Current projects
Direct Payments in Residential Care evaluation
Direct Payments in Residential Care evaluation

Direct Payments (DPs) have become a key mechanism for delivering social care support aiming to offer greater choice and control to people in need of social care. DPs have been used in community care for a number of years, but people living in residential care homes have not had access to DPs so far. The Government has decided to expand this approach to care homes from April 2016 and initiated a Trailblazer programme to test DPs and learn from the experience prior to DPs becoming national policy. Eighteen local authorities have volunteered to participate in the programme and its evaluation.

The evaluation will include the following elements:

  • A process evaluation will aim to understand the different ways in which DPs are being offered to residents of care homes and how any challenges to implementation can be overcome.
  • An impact evaluation will assess the potential effects of DPs on care home residents and their families, care homes and the local care home market, and on councils and their staff, such as care managers.
  • An economic evaluation will examine the costs and cost-effectiveness of different approaches to providing DPs for residents, their families and the local councils.

PIRU first carried out a scoping study aimed at understanding how each trailblazer site is approaching the implementation of DPs in residential care and what problems sites have encountered at the early stages of the trailblazer. It also included a rapid review of the evidence on the costs and benefits of similar ‘cash for care’ schemes in social care in the UK and elsewhere. This work resulted in a preliminary report to the Department of Health in November 2013.

A report with interim findings was completed in January and released for publication in March 2015. The report analyses data collected over twelve months (January to December 2014). During this period, 4 sites dropped out, leaving 14 sites in the programme. The data comprises self-completion questionnaires from service users, or their family members, who had either accepted or declined a direct payment; interviews with trailblazer project leads; and interviews with providers.

At the end of November 2014, 35 questionnaires had been received from users and family members, including 9 questionnaires from users who took up a direct payment, 3 users who declined a direct payment, 6 from family members of users who took up a direct payment, and 17 from family members of users who declined a direct payment. Early findings from the survey include:

  • The majority of service users who accepted a direct payment were very or fairly satisfied with the direct payment processes.
  • The majority of family members of users who accepted a direct payment were also very or fairly satisfied with the direct payment processes, but rather more were fairly satisfied and fewer very satisfied than service users.
  • Among service users, or their relatives, who declined a direct payment, the most common reason was that they were already resident in a care home and happy with their current arrangements. The next most common reason among relatives was that it would not give the user more choice and control.

Early findings from the interviews with project leads (n=14) in all sites and care home managers and owners (n=8) in selected sites were:

  • Project leads were supportive of the aim of the trailblazer programme to test the potential of direct payments to create more opportunities for choice and control for residents of care homes. However, they also raised concerns about the feasibility of direct payments to improve choice and control, especially for older people. There were also concerns about the potential impact of direct payments in local care home markets.
  • Project leads reported problems of operationalising direct payments in residential care in the absence of a practicable mechanism to determine the monetary value of direct payments. Three ‘models’ of such mechanisms have been developed in the trailblazers: model 1 is based on a resource allocation system as it is already used in community care; model 2 uses the existing fees currently charged by care homes; and model 3 offers direct payments in the form of a small sum paid by councils in addition to the existing fee. Models vary in how they distribute the financial risks between councils and care homes, and in the extent of choice and control they are likely to offer to service users.
  • Care home managers and owners expressed substantial concerns about the financial viability of direct payments if this involves identifying flexibility within existing budgets. Managers and owners were also sceptical about the ability of direct payments to promote choice and control, with some arguing that person-centred care in residential settings should be embedded in routine practice in other ways and may not be achievable through providing the option of direct payment for people with high dependency.

The final report of the evaluation was published in April 2017 and can be accessed here>>

Daniel Lombard describes some of the findings from the pilot evaluation in this LSE PSSRU blog. Read more>>

The article "Will Direct Payments make adult residential care more personalized? Views and experiences of social care staff in the Direct Payments in Residential Care Trailblazers" was published online in December 2016. The article can be accessed here>>

A second interim report of the evaluation was released for publication in December 2015 and can be accessed here>>

An interim report of the evaluation was completed in January and released for publication in March 2015 and can be accessed here>>

The evaluation team conducted a scoping study of DPs in residential care in 2013. A preliminary report was provided to the Department of Health in November 2013. A copy of the report can be accessed here >>