Direct Payments in Residential Care evaluation

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 had not had access to DPs. 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 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.

• assess 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.

• examine 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 was approaching the implementation of DPs in residential care and what problems sites had encountered at the early stages of the trailblazer. This 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 organisations representing the residential care sector and user groups. A total of 111 interviews were carried out and analysed. 

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, i.e., 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 £1,250 per week to cover the full care home fee to £8 per week as a part direct payment. 

Findings from the study were presented to a variety of national and international conferences including:

• International Long Term Care Policy Network (IPLN) International Conference, 4-7 September 2016, London.
• International Health Policy Conference, 16-19 February 2017, London. The presentation is available below.
• 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 is available below.