Abstract

Personal budget holders in England choose between opting for the local authority to commission the services they require on their behalf (a managed budget), or directing the arrangement themselves by taking their budget in the form of a direct payment, or a combination of the two. Direct payment users may choose to purchase services from within the formal social care sector (such as a home care agency) or from a personal assistant, or purchase equipment that they are assessed as requiring. Where a direct payment (DP) is the preferred option but a person lacks capacity to manage it, a recognized ‘suitable person’ may be granted permission to act as a proxy. Whether managed by the service user or a suitable person, DP management requires completion of core administrative tasks and other skills related to securing and supervising care. Since DPs were first introduced, external direct payments support (DPS) has been an integral part of the model, provided by entities referred to collectively as Direct Payments Support Schemes (DPSS). A decade ago, amidst a major policy drive to promote DPs, the sector expanded significantly.

As a result, by 2007 almost every council in England had a contractual agreement with a DPSS provider. This provider group was surprisingly heterogeneous, ideologically centered on User-Led Organisations (ULOs) and Centres for Independent Living (CILs), but actually composed of a variety of organisations ranging widely in their size and scope of services, albeit mainly voluntary organisations. As take-up of DPs grew, pressure mounted on local authorities to support an increasing user-base, both in number and in diversity. By 2010, significant turnover in DPSS was being reported. Concerned service users, DPSS staff and members of the independent living movement suggested that DPSS run by CILs and other ULOs were increasingly being decommissioned, whilst other organisations were growing, offering lower-priced services but less direct contact with service users. We set out to determine the extent of turnover from our database of organisations responding to the PSSRU national Direct Payments Survey (2007). We started by exploring the original data to establish if the variation in services provided was patterned and if it was linked to characteristics of organisations.

Five profiles emerged offering very distinct models of DPS. When we related the profiles to organisational characteristics a less clear-cut relationship between organisation type and service profile emerged than had been anticipated, for example there was no obvious CIL profile. To monitor turnover, we tracked the original sample in 2011 in 2014, observing changes in provision. With this data we explored how affinity to a certain service profile may have affected organisations’ staying-power. The results provide insight into the evolution of this market over the past decade, demonstrating the influence of local authority preferences on the delivery of DPS and the impacts of service viability, revealing a hidden face of DP with significant implications for service users.