Most agree that direct payments are a great way of turning the
rhetoric of service user empowerment into reality. Valuing People
and the adult social care green paper propose an increased uptake.
But there is a danger that direct payments could disappear off the
One major area of concern is abuse. There is an increasing
awareness of the ways in which vulnerable people can be abused, and
of the importance of staff checks via the Criminal Records Bureau
and the Protection of Vulnerable Adults list. Service provider
organisations are not completely free from abuse.
Similarly, direct payments will not be free from this risk, as
there are people who are determined to abuse if they can find a
So it is to be welcomed that the government has said that direct
payment service users will be able to use staff checking systems.
But will users of direct payments be informed and supported enough
to raise concerns about staff?
This is not to argue that service users managing direct payments
should have to undertake checks on the staff they employ – that
would surely prolong the view that vulnerable people cannot think
for themselves. It may well be true that if people are in control
of their lives and the support they need, they may be less likely
to find themselves in abusive situations. But, as yet, there is no
research evidence to substantiate this – just because service users
are to be given more choice over their care does not automatically
guarantee their safety.
What is needed is a concerted all-service approach to develop an
understanding of why abuse occurs, and how it can be prevented.
No system is free of abuse. When, and it will be when, abuse
happens in a direct payments situation, it will not only be bad for
the service user, but could lead to overreaction and an overly
Phil Madden is director of service development for learning
difficulties charity HFT