The system of direct payments to disabled people and other user groups could be radically expanded to transform lives, argues Jon Glasby

Published: 01/07/2004, Volume II3, No. 5912 Page 23

As the government continues to collate responses to health minister Stephen Ladyman's consultation on a new vision for social care, there are a number of potential implications for the NHS. Part of the forthcoming strategy is likely to include proposals on health and social care integration - possibly opting for care trusts as the best model for adult services, perhaps developing an alternative approach.

However, even more profound could be the current government emphasis on direct payments (cash payments made to disabled people and other user groups instead of directly provided services).

As Mr Ladyman has suggested: 'For some, but not enough, direct payments are a way to achieve...independence and control. Would it be too crazy to suppose that as self-esteem rises, social inclusion grows and reliance on statutory agencies reduces? Well, these are the messages coming back from people using direct payments, so no, not crazy at all.'

At present, direct payments are only available in lieu of social care. While some areas are experimenting with making payments through pooled budgets, there is considerable confusion about how the choice and control brought about by direct payments link to current policies about health and social care partnerships.

However, could direct payments be used to meet the health and social care needs of older people, disabled people and those with learning difficulties or mental health problems? We know that some health services withdraw once they know a disabled person is using direct payments to hire their own personal assistants, and that some disabled people ask their personal assistants to perform a range of minor health tasks. While ensuring a more joined-up approach to people's individual needs, this means that social care funding is used for healthcare and puts PAs in a potentially difficult position with regard to training and health and safety.

With greater use of pooled funds, however, direct payments could potentially have a crucial role to play in healthcare. In the same speech as he emphasised the importance of direct payments, Mr Ladyman also highlighted the Evercare approach to supporting people with long-term conditions in the community and avoiding unnecessary hospital admissions.

Presumably, these are precisely the people that could benefit from direct payments - those with both health and social care needs, with considerable expertise in living with and managing their own condition, and who arguably know best what would help them to maintain their independence. In the future, couldn't these people choose and organise their own health and social care, receiving a new form of direct payments that could be spent on direct services, but which could also be used for private or voluntary sector provision?

With all the interest in choice and patient-centred care, is not it time to bite the bullet and make the individualised funding represented by direct payments a more mainstream feature of health and social care?

Jon Glasby is head of health and social care partnerships, Health Services Management Centre, Birmingham University.