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ANNEX B: SUMMARY OF RECENT RESEARCH ON DIRECT PAYMENTS
Recent research has focused on the following themes:
(i) Independent living brings improvements in quality of life and emotional, physical and social health
Work by Sally Witcher, Jenny Morris, Frances Hasler and most recently, Riddell, Ahlgren, Pearson, Williams, Watson, and MacFarlane (2006) has demonstrated the positive benefits to disabled users of the independent living that direct payments can deliver. Other work has focussed on the benefits to older people e.g. Clark, Gough and Macfarlane (2004) and that of the Joseph Rowntree Foundation (2004 onwards).
(ii) Direct payments are cost effective
Research conducted on behalf of the British Council of Organisations of Disabled People is one of several studies demonstrating that direct payments are cost effective (cited in Pearson 2000).
(iii) There are recognised obstacles to overcome in local implementation
The recent Scottish Executive working group on Direct Payments for Older People ( DPOP) identified a number of contributing factors towards low uptake in many parts of Scotland, including:
(i) The need for awareness-raising, advice, information and training for service users through local support services
(ii) The need for a dedicated direct payments lead officer in each local authority, staff training, and the winning of 'hearts and minds' at all service and management levels on the benefits of direct payments
(iii) Many local authorities have yet to fund local direct payments schemes sufficiently
(iv) Local authorities' concerns about the ability of users to cope with direct payments, and the quality of care they may receive.
The above points are supported and further emphasised by findings presented by Riddell et al. (2006) 38 at the Scottish Parliament's Health Committee Care Inquiry 39 that looked at the effectiveness of direct payments implementation since enactment of the Health and Social Care (Scotland) Act 2002. This research currently provides the most up to date research picture for Scotland.
Riddell et al (2006) cite funding, training and confidence issues among users and social workers alike as current obstacles in Scotland. However they report that users' believe that direct payments management is manageable with support. Glasby (2002) identified availability and access to appropriate information and support and the attitudes of social work professionals who are concerned about direct payments as factors. Clark and Stafford (2002:255) concluded that whilst resource constraints impacted on direct payments delivery, there was also 'a need for a change in culture, values and attitudes if direct payments in particular, and user choice and control more generally, are to become a reality for… users'.
(iv) Best practice solutions are developing, for example, the need for local authorities to fund local support
Whilst such research raises legitimate concerns, they are largely issues concerning the process of direct payments which Rummery (2004) suggests 'could be fairly simply (if not necessarily cheaply) addressed'. Witcher, Stalker, Roadburg and Jones (2000)'s findings suggest with the 'right approach and support, infrastructure barriers can be dismantled or, better still, prevented from arising altogether'. Riddell et al (2006) are similarly positive.
Clark, Gough and Macfarlane (2004)'s best-practice solution focus recognises the pivotal role that both local authority care managers and direct payments support services have in direct payments delivery. They conclude that 'funding of support services should reflect their value both to users and to the local authority'.
The need to fund local support services was also a key conclusion of Riddell et al (2006) who further emphasised its importance in the spoken evidence they gave at the Care Inquiry.
References:
Clark, H., Gough H., and Macfarlane A., (2004) It pays dividends: direct payments and older people. Bristol: Policy Press
Clark and Stafford (2002)
Glasby (2002)
Pearson, C., (2000) 'Money Talks?: Competing discourses in the implementation of direct payments', Critical Social Policy, 20, 4.
Riddell, S., Ahlgren, L., Pearson, C., Williams, V., Watson, N., and MacFarlane H., (2006) The Implementation Of Direct Payments For People Who Use Care Services, Scottish Parliament Health Committee Report SP Paper 624.
Rummery, K., (2005) Disabled citizens and social exclusion: the role of direct payments', paper for the Cash and Care conference University of York, April 2005.
Witcher, S., Stalker, K. Roadburg, M. and Jones, C. (2000) Direct Payments: The Impact on Choice and Control for Disabled People, Edinburgh: Scottish Executive Central Research Unit.
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