as a potential carer. The delays often come through recruitment I’ve found..
    And also, as you say rightly, not everyone wants them..

  3. I shall be watching this topic develop with interest because my social worker and I are in the process of exploring the direct payments system with a view to actually using it. What I am finding most frustrating at the moment is the website the county council guide one to for the information is being ‘updated’ and has been being ‘updated’ for months. It’s a non-starter if one can’t even access the basic information to start with. I’m already frustrated.

  4. Direct Payments can work really well – but they aren’t necessarily speedy, which is one of the points I wanted to make – but hopefully by going through the process step-by-step it will at least be a little useful. I’m surprised you don’t have access to the information locally – as Direct Payments are one of our ‘performance targets’ the councils are extremely eager to push them forward as it is one of the ways that they are judged by the Audit Commission!

  5. Hey, I just want to thank you for describing various facets of the UK system so thoughtfully and carefully. Even though I work in the US, it’s so helpful to be exposed to the pros and cons of your policies. Your blog has been a great resource for me as I build a broader understanding of social work on an international scale.

  6. Thanks – I really appreciate that! The comparative angle is one that I find very interesting myself

  7. Pingback: Direct Payments - Chapter Two « Fighting Monsters

Comments are closed.