At their best, direct payments have the capacity to transform the lives ofdisabled people and the work of social services departments, empoweringservice users and enriching the jobs of social workers. Implemented after ahigh profile and sustained campaign by organisations of disabled people,direct payments are potentially revolutionary in terms of the opportunitiesthey offer to enhance the choice, control, health and wellbeing ofpreviously marginalised groups of disabled people. In some localauthorities, direct payments have been implemented with enthusiasm,benefiting service users, improving satisfaction with care arrangements andleading to greater cost-efficiency. However, this has not always been thecase, and many social services departments have been slow to recognise andcapitalise on the advantages which direct payments offer. Often, patterns ofimplementation have been strongly affected by regional variations, withparticular areas of the country dragging their heels and hindering progress.In many cases, little consideration has been given to the needs of usergroups other than people with physical impairments, and access to paymentshas often been denied to certain categories of people altogether (despitegovernment guidance). While this is partly due to the wording and focus oflegislation and official documentation, it is also the result ofdiscriminatory attitudes and a failure to provide appropriate and accessibleinformation to a range of user groups.

Throughout this book, we have attempted to highlight the strengths and thelimitations of direct payment schemes, and the potential advantages anddisadvantages of making payments to disabled people in lieu of directlyprovided services. However, if we are to maximise the positive aspects ofdirect payments and minimise their potentially negative features, a numberof changes will be required, both in social work practice and in officialpolicy.

Practice

The attitude of frontline social workers is crucial to the success or failureof direct payments. Disabled people currently rely on social workers for agreat deal of information and cannot be expected to make informed choicesabout their care arrangements without accurate and accessible advice aboutthe options available to them. Evidence to date suggests that social workersplay an important gatekeeping role, and that those people who receivesuccessful payments packages often do so at least in part because ofinformation and support provided by a social worker.