Personalisation: Who Cares About Personal Assistants?

Learning by Experience is a new section showcasing recent research in social care.  It will focus on research in important areas of social care and social work which contributes to the evidence base for practice. The research discussed in Learning by Experience can be anything from a small research project undertaken by a practitioner working on the front line to a major piece of academic research carried out by a university.

This research provides original empirical evidence from a PhD study, which investigated the affect on the support relationship of the direct employment of personal assistants by direct payment users. The study compared the experiences of direct payment users and their personal assistants with homecare users and their workers.

Government commitment to personalising adult social care, so that people are offered control of their support budget instead of using standardised services, has been clearly demonstrated (HM Government, 2007). This new way of supporting people will inevitably require radical changes to the social care workforce, including an increased supply of personal assistants to work for disabled adults. However, existing literature about personalised support fails to help us understand what the impact of direct employment will be, as almost all of the research focuses on the interests of users while ignoring the perspective of workers. Yet, to appreciate the dynamics of the support relationship, it is important that we recognise the experiences of both parties in that relationship. The literature also lacks a comparison between the direct employment of personal assistants and non-direct employment, such as homecare services where workers are employed by a local authority. This comparison is an important part of the understanding of the impact of direct employment, as personalised support should not be judged in isolation from similar support provision.

The research seeks to address these omissions by providing a comparison between direct and non-direct employment. It is also one of the few studies to consider direct payments through the eyes of both workers and users. It used qualitative in-depth interviews with 32 people (eight direct payment users, eight personal assistants, eight homecare users, eight homecare workers). It took place in one local authority in England, with three disabled researchers acting as a panel of experts to help formulate the research design. For a more detailed discussion of the methods used see Leece (2007, 2008).

What the study found
As part of the interview, all the workers in the study were asked to complete a questionnaire detailing the terms and conditions of their employment. The results showed striking differences between homecare workers and personal assistants. Relating to pay, homecare workers had an average hourly rate of £6.14, whilst for personal assistants this was lower at £5.16. One of the personal assistants provided live-in support for his employer, and he was earning only £2.77 per hour, which was well below the national minimum wage of £4.85, at the time the fieldwork for the study took place.

None of the personal assistants were members of either a pension scheme or a trade union; two said they did not receive compassionate leave, while six were not paid extra for working unsociable hours. One personal assistant said she did not receive holiday pay and a further six were unaware of their entitlement to sickness pay. This meant that some personal assistants were going to work even when they were ill:

But if you’ve got a cold here, you can’t let Gemma [employer] down, you don’t want to come, you don’t want to give her a cold, but what alternative have you got (Personal assistant)

However, in the study all of the personal assistants were entitled to both holiday and sickness pay, as the hourly rate of direct payment paid to direct employers by the local authority included an amount for this. It may be that the organisation responsible for supporting direct payment users had failed to make this clear to employers, although another interpretation is that employers chose not to tell their employees of this entitlement to avoid disruption to their support. In contrast to these findings all of the homecare workers received sickness and holiday pay; belonged to a pension scheme; received compassionate leave; travelling time; unsociable hours payment, and five were members of a trade union.

Direct employers in the study, in the same way as in other direct payment schemes (Davy et al, 2007), had a limited ability to set the terms and conditions of employment for their personal assistant. They were able to decide on the rate of pay, but the amount they could offer depended on the amount of direct payment they received from the local authority, and this in turn was influenced by central government funding. Direct employers were unable to offer pension provision, as contribution for this was not included in the direct payment.

During the interview workers were asked about formal qualifications, and again there was a difference between the two groups. Only one personal assistant had an NVQ level 2 in social care, while five homecare workers either held this qualification or were working towards it. At the time the study took place no funds were made available by the local authority for employers to train their personal assistants to NVQ standard.

Workers were also asked about support they received in their job. Most homecare workers said they had good support from their manager, although two talked about feeling isolated at work One of the homecare workers explained that other colleagues provided support by “sharing” users who were considered to be “hard work”:

If there is a client who is hard work as we’d call it, where they are depressed, I suppose it would be like living with a depressed partner, they’d gradually bring you down with them wouldn’t they?  So what we tend to do is share that client because it wouldn’t be fair on a colleague to go into that client every single day (Homecare worker).

Personal assistants, as direct employees, received no such support from managers or colleagues, although without exception all of the personal assistants said they did not miss having the support of a manager. Four said that if they experienced problems they could discuss them with their employer, nevertheless this lack of support could be problematic for direct employees. For example the live-in personal assistant talked at length about his difficulty of coping with the strain of supporting his terminally ill employer:

What I hate the most about the job is having to sit and watch someone in agony 24 hours a day, 7 days a week because even though I can’t feel the pain, believe it or not mentally it is just as bad.  (Personal assistant)

This personal assistant also explained that his employer’s death could mean he would be left without a job and a home, demonstrating the insecure position of live-in personal assistants:

If anything did happen to him [employer] with this, which is at the end of the day there is a good possibility, where do I stand with my job and all the rest of it. Deep down in my heart and my mind, because of the trouble we had with [social services], I know what they will do, they will cut it all off and maybe sort it out later on – high and dry with no job (Personal assistant).

