Direct payment is a healthy option

In the UK, current health care policy is focused on increasing choice and control for people who use services , and on developing more effective support for people with long-term conditions. As part of these agendas, there is talk of 'personalisation', of the 'expert patient' (who is able to use their knowledge of their condition to support others) and of 'contestability' (creating more of a genuine market in health care). In both primary and acute care, there are also new systems that help government spending on health care to get closer to individual patients (under 'payment by results', the funding follows the patient as they go into hospital; under 'practice-based commissioning', local groups of General Practitioners will be able to commission new services locally). Yet for all this talk, these policy goals are not new and are often already being pursued in other areas of the public sector. A good example of this is in social care, where 'direct payments' have long enabled disabled and older people to receive cash equivalents in lieu of directly provided services (sometimes also known as personal budgets or as a form of consumer-directed care in other countries) w1–6x. Often, direct payment recipients will use this funding to design their own support arrangements and hire their own staff—becoming a service commissioner rather than a passive recipient of statutory welfare. Introduced under 1996 legislation, direct payments have since been shown to lead to higher service user satisfaction, greater continuity of care, fewer unmet needs and a more creative use of resources which is able to invest the same level of funding in new and more imaginative ways. As a result of this, direct payments are now a central feature of government policy—they are now mandatory, increasing direct payments is a key government target, and direct payments feature prominently in a recent Green Paper on the future of adult social care. In spite of this, direct payments can only be used in lieu of social care services, and cannot be used to purchase health care. This has recently been reiterated by the government, who seem to be promoting direct payments and encouraging health and social care partnerships on the one hand, while at the same time preventing people from using their direct payments to create integrated packages of health and social care. This is in spite of evidence that suggests that direct payment recipients do indeed use …