Do direct payments improve outcomes for
older people who receive social care?
Differences in outcome between people
aged + who have a managed personal
budget or a direct payment
JOHN WOOLHAM*, GUY DALY†, TIM SPARKS††,
KATRINA RITTERS† and NICOLE STEILS†
ABSTRACT
Direct payments – cash for people eligible for adult social care and spent by them on
care and support – are claimed to enable care to better reflect user preferences and
goals which improve outcomes. This paper compares outcomes of older direct
payment users and those receiving care via a managed personal budget (where
the budget is spent on the recipients behalf by a third party). The study adopted a
retrospective, comparative design using a postal questionnaire in three English
councils with adult social care responsibilities in –. Included in the study
were , budget users aged +, living in ordinary community settings. The
overall response rate was . per cent ( respondents). Three validated scales
measured outcomes: EQ-D-L (health status), the Sheldon–Cohen Perceived
Stress Scale and the Adult Social Care Outcomes Toolkit (social care-related
quality of life). The study found that direct payment users appreciated the control
conferred by budget ownership, but in practice, for many it did not ‘translate’
into improved living arrangements. It also found no statistically significant difference
in outcomes between direct payment and managed personal budget users. The
paper argues that despite policy and other guidance and research evidence about
effective implementation of direct payments for older people, the absence of evi-
dence for better outcomes may at least in part be attributable to values underpinning
policies relating to personalisation and personal budgets.
KEY WORDS – adult social care, older people, personal budgets, direct payments,
outcomes.
* The Social Care Workforce Research Centre, Kings College, London.
† Faculty of Health and Life Sciences, Coventry University, UK.
†† Faculty of Engineering and Computing, Coventry University, UK.
Ageing & Society , , –. © Cambridge University Press
doi:./SX
of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S0144686X15001531
Downloaded from https://www.cambridge.org/core. IP address: 54.70.40.11, on 30 Jun 2019 at 00:25:23, subject to the Cambridge Core terms