This book provides an excellent introduction to direct payments, split into six sections: setting the scene; policy into practice; voices of experience; reporting from the field; working with direct payments; and developments in direct payments.

The book encompasses varied perspectives and views from disability-led and voluntary sector organisations and researchers to the ‘voices of experience’, documenting the impact of direct payments on individuals’ lives through their personal stories. These accounts outline the liberating impact of direct payments upon each individual's life. For example, Jackie Gelling discusses the difference direct payments made to her life: ‘The difference it has made to my life . . . was nothing short of miraculous . . . Direct payments have revolutionised my life’ (p. 129).

Much research and literature focuses on the experiences of disabled people when using direct payments, with the experiences being largely neglected of those employed by direct payments. Here however, the ‘voices of experience’ includes the ‘voices’ of those employed through direct payments - personal assistants.

The introduction charts the background to the development and implementation of the Community Care (Direct Payments) Act (1996), a piece of legislation campaigned for and pioneered by disabled people, their organizations and their supporters, and allies of independent living. The disabled people's movement embraced the concept of direct payments as a means of promoting choice and autonomy: offering direct payment users the opportunity to determine and control who, when and where support services should be provided. The philosophical principles of direct payments transform disabled people from passive recipients of care services to active agents in their support services as commissioner and employers of such services.

What is clear from the introduction of this policy is the difference in approach to direct payments by the Conservative Government, which was responsible for their implementation, and the disabled peoples’ movement. The Government perceived direct payments as a means of delivering high-quality services on a resource-limited budget. Disabled people and their organisations on the other hand regarded direct payments as a means of promoting and facilitating disabled people's independent living, social inclusion and participation as equitable citizens. It is hardly surprising that the principles and theory of the policy have not necessarily universally filtered through into practice. Indeed, what plays out throughout this book are the consequences of the divergent discourses in very practical terms. For example, individuals over the age of 65 years were initially excluded from using direct payments as it was thought that inclusion of older people would ‘open the floodgates’ (p. 80).

Moreover, the legislation reflected the requirements of those who led the campaign, with high take up amongst people with physical and sensory impairments. Although eligibility criteria has since widened, there remains low take-up from older people, people with learning difficulties, people with mental health problems and individuals from black and minority ethnic communities. Chapters by Val Williams and Andrew Holman, and by Heather Clark describe initiatives to increase the representation of users from under-represented groups and the potential benefits of direct payments for people with learning difficulties and older people respectively. Julie Ridley discusses the suitability of direct payments in their current form for people with mental health problems. Jeanne Carlin and Christine Lenehan explore the take-up of direct payments by parents of disabled children. It is also suggested that social workers lack of knowledge about direct payments may exacerbate low take-up of potential users.

Janet Leece's contribution, illustrates the ‘gap’ between policy and practice played out in the contentious issue of terms and conditions of personal assistants who are often employed on less beneficial conditions than their counterparts in the public sector (p. 200). Due to limited funding for care packages, disabled people are often unable to offer employees competitive rates of pay, sick pay or pensions. A number of unions have raised concerns regarding terms and conditions of employment for personal assistants.

Future challenges and aspirations for direct payments are also included in the book. For example, a more person-centred approach with individualised funding is suggested as a positive future development. It appears that although there is a theoretical commitment to widening access to direct payments, the issue of financial resources is a real threat to the future development of direct payments. Indeed, Frances Hasler suggests that the brutal reality of budgets is pushing direct payments and independent living apart (p. 285). This is of great concern for disabled people because as Jane Campbell notes ‘Personal assistance via direct payments is at the heart of independent living’(p. 130). Frances Hasler goes on to note another potential threat to direct payments and the concept of disabled people living independently with regard to:

A key strength of this book is the diversity of contributions from academics and researchers as well as direct payment users, who bring a richness of experience. I found reading this book incredibly helpful in furthering my understanding of direct payments. I would highly recommend this book to a broad spectrum of readers from academics, undergraduate and postgraduate students, social care and health service providers, direct payment users and personal assistants. Anyone with an interest in direct payments will find this book a useful resource.