Direct payments need renewed focus on choice and control, report finds

Direct payments can have a transformative impact on the lives of people who draw on care and support, but greater focus is needed on personalisation, choice and control, according to Think Local Act Personal (TLAP).

The comments follow the publication of new research by The King’s Fund, Direct payments: Creating the conditions for choice and control, which examines why direct payment uptake varies significantly between local authorities and what councils can do to improve access and use.

TLAP supported the research by convening a reference group of people who draw on care and support, alongside organisations and networks involved in direct payment practice, processes and improvement. The group contributed to the researchers’ interpretation of findings and helped develop and test the review’s conclusions and recommendations.

Martin Walker, Head of Practice Improvement, Self-directed Support, at TLAP, said: “Direct payments allow people to arrange their own care and support in ways that reflect their individual needs, circumstances and aspirations. This research highlights both the transformative impact that they can have on people’s lives and the need to renew our focus on the principles of personalisation, choice and control that underpin them.”

He said that while direct payments are established through policy and law, there remains a gap between people’s entitlements and their experiences of care and support.

“Direct payments are underscored in policy and enshrined in law, but there is a significant gap between what people are entitled to and what they experience. TLAP has worked extensively with partners to develop practical resources to close this gap. We are pleased to see these recognised in the report and encouraged by the continuing commitment of local authorities and practitioners to deliver greater choice and control for people who draw on care and support.”

Walker said improving direct payments required changes beyond guidance and implementation, arguing that the wider care and support system needed to provide greater consistency in how personalisation, choice and control are delivered.

“This is essential because, as the report recognises, improving direct payments is not simply a question of better guidance or implementation. It requires a wider shift towards a care and support system that delivers personalisation, choice and control more consistently.”

TLAP also linked the findings to the government’s wider commitments on social care. Walker said: “The Prime Minister has established social care as a key government priority and, on the steps of 10 Downing Street, committed to putting “the care of people at the heart” of everything he does. If this commitment is to be realised, direct payments have an important role to play.”

Dr Clenton Farquharson CBE, Associate Director of TLAP, said the value of direct payments should be measured by the difference they make to people’s lives rather than simply by the number of people receiving them.

“Direct Payments should be a route to a life, not merely a funding mechanism. As someone who draws on care and support and employs Personal Assistants, I know they can be transformative when they are backed by trust, practical support and genuine flexibility. But transferring money is not the same as transferring power. The real test is not simply how many people receive a Direct Payment, but whether people gain genuine choice and control, what becomes possible in their lives, and whether that experience is equitable.”