The initial implementation of the 1996 Community Care (Direct Payments) Act in April 1997 as enabling legislation gave local authorities in England, Wales and Scotland and health and social service trusts (HSS) in Northern Ireland the option whether to offer direct payments or maintain existing modes of service provision (see Pearson, 2004a for a discussion of this). In exploring some of the key problems underpinning this trend, this chapter focuses specifically on the impact and future directions of policy in Scotland.
The impact of the early years of direct payments across the UK may be described as limited. Indeed, although many areas largely in the south-east of England have consistently increased their user take-up (see Riddell et al, 2005), access has remained fairly marginal elsewhere.
This chapter begins by mapping the early impact of indirect payment and third party schemes in Scotland through the actions of local alliances of disabled people. Discussion then follows the initial take-up of policy in the period from April 1997 to 2000. Policy development at this time is shown to be especially poor, with only a small number of local authorities enabling access to direct payments. Indeed, changes since 2003 have seen a heightened drive from both the Scottish Executive and local authorities in promoting policy and encouraging a more diverse user population. However, drawing on preliminary analysis from the Economic and Social Research Council (ESRC) funded study, ‘Disabled People and Direct Payments: A UK Comparative Study’, being carried out by researchers at Glasgow, Edinburgh and Leeds Universities, the discussion outlines some of the key trends and policy issues that have emerged in relation to direct payments in Scotland over the past eight years.
This includes a focus on practitioner roles, which, in many areas, have been responsible for resistance to direct payments, thereby creating attitudinal and structural barriers to change. Such problems have often been linked to concerns from trades unions over the promotion of policy as a means to privatise social care services. Commentary at this stage examines some of these issues more closely and questions the emergence of these debates over the past few years. This is then extended to examining the development of support services for direct payment users.