Disabled People and Direct Payments: a UK comparative Study
This project was conducted jointly by researchers at the Universities of Edinburgh, Glasgow and Leeds, and funded by the UK Economic and Social Research Council. CDS staff involved in the project at Leeds were Debbie Jolly, Mark Priestley, Geof Mercer and Colin Barnes. Team members in Scotland were Sheila Riddell, Charlotte Pearson and Victoria Williams. Our project advisory group included a range of activists and policy makers (including cetnral and local Government and the National Centre for Independent Living).
From Summer 2004, and in consultation with the Department of Health, we also worked in collaboration with other research projects addressing related policy concerns. This included collaboration with researchers from the London School of Economics and the University of Birmingham on a national postal quetionnaire (a combined research team known as the ‘Direct Payments Survey Group’).
Findings from the Survey Group were highlighted at a launch event in London on 28 March 2006 and at a briefing for the Department of Health. Knowledge transfer seminars were also held for participants from government, local authorities and voluntary sector organisations in Edinburgh (13 March) and Leeds (22 March). These included collaboration with a number of key policy partners, including the Disability Rights Commission, Direct Payments Scotland, the Scottish Executive and the British Council of Disabled People.
This was a ‘four-country’ (UK) study of a relatively new and radical form of welfare provision, direct payments, conducted by leading centres for disability research in England and Scotland. The research explores national and local variations in the implementation of direct payments, and the power relations that underpin these differences. The main research questions addressed are:
- What are the key differences in direct payment policies, implementation strategies and practices in England, Wales, Scotland and Northern Ireland, and within each country what variations are apparent at a local level?
- To what extent have direct payment policies had an impact on forms of welfare production and consumption?
- To what extent have local authorities/health and social service trusts and health and social work practitioners changed their cultures and practices to facilitate new modes of welfare delivery?
The research design was based on a progressive focussing strategy – beginning with a ‘broad brush’ analysis of national policies and statistics, followed by 21 key informant interviews with policy makers and activists, a national postal survey and follow-up telephone interviews with purchasing authorities, and local case studies in each of the four countries.
Fieldwork responsibilities were shared within the team, with Debbie Jolly and Charlotte Pearson taking a lead on the initial data collection and analysis.
Papers available online
The summary final report and findings, including references to publications and dissemination activities
Documents relating to the mapping exercise (please note that these were produced as draft ‘work in progress’ papers and that we welcome feedback)
- Initial review of direct payments policy development in the UK
- Summary data on numbers of reported direct payment users in the UK
- Initial detailed analysis of quantitative mapping data
Documents relating to the key informant interviews
Documents relating to the postal survey questionnaire (Direct Payments Survey Group)
- Letter to purchasing authorities
- Questionnaire for purchasing authorities in England and Wales
- Questionnaire for purchasing authorities in Scotland
- Questionnaire for purchasing authorities in Northern Ireland
- Final report from the purchasing authority questionnaire (published by PSSRU)
- Final report from the support organisation questionnaire (published by PSSRU)
Documents relating to the telephone interviews
- Schedule for telephone interviews with purchasing authorities
- Initial findings from telephone interviews with purchasing authorities
Documents relating to the anonymised case studies
- English Authority A Direct Payment Case Study
- English Authority B Direct Payment Case Study
- Welsh Authority A Direct payment case studies
- Welsh Authority B direct payment case studies
- Scotland example A
- Scotland example B
- Northern Ireland example A
- Northern Ireland example B
Documents from the knowledge exchange seminar in Leeds (March 2006)
- Anne Pridmore (Chair: British Council of Disabled People) ‘Disability Activism, Independent Living and Direct Payments‘
- Mark Priestley and Debbie Jolly (Centre for Disability Studies: University of Leeds), ‘A Postcode Lottery: Explaining the Implementation of Direct Payments‘
- Charlotte Pearson, Sheila Riddell and Victoria Williams (University of Glasgow & University of Edinburgh), ‘Independent Living or Something Else?‘
