A lived-experience response to The King’s Fund report on Direct Payments from Dr Clenton Farquharson CBE, Associate Director, Policy and Influencing.
The new King’s Fund report, ‘Direct Payments: Creating the conditions for choice and control’, explores why Direct Payment uptake varies so widely across England, and what local authorities can do to improve it.
It is welcome because it brings a long-standing truth back into public view. Direct Payments can transform lives, but only when they are rooted in self-direction, backed by practical support, and delivered with trust. The report also exposes a deeper problem: the system often counts payments without asking whether power has really moved.
A route to a life, not a funding mechanism
Direct Payments are often discussed as a funding mechanism. That language can shrink their purpose. They are not simply a bank account, a compliance exercise, or a council performance target. At their best, they are a route to having control over everyday life.
As someone who draws on care and support and employs Personal Assistants through a Direct Payment, I know the difference between support organised around a service and support shaped around a person. Moving away from task-led agency care allowed me to choose support for qualities such as respect, compassion, and curiosity. That is not a rejection of skill or safeguards. It is a recognition that good support begins with a human relationship and with the person directing it.
The benefit is being able to decide who comes into your home, what good support looks like and how it fits around family, work, relationships, and community life. The point is to thrive, not simply to survive. A Direct Payment should transfer power, not merely cash and administration.
What the numbers do not tell us
The report confirms a worrying national picture. In 2023/24, 25% of adults receiving long-term community support used a Direct Payment. That overall rate had fallen from 28% in 2015/16, with around 9,400 fewer people using a Direct Payment. The scale and the variation between places matter.
But uptake is different from quality. In the five local authority areas studied, The King’s Fund found no obvious relationship between councils’ reported improvement efforts and the number of people using Direct Payments. Headline figures can also be shaped by recording practice and tell us little about whether people feel informed, supported and genuinely in control.
Freedom and frustration can sit side by side
Everyone interviewed who used or managed a Direct Payment wanted to keep it. Some people found the paperwork manageable and the support excellent; others spent hours on administration, struggled to recruit Personal Assistants, could not get a named contact, or lived in fear of a financially led review.
Paula Sardinha, a member of TLAP’s National Co-production Advisory Group, has described her experience as a hurdle race. Choice and control can be promised, then narrowed by bureaucracy, funding constraints, risk aversion, 15-minute blocks and restrictions on spending. Yet when decision makers listen to the story behind the spending, a trike, a support dog, mental health support, or an adapted space can be life-changing because each helps a person achieve outcomes that matter to them.
Other TLAP lived-experience evidence shows the same two sides. One person said that moving from poor agency care to employing their own Personal Assistant restored dignity and quality of life. Another family chose Personal Assistants for respect, reliability, and honesty, enabling a son to live independently with a team able to adapt as his life changed. But shortages, low pay, weak recruitment support, and excessive paperwork can leave people without support and push pressure back on to families.
This is a system problem, not a story of people not trying
The report is right to recognise that councils are not standing still. It found staff training, specialist roles, peer support, Direct Payment cafés, better links between finance and social work, multilingual information, support with Personal Assistant recruitment, mixed packages and attempts to make budgets more flexible. It also references practical resources developed by TLAP and partners.
Frontline staff are often trying to personalise support while managing waiting lists, crises, hospital discharge, safeguarding duties, and financial pressure. Many work in systems designed to commission standardised services, not to share power. In that context, more training or another toolkit will help only so far. Good people cannot compensate indefinitely for poor system conditions.
Too often, the person is given responsibility without power. They may recruit staff, run payroll, keep records, and carry employment duties, while the council still controls rates, restricts flexibility, and applies rules that are difficult to understand. That is not self-direction; it is administrative burden transferred to the individual. Recognition is important, but recognition is not reform.
Risk does not disappear when control is taken away
The King’s Fund blog on the new report says Direct Payments involve more risk. I would frame this slightly differently: they can involve different and more visible risks. Commissioned care also carries risk: inflexible routines, unfamiliar workers, missed care, isolation, and loss of control, but these can be hidden by organisational processes.
The answer is not to push risk onto the person or to take control back. It is shared and relational responsibility: clear contingency planning, accessible employment advice, responsive safeguarding, proportionate financial assurance, and trusted support that can act quickly without treating the person as a problem to be managed.
Five shifts that would make the promise real
- From offering a payment to enabling informed choice. People need accessible information, independent advice, and the genuine choice to use a Direct Payment for all or part of their support. Nobody should be pushed towards one route or quietly discouraged by how the choice is presented.
- From transferring risk to sharing responsibility. Ongoing help with recruitment, payroll, employment duties, contingency planning, and safeguarding should build confidence without taking control back.
- From monitoring transactions to learning about lives. Assurance should be proportionate and linked to outcomes. Councils and the Care Quality Commission should use experience, equity, and feedback alongside financial and uptake data.
- From an empty wallet to genuine local choice. Budgets must cover the actual costs of employing people, including fair and competitive Personal Assistant rates. Councils should invest in user-led organisations, peer networks, community micro-enterprises, and diverse local markets.
- From a Direct Payment silo to a self-directed system. Choice and control should not depend on whether someone can or wants to become an employer. The same principles must shape Individual Service Funds, mixed arrangements, council-managed budgets, and support for people who fund their own care.
Three routes for reform — pursued together
The King’s Fund sets out three routes: improve the current Direct Payment system; examine alternative ways of providing financial choice and control; and build a wider care and support system that offers personalisation to everyone. These should not be treated as competing options or a sequence in which people wait years for the next review. They should be explored in parallel.
Looking at models in countries such as Germany and Australia may help us question assumptions about budgets, scrutiny and the relationship between the person and the state.
National leadership must match local ambition
Councils can improve information, reviews, peer support, and market development now. But national government must create the conditions for success. The Department of Health and Social Care should make choice and control a clear priority, invest in peer and user-led support, strengthen accountability, and help build evidence about what works for whom. The Care Quality Commission should examine experience and outcomes, not rely on crude league tables.
Some barriers sit outside adult social care. Clearer HMRC guidance for individual employers, Home Office action on recruitment constraints and DWP rules affecting family carers are all part of the picture. The government’s commitment to reform and Baroness Casey’s work offers an opportunity to join these issues up rather than asking local areas and individuals to navigate them alone.
People who draw on care and support must be part of national and local system leadership shaping decisions, testing solutions, and judging impact, with their time and ability properly recognise and paid. Lived experience should not be added at the end as a story that illustrates policy; it should help govern the work from the beginning.
The test is real control
The purpose of Direct Payments is not to save money, increase a percentage or produce accounts that reconcile. The real test is whether people have more control, dignity, security, connection, and possibility in their lives. Direct Payments should not require someone to become an expert in council systems before they can live a gloriously ordinary life — as a parent, partner, friend, neighbor’s, worker, and citizen.
The question for every part of the system is simple: do we trust and support people to direct their own lives, or do we hand them the money while keeping hold of the control?
Sources
The King’s Fund (2026). Direct payments: creating the conditions for choice and control. Cheryl Gowar, Julia Cream and Simon Bottery.
The King’s Fund (2026). Direct payments uptake: what the numbers do not tell us.
Clenton Farquharson CBE. Thriving not surviving: we need to care about each other.
Paula Sardinha. Clearing the hurdles: making Direct Payments work.
Think Local Act Personal. A survey of people supported by a Personal Assistant.
Think Local Act Personal. Beyond routine: embracing values-based support.
