As a result, people who would be entirely capable of organising their own lives, and very much wish to do so, cannot live in the freedom that the rest of us take for granted.
However good the intentions of social services staff, they cannot provide services with the same sensitivity, flexibility and precision that disabled clients can for themselves. Local authority employees have to juggle the interests of different clients among all the rigidities that bureaucratic life entails. 'They canna do this, canna do that,' as one disabled person puts it.
Unfortunately, instead of using the opportunity of the NHS and Community Care Act 1990 to abolish the archaic restriction in the 1948 Act, the Government effectively rediscovered and re-emphasised it. Nicholas Scott, the minister for disabled people, was able, however, with the Disablement Income Group, to establish the Independent Living Fund (ILF) as a Government-funded charity to make cash grants to severely disabled people.
As Ann Kestenbaum, reviewing the history of the ILF, found: 'When clients and family carers were asked what it was about their care arrangements that they valued most highly, a number of themes repeatedly emerged: choice of care; assistant continuity; flexibility; respite; self-respect; control and choice of where to live. Those benefits were clearly perceived as being directly related to their ability to pay for care.'
Jane Campbell, a beneficiary, wrote earlier this year: 'Almost overnight I gained full control over my physical and, to some extent, mental being. Can you imagine that until the age of 29 everything I wanted to do, from getting out of bed to attending an important meeting, had to be negotiated? Employing your own personal care assistants places negotiation on a different plane. You are not asking for favours. Whereas my traditional form of help gave me no privacy and was often loaded with what people thought was 'best for me', I now decide my routines and I have an equal say in how my home and family life is run.'
While the case for direct payments has to be made above all in terms of human dignity, the financial arguments point in the same direction. Abundant research shows that direct payments provide better value for money. It cannot be sensible to use the expensive time of social workers to organise the lives of intelligent people who could be doing it themselves. Instead of being assisted by a series of people employed at local authority rates and bound by standardised job descriptions, disabled people would be able to employ just the people they needed and at the best rates they could negotiate.
The local authority would be better able to monitor its expenditure, paying grants into separate bank accounts, scrutinising timesheets, invoices and receipts, and releasing further funds only as it was satisfied that the money was being appropriately used. Not only would accountability be improved, but a single overall cash budget per client, rather than a mixture of cash from the ILF and services from the local authority, could be used more effectively.
The Treasury is concerned that disabled people may use grants to pay members of their own family for care. But the Government already pays Invalid Care Allowance. If modest state grants can enable people to carry on taking responsibility for the care of those who are close to them, that will be supportive of family life and - given the cost of institutionalised care - will be extraordinarily good value for the public purse.
So far, however, the Government has remained resistant. Indeed it has reduced the scope for direct payments. The original Independent Living Fund was closed to newcomers, and the 1993 Disability (Grants) Act has established a new fund on a markedly more restrictive basis.
The non-financial arguments deployed against reform are equally unpersuasive. It was said that it is the job of the Benefits Agency to provide cash benefits and of local authorities to provide services. That is not an argument but a description of the status quo. Nor is it accurate, since local authorities make cash payments to foster parents and to children leaving care, as well as to voluntary organisations. Fear was also expressed of creating administrative 'imbalance', as if the existing bureaucratic structure was a thing of such beauty that its preservation was paramount.
Then it was argued that local authorities would have difficulty defining eligibility for payments, although this is their job under the care in the community policy. In an excess of concern for local authorities, it was said that it would not be right to lay an extra burden on them by asking them to handle cash payments - ignoring their own expressed desire to do so.
Allowing cash payments would cost no money, make possible an enormous improvement in the lives of disabled people and be welcomed by local authorities. How can the Government resist?
Alan Howarth Conservative MP for Stratford-on-Avon.Reuse content