- Caroline Ellis (Disability Rights Commission) ‘The Independent Living (Disabled Persons) Bill‘
Other Published Papers
C., Barnes, Jolly, D., Mercer, G., Pearson, C., Priestley, M. and Riddell, S. (2004) Devolving direct payments: a review of policy development in the UK, Paper presented to the Disability Studies Association Conference, University of Lancaster, 26-28 July 2004
Pearson, C., Barnes, C. Jolly, D., Mercer, G., Priestley, M. and Riddell, S. (2005) Personal Assistance Policy in the UK: What’s the problem with direct payments?, Disability Studies Quarterly, 25(1)
Riddell, S., Pearson, C., Jolly, D., Barnes, C., Priestley, M. and Mercer, G. (2005) The development of direct payments in the UK: implications for social justice, Social Policy and Society, 4(1): 75-85
Barnes, C. (2005) Independent Living, Politics and Policy in the United Kingdom: A Social Model Account, Review of Disability Studies, 1(4): 5-13
Priestley, M., Jolly, D., Pearson, C., Riddell, S., Barnes, C. and Mercer, G. (2006/7) Direct payments and disabled people in the UK: supply, demand and devolution, British Journal of Social Work, 37(7): 1189-1204
The NHS & Community Care Act 1990 put in place new arrangements for the management and delivery of social care. Following the White Paper Caring for People these changes sought to develop a strong independent sector alongside high quality public services. In England and Wales, but not in Scotland, it was stipulated that 85% of new resources (money transferred from the social security budget) should be spent on private and voluntary sector providers. The development of a mixed economy of welfare was further promoted by the White Paper Modernising Government. In addition to advocating public/private partnerships, the White Paper also recommended tighter regulation through the establishment of service standards and stricter audit and inspection regimes. A subsequent White Paper, Modern Markets: Confident Consumers, dealt with individual consumers of private sector services, but had relatively little to say about the consumption of welfare services. However, since direct payments involve individuals commissioning and purchasing their own services from a range of providers, there is clearly a blurring of the boundaries between public and private spheres of consumption. The DTI White Paper noted how more complex markets, and the increasing information needed to make good choices, may have negative consequences for those with lower levels of education and skills, and on those vulnerable to social exclusion. A central aim of this research is to explore the varying response to direct payments among different groups of disabled people (for example, in relation to age, sex, ethnicity, socio-economic status, impairment and geographical location).
The Community Care (Direct Payments) Act 1996 extended community care policies by allowing local authorities across the UK to make cash payments to disabled people to purchase services on their own behalf, rather than using those supplied by the local authority. In order to qualify for a direct payment, an individual had to be assessed as requiring community care services. Direct payments provisions came into force in April 1997 in England, Wales and Scotland, and in Northern Ireland a year later. Access was initially restricted to those between 18 and 65. Direct payment provisions were then extended to older people and later to other groups, such as 16 and 17 year-olds and parents of disabled children. In England and Wales, changes in 2000 also allowed carers to receive a direct payment. This change has yet to be implemented in Scotland and Northern Ireland. Our research design addresses this rapidly changing policy arena.
It has been argued that the British post-war welfare state is a hybrid of liberal and social democratic welfare models, and that neo-liberal principles may be of growing importance. Responses to direct payments in the UK may be seen as an indicator of the extent to which neo-liberal principles are likely to dominate in future modes of welfare consumption. The application of neo-liberal principles to welfare provision is likely to throw up a number of contradictions, since the freedom of the individual service user will always be constrained by limited welfare budgets and state regulation, and these contradictions will be explored. By highlighting responses to direct payments in different parts of the UK, this research will highlight national and local differences in interpretating the new policy agenda that direct payments may be seen to embody. A ‘policy cycle’ approach will be adopted, taking into account the perspectives and differential power bases of key stakeholders. It may be the case, for example, that social policies promoted at national level may be resisted at local levels, and vice versa.