Direct Payments and Continuing Care


We are used to ‘Direct Payments’ in the social care sector. They were introduced in the Direct Payments (Community Care) Act 1997.

While without doubt they are incredibly beneficial and empowering to some service users as they allow the user to receive the money paid for care directly and for that care to then be bought independently – the concerns remain about access to direct payments not being entirely equitable.

The actual direct payments themselves though, where implemented, in my experience,  have had an incredibly positive effect on a large group of people who are able to choose how their own care needs will be met and in particular by employing their own care staff directly rather than relying on council provided care agencies and staff.

image otama at Flickr

There is also a significant government policy shift to broaden and develop the ideas inherent in the ‘direct payment’ system through the introduction of ‘individualised personal budgets’. There is even a proposal to pilot a system of ‘personal budgets for healthcare’ – something I had been a little more detached from without having read too many of the details.

I was interested then to read this story in the Independent.

A case brought by a paralysed former soldier and a woman suffering from a progressive muscular disease who wanted the NHS to provide a direct grant allowing them to live independently by employing their own care staff was dismissed after a judge found that legislation prevented any such payments.

Steven Harrison, 41, who broke his neck in a diving accident in 1998, and Valerie Garnham, 60, who has suffered her condition since birth, were told in October last year that the NHS primary care trusts funding their care at home would no longer be able to do so because of an edict from the Department of Health (DoH).

Steven Harrison and Valerie Garnham had been receiving ‘direct payments’ however their physical health and social care needs had increased to the degree that they now meet the criteria for receiving ‘Continuing Care’ – namely having their care funding from the NHS rather than the local authorities.

So once the band shifts from social care to health care, the entitlement or even the ability to receive direct payments shifts and the carers who have been working with the individuals closely, sometimes for years, have to be dismissed so that support can be funded directly from the NHS.

Mr Harrison, from Wakefield, West Yorkshire, and Mrs Garnham, from Holloway, north London, claimed their human rights were breached by the denial of direct payments and that the legislation governing the health service meant that such funding could already be given legally.

Mrs Garnham said: “I don’t look at myself as a useless cabbage that sits at home and gets withered and wizened. Is my life worth living if I’m going to stay in bed and wait for a local authority nurse to turn up? We were very proud that we actually employed five people.”

Islington Primary Care Trust in north London, which pays for Mrs Garnham’s care, is expected to pay up to three times the amount it paid her in the form of a direct grant to cover the cost of employing a nursing agency to do the same work.

But Mr Justice Silber, ruling in favour of the DoH, said there were no powers under the NHS Act 2006 for direct payments to patients. Lawyers for Mrs Garnham said they planned to appeal.

It makes no logical sense of course, but the law is the law even when it is an ass. I hope the appeal succeeds and imagine, from the perspective of a layman, there is more than a little merit to it. We seem to be moving towards systems of increased individual budgetary control and to steal the money away when a cohesive and individualised plan of care is in place already, seems like a step back many decades.

It seems like a ridiculous position to be maintained even if it needs some quick adjustments to primary legislation just to affect these particular cases.

We know that government policy is aiming to move in this direction in any case and it seems absurd to remove independence forcibly and as well as potentially less costly and better quality care for the individuals receiving it.

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