Not every disabled person wants the responsibilities that direct payments bring. If the system is to work a range of options are needed, says Robin Currie

Why is a major plank of the government’s new social care programme so unpopular? Surely it is a significant step towards independence for people with disabilities that irrespective of their income they can arrange and buy their own care instead of having to receive it from social services?

Since direct payments were introduced in 1997 take up has been painfully slow. Even in areas where interest is highest, only around 3% of care recipients have opted to transfer. Why are service users so reluctant to take control of their care?

A tiny minority of disabled people feels the system has improved their lives. However, most say they do not want to be employers with all the problems and risks involved in engaging their own staff nor do they want the bureaucracy of completing local authority time sheets to make financial claims. They are frightened that they might make a mistake in hiring or firing their personal assistant (PA) and end up before an employment tribunal accused of discriminating against someone’s sexual orientation or racial origin. They are scared about what would happen if their PA went off sick or on holiday.

Some have understandable anxieties about taking on liabilities under health and safety legislation for workers in their home. They say they already have enough problems in their lives without more worries.

For those who have taken up the direct payment option, the problems are often no less real. The shortage of potential care staff in the employment pool is well known. Social care organisations themselves have been forced to offer a variety of incentives to recruit and retain staff, some turning to eastern Europe to make up their workforce requirements. Individual disabled people struggle in this competitive market. A seemingly endless trail of adverts in newspapers and shop windows to find anyone willing to help can make the concept of empowerment and choice feel somewhat empty. Finding cover for staff holidays or sickness can be even worse.

Some disabled people see the problem as one of resources. They would prefer to buy the care they want from an agency of their choosing and let the agency take on all the hassles of being an employer. However many local authorities set payments at a level which only allows for the direct costs of employing care staff, not the additional agency management costs. Some people become so desperate to secure help that they top up the direct payment themselves and buy it from an agency.

Currently, the government is pursuing conflicting policies in relation to social care. On the one hand it imposes stringent standards and training requirements for care staff employed through registered and inspected care agencies to ensure good quality services for vulnerable people. Yet at the same time through direct payments it is promoting the expansion of a system of lone workers where there are no regulations or protection and often little training.

If the system is to work a range of options are needed. A limited number of people want and succeed in taking complete control of their care package, though most say they need more support than is currently available. Some want to direct their care and select their own staff but have it managed by an agency on their behalf. Others want to be able to buy their care directly from an organisation of their choice.

Much needs to be done to convince a sceptical audience that the direct payments policy is not just another attempt by government to reduce costs and transfer the headaches of service provision onto individual people who already feel grossly disadvantaged.

· Robin Currie is the chief executive of the social care charity PSS Caring for Generations

Tuesday March 8, 2005