As the previous chapter has demonstrated, direct payments bring a range oftangible benefits which can enhance the choice, control and wellbeing ofrecipients. We have also seen how pressure for direct payments built up overa long period (Chapters Two to Five) and how organisations of disabledpeople were able to mount a sustained campaign for the new legislation to beintroduced. As a result of this, direct payments are almost always viewed asan essentially positive policy measure, and have probably been subjected toless careful analysis and critical reflection than should perhaps be thecase. While direct payments do bring a number of very realadvantages for service users, there are a number of limitations andcontradictions that workers and service users need to consider:

• • Are direct payments the product of a government seeking torestrict public spending and introduce a flawed notion ofconsumerism into community care services?

• • Could direct payments represent a subtle shift in theboundary between health and social care?

• • Does the success of direct payments rely too heavily on theattitudes and training of frontline workers?

• • Are direct payments schemes adequately financed and dorecipients receive enough money to purchase sufficient care?

• • Might direct payments lead to the greater exploitation ofwomen?

• • Could direct payments leave service users vulnerable toabuse or at risk of significant harm?

• • Is there a risk that some authorities could use directpayments to distance themselves from service users they perceive as‘troublemakers’?

• • Are the practicalities of managing direct paymentsprohibitive?

Consumerism and public expenditure

Although direct payments offer a range of social service users increasedchoice and control (see Chapter Seven), it is often forgotten that the 1996Community Care (Direct Payments) Act was introduced by a Conservativegovernment firmly committed to New Right or neo-liberal social and economicpolicies. Building on the work of thinkers such as Hayek (1944), Friedman(1962) and, more recently, Murray (1984), the New Right approach has beensummarised in terms of a belief in three key issues:

• • the free market;

• • the minimal state;

• • individual liberty and responsibility. (Adams, 1998, p85)