Get out of the back seat

Some say that public transport is overrated. Who wants to squeeze
onto a bus with lots of other people, all going to the same
inconvenient “one-size fits all” destination, when driving yourself
means you go where and when you like?

Direct payments offer service users an unprecedented opportunity to
drive their own care. But a new report from the Commission for
Social Care Inspection suggests that some professionals would
prefer their clients to stay in the back seat, where they
belong.

It concludes that “many thousands of people are being denied the
chance to take control of their own lives because of a failure to
properly implement the direct payments policy”. And the figures
back up the argument. While hundreds of thousands of people are
potentially eligible, just 13,000 are receiving them. True, the
total has more than doubled since 2001, but from such a low
starting point the increase is hardly impressive.

In fact, what the latest figures demonstrate most clearly is the
vast variation in the take-up of direct payments across different
authorities. Why, for example, does Plymouth only have 14, while
Leeds has 456? The rate of increase is also enormously variable –
Hounslow has increased by 900 per cent since 2002, Barking and
Dagenham has fallen by 12 per cent. What on earth is going
on?

The CSCI suggests that a combination of incompetence, lack of
information, patronising attitudes and unhelpful paperwork have
stalled the direct payments revolution. Certainly, many councils
and individuals are daunted by the administrative tangle. But it is
too easy to conclude that professionals simply don’t want to
relinquish control or don’t think their clients are up to it. Many
front-line staff – whose job it is to recruit new service users
into the scheme – are entirely supportive of the initiative but
lack the necessary support from above. Without a clear commitment
from managers, direct payments will remain mired in confusion and
apathy.

The CSCI has called for a taskforce to work alongside councils to
improve their performance, and is recommending “rewards” for high
performers. Perhaps these initiatives will encourage councils to
unlock the door to the direct payments vehicle. But service users
in less enlightened authorities might have to adopt the Dukes of
Hazzard approach, and hurl themselves in through the window.