Direct Payments
Priorities, Choice and Control in Care
About the Project
This report presents the findings from the first phase of engagement undertaken to inform Wiltshire Council’s work on the future direction of Self-Directed Support (SDS), with a particular focus on Direct Payments (DPs) as the main way in which people currently experience self-directed approaches in practice.
Participants included people using Direct Payments, people who had declined them, unpaid carers (including parent carers and spousal carers), and professionals supporting the delivery of SDS and DPs. Together, this provided a rich and consistent picture of how self-directed support is currently experienced across Wiltshire.
Key Findings
Direct Payments can work extremely well when people receive clear information, timely support and consistent guidance. Participants described Direct Payments as enabling choice, control, independence, continuity of care and more personalised support.
However, experiences across Wiltshire were highly variable. The findings show that the benefits of Direct Payments are not always realised because people often face unclear information, inconsistent guidance, administrative burden, recruitment challenges and delays.
When Direct Payments work well, they can support dignity, independence, flexibility, continuity and genuine choice.
People valued being able to shape support around their own lives, routines, relationships and needs.
Strong relationships with practitioners, Personal Assistants and support services made a significant difference to people’s confidence and experience
Clear, accessible information at the outset was essential, but many people did not receive this consistently.
Confusion between Self-Directed Support and Direct Payments created uncertainty
Practitioner knowledge and confidence varied, leading to mixed messages and unequal experiences.
Administrative and employer responsibilities placed significant pressure on individuals and unpaid carers.
Recruiting and retaining Personal Assistants was difficult, particularly in rural areas or for specialist and unsocial-hours care.
Delays in financial assessments and unclear processes created anxiety about debt, unspent funds and disrupted care.
Reviews and reassessments were experienced by some people as intrusive, repetitive or insensitive.
Direct Payments Report
To truly understand the impact of Direct Payments, we engaged in meaningful 1-to-1 conversations with individuals, carers, and professionals across Wiltshire. These personal stories and experiences provide a rich, nuanced picture of self-directed support in practice. To hear the voices of those with lived experience, download the full report.
For questions about the report, please email: voice@communityfirst.org.uk
“Direct Payments let me shape support around my life, not the other way round.”
“The questions don’t change even though my condition never will.”
“I didn’t arrange the care because I was terrified of getting a massive, backdated bill.”
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