There is scope for more imaginative uses of direct payments through group approaches and mutual models, say Jon Glasby and Mick Taylor
With direct payments and individual budgets a central feature of the adult social care green paper and likely to be part of the health and social care white paper due out as Community Care went to press, directors of adult social services are pondering how to promote new ways of working within existing budgets. So far, the evidence suggests that direct payments are more cost-effective than services that are directly provided, as they purchase better services for the same (and perhaps less) money.(1)
However, this was in the early days; it is less clear what will happen when the system is used by large numbers of people as care institutions close down. Put simply, there is a strong suspicion that it is cheaper to warehouse service users in institutional settings than provide individual and person-centred responses to need.
Luckily, this assumption is based on a false dichotomy: either we provide large collective services or individual ones. In fact, there is considerable scope to do something in-between. This might involve encouraging the uptake of direct payments, but with people using some of this for individual support and some for group activities. As an example, a group of people with learning difficulties attending a day centre may wish to leave the centre and receive direct payments.
Although this could be used for individual services – such as supporting someone to go to college – the group might also want to meet friends once a week to undertake an activity. In this case, people would need individual support for part of the week but only one personal assistant may be needed to support the whole group at the activity. This mix of time alone and time with friends supports the principle of community presence and would be more cost-effective than them spending the entire week at the day centre. It would also be more fun.
Similarly, another group living in a small care home might want to live more independently. Here, an independent living trust with family and friends as trustees could be established to rent a suitable property. By pooling their direct payments, this group could buy enough support to provide round-the-clock cover, but would be doing this with staff of their choosing in a setting of their choosing.
Elsewhere, a group of people with mental health problems might decide to leave day care, where they used to do some art work for example, and pool their direct payments to hire an artist to run a class for them. This would fulfil the same need for social activity but could take place not as an organised day centre activity but with friends in ordinary community settings.
There is also scope to develop a mutual or co-operative model of direct payments. A paper by Co-operatives UK proposes three models (see Clients in control, below).(2) In each, direct payment recipients have direct control over the day-to-day delivery of their support but a co-operative with paid staff takes on the organisational and legal responsibilities of recruitment, regulation, employment, training and contracting.
All three models retain care provision within current care standards frameworks and could include a mutually run support service. This way of working may be especially suitable for those individuals or user groups – such as older people – that find the current “hiring and firing” approach to direct payments difficult.
In addition to encouraging more collective approaches to direct payments, this would reduce the administrative complexity of managing staff and would provide personal assistants with peer support, more secure employment and greater opportunities for career development.
It would also satisfy the government emphasis on social enterprise, the role of the voluntary sector and a mixed economy of service provision. Above all, it would take us away from traditional debates about individual versus collective approaches towards a more imaginative approach that could allow the best of both worlds.
Clients in control
Jon Glasby is a senior lecturer and head of health and social care partnerships at the University of Birmingham’s Health Services Management Centre. Mick Taylor is a senior partner at mutualadvantage, a small consultant practice supporting the development of co-operative and social enterprise solutions for the public sector.
Training and learning
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The system of direct payments is a key component of the government’s vision for the future of social care. However, progress has tended to focus on the payments as an individual way of working. In contrast, this article argues that there is scope for much more imaginative uses of direct payments through group approaches and mutual or co-operative models. This draws on work already undertaken by Co-operatives UK and challenges social work practitioners and policy-makers to think about direct payments in new ways.
(1) J Glasby, R Littlechild, Social Work and Direct Payments, Policy Press, 2002
(2) Co-operatives UK, Mutual Solutions: New models for Direct Payments, 2004
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