Money talks? : direct payments and competing policy discourses
Implementation of the Community Care (Direct Payments) Act 1996 in April 1997 enabled local authorities to make cash payments to service users under the age of 65 with physical and sensory impairments, learning difficulties and mental health problems. This gave users control over money spent on meeting their community care needs rather than receiving services arranged for them by the local authority. The policy is often represented as a victory for the disability movement and as a push towards independent living and social justice. However, direct payments also need to be understood as part of a wider market discourse prominent in the restructuring of welfare. Therefore, a growing culture of localised care markets led by local authorities with increasing ideological diversity may ultimately erode the scope for independent living, choice and control. This thesis examines the impact of these policy discourses informing the planning constructions and user experiences of direct payments in two contrasting areas - one in England and one in Scotland. A third authority - also in Scotland - is examined where direct payments have yet to be implemented and an indirect payment scheme remains in place. In the English authority - 'East Anglia' - findings show direct payments promoted both as part of a wider marketisation of community care and development of independent living services. Implementation has seen a relatively rapid promotion of policy but this is found to be located within wider New Right confines of cost efficiency and accountability. Like East Anglia, the Scottish authority - 'East Scotland' - has also demonstrated a long-term commitment to independent living services and has worked in partnership with the local disability movement to establish a momentum for policy change. However, wider policy use is shown to be restricted by a more dominant anti-market discourse. Similarly for the second Scottish authority in the study - 'West Scotland' - planning fears of service privatisation coupled with limited disability activism and a chaotic aftermath of service reorganisation has resulted in non-implementation of direct payments. By focusing on the impact of these discourses alongside wider controls made by central government, this research examines user experiences of direct payments in East Anglia and East Scotland and indirect payments in West Scotland through a series of semi-structured interviews. Additional information is generated through a discourse analysis of key policy documents and discussions with planners. Whilst findings highlight an overall enthusiasm for both direct and indirect payments, user experiences are shown to be strongly influenced by market and independent living discourses in each area. This has implications not only for individual user constructions of independence but draws more widely on an understanding of collective disability identities.