Service users, personal budgets and Amsterdam

Does the spirit of personalisation extend to councils allowing people to spend direct payments on sexual services? Vern Pitt examines a debate that has divided social workers

“The poor guy was all ready with his erection and not allowed to see it through,” exclaims Tuppy Owens, founder of TLC Trusts, a website which puts disabled people in touch with sex workers. The “poor guy” in question was a disabled man in receipt of direct payments, which he intended to use, in part, to pay for sex, until the council declared that to be against the rules. He received a last-minute phone call while he was with a sex worker.

Owens says it’s a typical situation she hears about from users of the site. “One minute they can buy sex and the next minute they are banned,” she says. With the government’s personalisation agenda driving increasing uptake of direct payments and personal budgets, this has the potential to become a bigger issue.

However, it appears not to be one recognised by councils, 97% of whom have no policy on the use of direct payments to pay for sex workers, according to a freedom of information request made by TLC Trusts. But it is clear that there is general opposition to the practice in councils, with 87% saying that they did not condone the payment of sex workers by disabled people in their care through direct payments.

Nevertheless most councils (53%) had a strategy that “explicitly empowered” disabled people to pursue their sexual aspirations, according to the survey, answered by 121 of the 206 relevant councils in Great Britain.

“A sexual relationship helps people to feel good about themselves, more attached and more secure,” says Denise Knowles, sex therapist at Relate. “Even people’s health can improve. Research has shown that immune systems are bolstered by a healthy sexual relationship,” she adds.

Owens concedes that consensual long-term relationships are preferable but believes the use of sex workers can be an educative and confidence-building experience to reach this goal. She recounts the tale of one young man with an acquired brain injury who started a relationship with a woman whom he later married, only for her to leave with his money. She says that sex work has become part of his care package, organised by an occupational therapist, to teach him to be sexually self-reliant, increase his confidence and restore his faith in women.

Owens says councils are not engaged with the issue because they don’t understand the nature of the work. “Actually councils and sex workers could work together, instead of councils’ very childish refusal to engage in what is already happening,” she says.

Regulations require councils to ensure direct payment users’ support plans meet their eligible needs but not to prescribe how money is spent beyond this.

However, the issue of paying for sex brings two social work values into conflict – service user empowerment and the sense that prostitution is inherently exploitative. This conflict came alive in a recent debate on CareSpace, Community Care’s discussion forum, about whether a man with learning disabilities should be allowed to spend his personal budget on paid sex in Amsterdam (see case study below).

“What social workers need to be sure about is that no one is being exploited, both the service user themselves and anyone they were buying sex from,” says Ruth Cartwright, the British Association of Social Workers’ joint manager for England.

Service users’ own safety is also a consideration for councils, she adds, given that sex workers do not come with a regulator’s stamp of approval.

Legality is another hurdle to be navigated. In the UK, paying for sex is not in itself illegal, but soliciting, kerb crawling and supporting the trafficking of women by paying for sex with them, all are. This puts professionals who want to help a client by organising a sex worker’s visits in a difficult position because they may be breaking the law. This is most often the basis for council policies on the issue, which thereby prevent service users from buying sex.

There is also a broader legal framework to consider, however, in the shape of the Human Rights Act 1998. “We need to think about disabled people’s rights to sexual relationships as a matter of human rights,” says Liz Sayce, chief executive of disability network Radar. Owens agrees, arguing this means councils have a duty to provide assistance where necessary.

However, Neil Coyle, director of policy at Disability Alliance, says that while councils have a duty not to curtail people’s rights, actively assisting in this area is another matter. “Public bodies don’t exist to find people sexual partners,” he says.

Councils are also wary of news stories about public money spent on prostitution.

“Councils are probably just terrified that it’s going to get into the local paper and make them look silly,” says Owens. “And it probably would because it’s a great story.”

Sayce warns that too wide a debate around the use of direct payments for sex could eclipse their real purpose – to promote choice and control for users more generally – undermine their image with the public and reduce their take-up, which she believes would hamper the equality of disabled people.

These issues illustrate the need for councils to draw up clear policies on whether and how far service users should be allowed, or enabled, to use direct payments or personal budgets on sex. This may not seem like a priority, but for service users who apply and the staff who work with them it could provide clarity and enable them to get on with achieving personalisation’s wider aims.

Case Study: Green Light Given for the Red Light

I have a service user with a moderate learning disability who wants to have sex. He is 21 and has no real social network. He has had one girlfriend but she didn’t want sex, and he was conscious of his disability insofar as he compares himself to others.

He mentioned to me that he heard that he could use his personal budget to go to Amsterdam with a carer, paying for sex through their licensed industry. Under personalisation this should theoretically be possible.

He has been to two different sexual health and sexual awareness courses and basically wants to try it.

Who says he can’t do what he wants? We can’t place restrictions on a young man who wants to experience the world.

Management hate the idea of him going to Amsterdam. They were aghast at what I proposed. But I did more research, built up a strong argument using outside sources, and now he’s going.

Now he’s using his personal budget, supported one-to-one by a family member (his brother) who knows exactly the purpose. I’ve conducted a capacity assessment and a best interest meeting has already been held. Management hate me for this but colleagues are supportive.

The bosses are petrified it’s going to make the press and although I understand the rationale behind their concern, I personally think we should promote this even more.

He has calmed a bit since he’s been told. He’s planning to do more than just get his end away anyway – he’s having a holiday (the first time he’s ever left the country) which he’s funding partially by himself.

The lesson I’ve taken from this is not to listen to management and their self-serving concerns, ignore expectations and ignore people’s prejudicial belief that just because you have a learning disability, you don’t need sex.

This social worker, known as AOGT, posted this story on CareSpace, prompting a vigorous debate about the rights and wrongs of the case. Join the debate

Related articles

Don’t be so squeamish about sex

Social workers imposing direct payments on users

What future for the Independent Living Fund?

Community Care special report on the state of personalisation

This article is published in the 12 August 2010 edition of Community Care magazine under the headline Putting Sex on the Budget