Direct Payments (DPs) have become a key mechanism for delivering social care support, aiming to offer greater choice and control to people in need of social care. DPs have been used in community care for a number of years, but people living in residential care homes have not had access to DPs so far. In 2013, following a recommendation by the Law Commission, the Government initiated a Trailblazer programme to test DPs for residents in care homes. Eighteen local authorities volunteered to participate in the programme and its evaluation.
The evaluation included the following elements:
- A process evaluation aimed to understand the different ways in which DPs were being offered to residents of care homes and how any challenges to implementation could be overcome.
- An impact evaluation assessed the potential effects of DPs on care home residents and their families, care homes and the local care home market, and on councils and their staff, such as care managers.
- An economic evaluation examined the costs of different approaches to providing DPs for residents, their families and the local councils.
PIRU first carried out a scoping study aimed at understanding how each trailblazer site is approaching the implementation of DPs in residential care and what problems sites have encountered at the early stages of the trailblazer. It also included a rapid review of the evidence on the costs and benefits of similar ‘cash for care’ schemes in social care in the UK and elsewhere. This work resulted in a preliminary report to the Department of Health in November 2013.
The main evaluation included:
- A survey of care home residents and family members who were offered a direct payment for their residential care and who either accepted or declined one.
- A survey of care home providers who were aware of the scheme in the participating trailblazer sites.
- A survey of administrative costs in participating councils.
- Monitoring data provided by each of the project leads on number, type, user group and cost of direct payments.
- Interviews with a range of council and care home staff, service users and family members within a small number of in-depth case studies.
- Interviews with trailblazer project leads and other stakeholders, such as national organisatons representing the residential care sector and user groups. A total of 111 interviews were carried out and analysed.
Findings from the main evaluation
The number of people taking a direct payment for their residential care was lower than expected. Project managers in the 18 trailblazer councils had anticipated that around 400 people might want to take up a direct payment. However, at the end of the programme, only 71 people had accepted a direct payment and, of these, 40 were set up and in use. Six months after the official end of the programme, only 29 people were receiving a direct payment for their residential care.
Most of the direct payments (19 of the 29) were used to pay for the full care home fee. These were termed 'full' direct payments. The other 10 were 'part' direct payments, ie, paid in addition to, or as part of, the care home fee. These were mostly used to pay for activities outside the care home chosen by the resident.
Amounts made available as direct payments ranged from £1250 per week to cover the full care home fee to £8 per week as a part direct payment.
The final report of the evaluation was published in April 2017 and can be accessed here>> Appendices to the final report can be accessed here>> A short summary of the final report can be accessed here>>
Findings from the study have been presented to a variety of national and international conferences including:
- International Long Term Care Policy Network (ILPN) International Conference, 4-7 September 2016, London.
- International Health Policy Conference, 16-19 February 2017, London. This presentation can be accessed here>>
- Transforming Care Conference: Innovation and Sustainability, 26-28 June 2017, Milan.
- British Society of Gerontology, 46th Annual Conference, 5-7 July 2017, Swansea. This presentation can be accessed here>>
Daniel Lombard describes some of the findings from the pilot evaluation in this LSE PSSRU blog. Read more>>
The article "Explaining Low Uptake of Direct Payments in Residential Care: Findings from the Evaluation of the Direct Payments in Residential Care Trailblazers" was published online in January 2018 in the Journal of Social Policy. The article can be accessed here>>
The article "Will Direct Payments make adult residential care more personalized? Views and experiences of social care staff in the Direct Payments in Residential Care Trailblazers" was published online in December 2016. The article can be accessed here>>
A number of other articles are being prepared for publication.
A second interim report of the evaluation was released for publication in December 2015 and can be accessed here>>
The first interim report of the evaluation was released for publication in March 2015 and can be accessed here>>
The evaluation team conducted a scoping study of DPs in residential care in 2013. A preliminary report was provided to the Department of Health in November 2013. A copy of the report can be accessed here >>