Direct debacle

Campaigners and the Scottish executive have laid the blame for
the failure of direct payments to take off in Scotland firmly at
the door of social workers not promoting them to clients
properly.

But one long-time critic of the scheme, Ruth Stark, professional
officer at the British Association of Social Workers in Scotland
(Basw), says social workers will continue to be reluctant to
promote direct payments because of the lack of checks on carers
employed by service users. In fact, Basw intends to intensify its
campaign against them over the coming months, she says.

Stark fears that direct payments “may see vulnerable people left
open to abuse”, leaving social workers “naturally reluctant to
support it”.

“We’ve been there too often to go back,” she says. “When the
first case of abuse arrives it will be the social work sector that
gets blamed.”

In April, the scheme – which allows clients to buy services they
are assessed as needing – was expanded to include disabled children
and adults and the over-65s.

Stark supports the rights of service users to have “control over
who comes into their homes but the system has to have checks”. She
adds that the code of ethics social workers follow prevents them
promoting direct payments. “We must keep vulnerable people
safe.”

But Jim Jackson, chief executive of Alzheimers Scotland,
believes this is a smokescreen.

“Is the lack of promotion because of the worry over checks or
because they have been brought up in the tradition of valuing the
public sector? Do they find it difficult to accept that people can
access these services on the market? They are protecting their
position.”

Jackson is cautious about exactly how many checks are needed in
the direct payments scheme. “If a service user chooses to buy
services from us, they are assured of quality carers. Perhaps there
is a way of doing what Basw wants, but you have to be careful how
you do it without restricting the growth of direct payments.”

Direct payments allow service users to create a care package on
their own terms and for their own needs and, claims Jackson, “if
the opportunity is there, people are using it”.

According to the Scottish executive, 1,000 people are now using
direct payments. This increased from 207 payments in 2001 to 912 by
31 March 2004. The value of payments increased from £2.1m in
2001 to more than £8.3m in 2004.

Richard Brewster, project manager at Direct Payments Scotland,
agrees with Jackson that this increase has come about without the
help of some councils.

“One reason behind this is funding. Local authorities are paying
for it out of their existing budgets. That can mean taking money
away from existing services. The other is this concern over
checks,” he says.

Brewster believes that if service users have been judged able to
manage direct payments they should be able to choose who they
employ.

He says: “Some people prefer that carers don’t have previous
social work experience because they don’t have any preconceptions
about the work. Local authorities have got to balance risk and
empowerment.”

Brewster knows of local authorities which have told direct
payment service users that “they have to use someone on their
approved list and had vetoed their decisions”. Brewster is hopeful
that the more social workers see direct payments working, the more
they will be confident in promoting them.

But the executive seems reluctant to let this happen
organically. From 2005-6 direct payments options will be formally
part of assessment and care management procedures across Scotland.
The focus of the executive will be increasing the uptake of direct
payments among eligible groups, in particular people with mental
health problems and users of services for disabled children. A
spokesperson says: “Councils have a duty to provide direct payments
to those eligible, and this will be monitored.”

Perhaps the answer lies in talks. Jackson wants “a discussion on
how far Basw’s ‘vulnerable’ argument is legitimate and how far it
is a cover”.

For Stark the solution could be including a clause on
registering direct payment carers in the Vulnerable Adults Bill now
going through the Scottish parliament.

“We will campaign for this,” she says. “The bill won’t come in
for another year, so now is the time to say there is a problem. We
don’t want to be a nanny state but we must find a balance.”