This thesis is about direct payments; the name given to cash payments made by local authorities to disabled adults, to enable them to buy their own care. Many people use their direct payment to become an employer by recruiting a personal assistant to provide their support, and it is this direct employment relationship, between disabled adults and their employees, that is the focus of the thesis. The study examines the history and policy of social welfare in Britain showing that the use of cash payments has been a recurring theme in care provision, and is part of an evolving process. The present government has demonstrated ongoing commitment to the radical increase in the numbers of disabled adults accessing user-controlled support, such as direct payments. In order to explore the implications of this policy, a comparison of direct and non-direct employment, using data from open-ended interviews was undertaken.

The study investigates the affect of cash and direct employment on the support relationship in one local authority in England. It uses a grounded theory approach, with two questionnaires to measure job satisfaction and stress, and in-depth interviews with respondents. It explores and compares the experiences of eight direct payment relationships with eight traditional service delivery homecare relationships. The research provides a comparison between direct and non-direct employment, together with an examination of the experiences of both parties in the relationship.

The analysis of the data reveals the inherent complexity of care relationships and shows the importance of the concept of power in helping to understand the impact of direct employment on these relationships.

Key words: direct payments; disabled people; older people; care relationship; support relationship; user-controlled support