‘Service users should get direct payments for residential care’

Restrictions on giving service users direct payments to buy long-term residential care should be abolished to increase choice and control, today’s Law Commission report on the reform of adult social care law has proposed.

The commission said the reform would enable users to have greater choice over accommodation, while also bringing residential services into line with non-residential care.

The UK government has previously opposed the idea but the commission has said that it is now more open-minded on the issue.

[Read our full analysis of the Law Commission’s report].

The plan drew a mixed response from sector leaders, however, who voiced concerns over whether direct payments would be of sufficient value for service users to purchase the accommodation they wanted.

“Care homes have been left out of the loop too long,” said Caroline Bernard, deputy chief executive of Counsel and Care. “Our concern would be, ‘Will the budgets be sufficient?’,” she added.

There are also fears that direct payment users will face higher bills for residential care without the backing of local authorities’ power to depress prices in the care home market by purchasing in bulk.

“There are particular problems because residential homes routinely charge self-funders more than local authority residents,” said Stephen Lowe, social care policy adviser at Age UK.

But Sheila Scott, chief executive of the National Care Association, rejected this concern, saying that direct payments should be sufficient to meet people’s assessed needs. However, she said, some families may decide to top up personal budgets to afford the care home they want, as is currently the case without direct payments.

The Law Commission said it did not think the reform would lead to prices going up.

“Local councils will still be very important purchasers of residential care,” said Frances Patterson, commissioner at the Law Commission. “But rather than direct control via block or spot contracting, they will exercise control by limiting the amount of money available in the form of a direct payment to a reasonable sum.”

There are details to be worked out to make the scheme effective.

For instance, direct payments currently cover care costs and not the accommodation costs that councils also pay to residential care providers.

“Somehow or other we have to find a way to pay for their board costs as well because, if a personal budget pays for care, who pays for housing or hotel costs?” asked Scott.

Sarah Pickup, vice-president of the Association of Directors of Adult Social Services, said most councils’ systems allowed them to top up someone’s allocated personal budget to include hotel costs, but this meant the decision to go into residential care had been made, meaning there would often be little point in a direct payment.

Julie Stansfield, chief executive of In Control, the charity that has pioneered personalisation, said direct payments would only work if there was comprehensive support available for care home residents, a more vulnerable group than those in the community.

“In the current environment we have some concerns as to whether local authorities will prioritise the support arrangements necessary for this to be effective and genuinely empowering,” she said.

Further coverage of the Law Commission report

Legal analysis: ‘Don’t let jargon ruin Law Commission’s reforms’

Biggest shake-up in adult care law in 60 years proposed

Law review backs off giving social workers powers of entry

What do you think? Have your say on the plans on CareSpace.

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