Given we all agree on the principles of choice, control and flexibility, why is it that we are a bit stuck with direct payments? In recent years, we are seeing some concerning trends across adult social care. Work on individualised personal commissioning in our Integrated Care Systems is stagnant, and yet we would expect to see our newly created partnership arrangements driving personalisation and integration.
Whilst in Nottinghamshire I am confident we are increasing our use of direct payments, I am not convinced we are using them in the way we intend them – whether it’s choosing the right caregiver, determining the timings of assistance or selecting the activities that bring them joy, I am seeing more direct payments being used to purchase and manage care arrangements.
Direct payments provide the autonomy necessary for individuals to lead fulfilling lives, giving people the freedom to decide how and when they receive their care. This level of control is incredibly empowering, as it allows people to tailor their support to meet their unique needs and preferences. Yet many places are seeing the use of them decline.
We know that in the pandemic we saw the need to act to ensure continuity of care and a focus on safety given the incredible restrictions and conditions we lived in. Stagnation is understandable, yet we are now three years on and are not yet seeing the shoots of recovery we would expect.
Public sector finances are tight. Financial controls in local government are stringent. Colleagues are pressured to account for every penny spent. Yet we know that social care direct payments have proven to be cost-effective. By empowering individuals to arrange their own care, we eliminate unnecessary bureaucracy and reduce administrative costs associated with traditional care models. In turn, this frees up resources that can be better allocated to improve the quality and availability of care services for all. So, what are we collectively missing here?
I am curious as to whether we have lost a sense of what is important and that in the midst of crisis, pressure and busy-ness, we are losing a sense of how care and support needs to think about tomorrow’s outcomes for people alongside taking care of today. Through the Association of Directors of Adult Social Services (ADASS), social care leaders have come together to ensure co-production is at the heart of our work and that principles of social justice and equity drive our practice and policy. Direct payments are a very real and practical way we can demonstrate that.
The Direct Payments Summit being jointly convened with Think Local Act Personal (TLAP) will bring together leaders to demonstrate our commitment and start to consider very practical steps we can take to re-embrace direct payments as the central approach to care and support.
