Published: 07/04/2005, Volume II5, No. 5949 Page 21

Terry Philpot says direct payments may give social care users independence, but could pose dangers

Direct payments nicely suit the tenor of modern social care. They give power to service users. They also remove power from what politicians like to regard as paternalist social service departments.

Direct payments can be seen as a logical extension of the changing face of care over the last 25 years where the opportunity to live as independent a life as possible in one's home is seen as preferable to other forms of care.

The agitation for these payments came largely from physically disabled people, but successive governments have worried that take-up is comparatively low and that other groups, like older people and people with learning disabilities, could similarly benefit.

This appears to be the thinking of the social care minister Stephen Ladyman, whose forthcoming green paper on adult services will propose a massive extension of the scheme.

There are, though, unspoken reservations about the employment of personal care assistants, whose services are most frequently purchased. These are never voiced because the disability lobby has firmly set its stall out against interference with what it sees as a private arrangement between user and personal care assistant.

It is this, the lobby argues, that makes disabled people independent and free to employ whom they wish. But they can do so with taxpayers' money.

The argument is not one that holds good for any other area of work with vulnerable people. Criminal Records Bureau checks have now reached the (admittedly nonsensical) point where some workers have two or three, simply by changing jobs or taking on another role.

But personal care assistants are not subject to checks. They are not required to meet any standard of competence.

They require no qualifications. They are excluded from regulation by the General Social Care Council. And yet they are called upon to perform intimate tasks in users' homes.

The anomaly is that some services users can choose to buy regulated domiciliary care, whereas others can invite personal care assistants into their home subject to no more than the user's preference.

Such an irony not only undermines the hard-won battle for regulation, registration and training; it also leaves vulnerable people, who can often live isolated lives, exposed to exploitation.

With bad practice and undesirable workers being squeezed out by more stringent checks of competence and suitability, the present system offers a helpful loophole for the potential criminal. It took the deaths of children and people with learning difficulties and dozens of scandals to create our present regulatory and registration system.

How long will it be before the death of a direct payments recipient prompts questions that should have been asked some years ago?

Terry Philpot is author (with Anthony Douglas) of Caring and Coping: a guide to social services.