Turning now to issues of power in the relationship. The research found that the ability to employ their own workers appeared to give direct payment users greater power than homecare users to shape the nature and boundaries of their relationship with workers. The boundaries of the direct payment relationships were more blurred than in the homecare sample, with personal assistants undertaking a whole range of tasks such as: decorating, cleaning, gardening, pet care, companionship, and chauffeuring, whilst homecare workers were concerned mainly with personal care.

Direct employers also had greater power than homecare users to decide how things were done, or in other words to set the agenda in the relationship (Leece 2007, 2008). Because of this employers were able to be more reciprocal with their workers, and allow them to do things that homecare workers were not permitted to do. For instance, some personal assistants were doing their own shopping while at work, and one looked after his daughter in his employer’s home. However, direct employers’ greater power in the relationship appeared to help them in ensuring that their interests took priority. An example of this is that, unlike homecare workers, almost all personal assistants were doing some form of unpaid work for their employer. One personal assistant was paid for 16 hours per week, but working 8-10 hours a day. Undertaking unpaid work seemed to be linked to the closeness of he relationship, and two direct employers made reference to this:

Say you fell or your children were ill. If they [personal assistant] are your friend then they will help you even if it is not their time to be at work (Direct payment user)

Not only were personal assistants doing a lot of unpaid work, they were also on-call for their employers’ emergencies. In contrast to homecare workers, direct employers had their personal assistant’s home address and phone number, and could contact them as necessary. The live-in worker was providing cover for his employer throughout the day and the night.

Implications for practice
Generalising the findings of qualitative research to wider society can be problematic as it contains neither a representative or random sample. This study provides a comprehensive examination of the comparison between direct and non-direct employment in the framework of one local authority. It is one of the few studies to involve users with their workers, and the findings correspond with other research involving personal assistants. For example, Glendinning et al (2000) report instances of personal assistants doing tasks they were unhappy about, while Ungerson (2004) suggests direct employees were at risk of emotional blackmail, and Unison (Scotland) found some workers were “failing to benefit from the minimum wage, statutory leave or maternity pay” (Lombard 2008:5). Thus it seems likely that personal assistants are also being disadvantaged in other local authorities; indeed it could be just the tip of the iceberg.

Some suggestions for policy and practice, based on the research, can be made:

  • Government funding of social care should be sufficient to ensure that direct employers can offer pay and conditions that are comparable to local authority homecare workers.
  • Power should be more evenly shared within the direct employment relationship to achieve more equal benefits for both employers and workers. Providing support for personal assistants could help to do this.
  • A trade union such as Unison should open its membership to personal assistants and develop ways of supporting them (legal advice, codes of good practice, dispute resolution, access to work-based qualifications).
  • Carers’ organisations should create networks of support (information-giving, 24-hour phonelines, peer support).
  • Personal assistants should be required to register with the General Social Care Council as this confers status, which could help to equalise the power imbalance in the employment relationship.


  • Davy, V. Fernandez, J. Knapp, M. Vick, N. Jolly, D. Swift, P. Tobin, R. Kendall, J. Ferrie, J. Pearson, C. Mercer, G. and Priestly, M. (2007) Direct Payments: A National Survey of Direct Payments Policy and Practice, London: Personal Social Services Research Unit

  • Glendinning, C. Halliwell, S. Jacobs, S. Rummery, K. and Tyrer, J. (2000) Buying Independence: Using Direct Payments to Integrate Health and Social Services, Bristol: Policy Press.

  • HM Government (2007) Putting People First: A Shared Vision and Commitment to the Transformation of Adult Social Care,

  • Leece, J. (2007) Paying the piper and calling the tune: A study to consider how the opportunity to employ workers using cash payments affects the support relationship, unpublished PhD Thesis, Milton Keynes: The Open University

  • Leece, J. (2008) ‘Paying the Piper and Calling the Tune: Power and the Direct Payment Relationship’, British Journal of Social Work, advanced access doi:10.1093/bjsw/bcn085

  • Lombard, D. (2008) ‘Rights of care assistants breached under personal budgets, says union’, Community Care 19/6/08, London: Reed Publishing

  • Ungerson, C. (2004) ‘Whose empowerment and independence? A cross-national perspective on ‘cash for care’ schemes’, Ageing and Society, 24(2): 189-212

    Dr. Janet Leece is a registered social worker who has worked in social care for many years, both as a social work practitioner, and later as a commissioning officer. She is also an honorary research fellow at Staffordshire University. Janet has published extensively in the area of direct payments, including a co-edited book, Developments in Direct Payments, published by Policy Press in 2006.


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