Alex Fox, CEO at Community Catalysts, calls for us to be more ambitious about how we plan for and use Direct Payments, to improve people’s lives and save money.

People who take Direct Payments – cash to buy your own support, in place of care provided or bought by the council or NHS – report feeling more in control of their support, and getting better outcomes. In social care and in NHS Continuing Healthcare, people who draw on ongoing support have a Personal Budget – an amount awarded to them to cover their support costs – which they can choose to take as a cash Direct Payment or as a budget which is managed by an organisation on their behalf.  

Offering one million people a Personal Health Budget (PHBs) by 2030 is now a national NHS target and there is a renewed focus on how to bring Personal Budgets and Direct Payments to more people. Councils have been offering Direct Payments since the 90s and they now account for 118,000 people or around 25% of people receiving long term support (37% amongst 18-64s but only 14% amongst over 65s). Uptake is increasing, but not as fast as the number of people using social care. So, Direct Payment use is falling as a percentage of social care use, meaning that most areas are missing out on a ‘win-win’ way to improve lives and save money. This is at a time when many council finances are in dire trouble, because the average cost to the council of a Direct Payment is around £19k per person, not only lower than the £50k+ average costs of residential or nursing care, but also nearly 30% lower than average community care.  

Our report last year for NHS England North West Personalisation and Community Services Team found that for 62 Personal Health Budget holders, taking those PHBs as a Direct Payment saved nearly £300,000. This money was saved not through cuts, but through people being able to pursue good lives their way. We see this all the time in our Community Micro-enterprise programme areas, where people with Direct Payments draw on the support of a local micro-enterprise that gives them the support they need, as well as ways to be more connected, active and healthy. Aspire Support in Oxfordshire is an example of a community micro-enterprise that has supported Millie to live a better life.

The key to increasing both uptake and impact of Direct Payments, whether in social care or Continuing Healthcare, is to think both demand and supply:

• Council and NHS teams need clear information and systems which help them offer Direct Payments with confidence, and a culture of forming relationships with the people they support and planning creatively with them. Aligning social workers and brokerage teams around this ambition is vital. To help people create these relationships and think and plan more creatively, we have an immersive workshop and tool we call Thinking Outside of the Box.
• If all that’s on offer is the ‘same old stuff’, fewer people will opt to manage their budget themselves, and the impacts of doing so will be lower. In some areas, responsibilities are simply being shifted onto unpaid family members, missing opportunities to build independence and leading to crises for whole households. It’s vital to build diverse community marketplaces where people can co-create new approaches together. Our Community Micro-enterprise Development Programme is one of the few approaches that makes this work for both older people and working age adults. Our recent blog for Think Local Act Personal (TLAP) says more about how community micro-enterprise can help increase uptake of Direct Payments.  

Some people see Direct Payments as what you offer when you don’t have a good service for someone. If the NHS’s hugely ambitious Personal Health Budget target is not only to be achieved, but make a positive impact on people’s lives and the sustainability of services, local Direct Payment strategies need to be so much more ambitious than that.

We are really pleased to be delivering workshops in partnership with Social Care Future and TLAP across NW ADASS to help shift thinking and practice with councils in that region and embed choice and control.