Introduction

The current social care system in the UK is undergoing a period of radical transformation. This transformation and the accompanying transition from service provision to a model of self-directed support forms the focus of this chapter. There are many elements in transition throughout this change as the whole system is redesigned, with an overarching shift from service users as dependent, passive recipients of generic services with very little choice or say in the matter to independent, active decision makers with personalised choices and options available to them. This wholesale transition and the changes associated with it are explored.

Overview of policy and introduction to a system in transition

Direct Payments were first introduced in the UK in 1997 when local authorities were given a discretionary power to make payments to disabled people. The 1996 Community Care (Direct Payments) Act and its associated legislation was welcomed by the disability movement and considered a reward for a long campaign by the independent living movement and disabled people who were increasingly dissatisfied with the services available to them (Glasby and Littlechild, 2006). In 2003, the power to provide Direct Payments was replaced by a requirement for all local authorities to offer them to those assessed as needing community care services who wished to have them and were capable of managing their own support, with or without assistance (DH, 2003; Scottish Executive, 2003).

Ten years on from their introduction, the 2006 White Paper Our health, our care, our say (DH, 2006a) continues to add support to the policy of Direct Payments. The White Paper considers Direct Payments as key to personalised services and also made a commitment to developing a risk framework. The first update on the progress towards the goals in the White Paper – Making it happen (DH, 2006b) – includes a road map that plots the actions for implementation. It states that: