ABSTRACT

Direct control of cash, or the voucher, is not a new principle for the NHS. But when direct incentives have been used even with the limited approach that relatively small cash payments out of pocket represent research has demonstrated that significant changes in behaviour occur, as the well-known Rand Corporation Study showed as long ago as the 1980s. It will be compulsory for local authorities to give older people a choice between provision of services and a cash grant that can be used to pay a relative or alternative home help. The disabled and the elderly can now buy social services direct, instead of just taking what they are given by Social Services departments. They provide information, and offer advocacy, peer support, advice and training in getting the best from the new system. The mutual-aid organisations offers the revival of old co-operative and working-class traditions and the legitimacy of individual choice.