Adapting to the culture of user control?

In February 2000, local authorities were empowered to extend direct payments to older people who were eligible for a community care service. Direct payments put the control of support arrangements into the hands of service users and are a major means towards independent living. In 1999 one local authority social services department decided to pilot a scheme which they hoped would sufficiently emulate direct payments as to provide learning points for their extension to older people. Importantly the scheme was to instigate a shift in the culture of care management to enable greater user control. This paper discusses care managers' reactions to the change and in particular: i. their initial difficulties in taking ownership of the scheme because of pressures of time and work, and their anxieties about how to offer it; ii. their concerns about how to apply the 'willing and able' criteria; and iii. the tensions they perceived between promoting user empowerment and protecting users from 'risk' and exploitation, and between meeting individual needs more creatively and flexibly versus ensuring equity for all. Many of the issues raised are transferable to the direct payments scenario and to other initiatives geared towards user control. Few of the care managers had experience of working with independent living schemes, and the paper will identify barriers and point to some of the training needs of care managers if direct payments are going to be a real option for older people.