The risk of users’ choice: exploring the case of direct payments in German social care

Abstract

In this article, we explore the risks associated with direct payments to users enabling them to purchase social care. These payments are intended to enable people with disabilities to make choices and increase their autonomy. However, there is little evidence in the existing literature about the risks involved in direct payments as seen by service users. In this paper, we draw on data from a qualitative study of direct payments for people with disabilities in a federal state of Germany. We interviewed 37 individuals involved in direct payment schemes including individuals receiving payments, care assistants, members of organisations providing care and the administrative officers of the local authorities between December 2011 and January 2014. In this article, we use a governmentality perspective to explore how individuals who received the payments saw and sought to manage the risks associated with the scheme. We found that while users reported that direct payments reduced the risk associated with being directly dependent on the care providers and hence increased their desired selfdetermination, they identified new risks linked to their liability for the transferred money, problems associated with their liquidity and cash flow, challenges presented by budget cuts, and sanctions resulting from violation of norms of 'appropriate use' and the difficulties of negotiating with the funders. To manage these perceived risks users indicated that they had subjected themselves to a new way of active self-control and self-management, normalising their behaviour. We note that risk to service users has been neglected in policy design and should be acknowledged more explicitly. IntroductionIn this article, we examine users' accounts of the choices and risks they face and what effects direct payments and user choice have on them. Drawing on governmentalityinspired research, we conceptualise the reactions of users as a form of active selfsubjectivation -a way of governing through freedom (Rose, 1999). To do this, we draw on data from a case study of user choice around direct payments to people with special needs, ranging from serious physical to mental impairments, in Germany. We show how, contrary to a discourse emphasising choice and freedom, risks shape part of the lifeworld of recipients of user choice. Contributing to governmentality-inspired research on risk, we explore how users in social care subject themselves through selfcontrol and self-management in this context and how risks serve as a springboard for this.

Perspectives of self-direction: a systematic review of key areas contributing to service users’ engagement and choice-making in self-directed disability services and supports

“…Of the 18 articles, 15 were original research papers from Australia (Dew et al . ), Finland (Eriksson ), New Zealand (Espiner & Hartnett ), Germany (Junne & Huber ), the United Kingdom (Mitchell ,b,c, ,b, Kendall & Cameron ) and the United States of America (Heller et al . , Gross et al .…”

“…Nine of the research papers included the perspectives of carers or stakeholders involved with supporting care services, family members and/or service users (Espiner & Hartnett , Mitchell , ,b, Gross et al . , Eriksson , Junne & Huber , Kendall & Cameron , Swaine et al . ).…”

“…, Dew et al . , Junne & Huber , Kendall & Cameron , Timberlake et al . ) where participants might be exposed to risks (Junne & Huber ).…”

Personalised risk: new risk encounters facing migrant care workers

“…Therefore, the point of departure in this article is the sociological inspired concept of 'personalised risk', as framed by personalisation policies that are throwing light on direct employment of care workers more generally. In contrast to researchers' general focus on care user perspectives (see Junne & Huber, 2014;Salami, Duggleby, & Rajani, 2016), we explore the perspectives of those providing social care.…”

“…The care plan setting out these arrangements has to be approved by the funder, the local authority. This policy of increasing user choice and control is designed to promote user empowerment and such aspirations are echoed internationally Junne & Huber, 2014). However, Land and Himmelweit (2010) suggest that personalisation 'takes the logic of privatisation one step further' and argue that 'By putting purchasing power directly in the hands of the care recipient, personalisation takes this idea [the idea of privatisation based on mainstream economic theory] to its logical conclusion' (Land & Himmelweit, 2010, p. 17).…”