ALISON NAPIER

TODAY, just for a change, I chose a tuna sandwich instead of egg and cress. Yesterday evening I chose to read a novel rather than watch TV. Some nights I'll watch Channel 4 news instead of Emmerdale. Choice can be good. It's OK and usual to have preferences. Each day brings different desires and needs.

However, there are some areas of life where I don't want a choice. I don't need 13 different soap powders to keep my clothes clean and I don't need seven different TV listings magazines to find the weather forecast or Heroes. Only one that does the job well and meets my needs. That'll do.

I like to feel empowered as well (that's a social work word which probably means the opposite of powerless). Sometimes, choice doesn't make me feel empowered, though, it just makes me tired. Being respected makes me feel empowered. Having my views and opinions listened to does that, too.

Mrs Thatcher was in power a long time ago now. We acquired bargain basement shares in utilities and bought our council houses for a song. We created thousands of small businesses, now scattered across the land. Be your own boss. Be empowered.

All these years later, who would have thought that direct payments - a much-trumpeted flagship policy of our over-stretched social services - would clutch at these very same sentiments.

Pick and mix a collection of buzz words and - jings - a system where, no matter how frail or disabled or disinclined or disillusioned you may be, you too can be an employer, be your own business.

You too can have a staff, select them, pay them, learn about tax and superannuation and public liability insurance, sort out holiday and sick-leave cover when they are off, sack them if they're rubbish, see them in court if they feel they have been unfairly dismissed.

Ooh, lots of new skills to learn, and all by yourself because the under-resourced charity that was set up to help you just lost its funding. Careless wee organisation.

The argument goes something like this (and forgive me if I have got this wrong, but every time I hear it a red fuzz of rage crackles across my brain and drowns out the details): you can choose who provides your care, and you can employ them, even make up the advert and do the interviewing - but not if you are 85 with severe Alzheimer's, maybe? - and that will make you feel empowered.

And the local authority will give you the money it decides you need (based on the local authority's assessment, not your own) and you can spend it as you wish,within a range of very reasonable limits.

But stop. Is this really what people want? Some, yes. And I have nothing but praise for those who make it work for themselves.

Direct payments sometimes work. I don't deny this. They work particularly well for younger physically-disabled people and for those people with professional family members to do the paperwork. They also work well when there is a local organisation able to advise and assist.

But sometimes, crucially, they don't work. Social workers are urged, indeed duty-bound, to promote them, to encourage even older people with dementia to become an employer for perhaps the first time in their lives.

It is these others I am deeply worried about. People such as Maureen, who got a head injury after a cycling accident eight years ago. She lives at home and is supported by her sister and a team of carers financed through the Independent Living Fund and direct payments.

Recently she had to go into hospital and, following complications, had to remain there for four months.

Her carers could be paid only for the first four weeks and then they had no income. Maureen is being sued for constructive dismissal. The outcome is unknown, but it's stress she certainly does not need.

And there are people like Mrs Johnson, holding down a job while her profoundly disabled son, Donald, "employs" carers through similar funding. He was overpaid for a year and nobody noticed. Mrs Johnson has given up her job and stopped the care, and is looking after her son herself and repaying the debt from her benefits.

If I was unwell or disabled or "just" old and frail, I would want to encounter a minimum of obstacles to leading a fulfilling life.

In my opinion, this type of semi-devolved care is passing the buck. It means that, for some people, their carers do not have the experience or training to do the job. Nor do they have access to on-going training to improve and develop their skills.

Their employer may not have the knowledge or the confidence to identify either training needs or failings in their employees' work.

Their employer may not know how to sack someone, particularly when the person needing sacked is the person dressing them, opening their mail and taking them to the toilet.

This is a crazy and irresponsible way to provide care and support to people. An adequately-resourced social care system should be able to provide workers that the service user is happy with, at times that the service user wants, to be flexible.

If there were particular individuals that the service user wanted as his or her carer than the local authority could employ them. Train them. Give them the full range of access to policies, procedures and skills that have been built up over decades and use that to provide a first-class service to a disabled or ill person and, vitally, to the carer.

If I am ever ill or disabled and dependant on a high level of help for my personal and social needs, please do not ask me, for the first time in my life and at a time when I may feel extremely low and anxious, to become an employer and set up a small business.

Provide me with a high-quality service instead, leaving me to use my remaining skills and abilities for matters other than employment law and public liability insurance. I promise that being considered someone who is worth providing a high-quality, flexible service to will make me feel empowered and respected. I will trust you. And I can reserve my decision-making abilities for the things that really matter.

Some people might call this scary socialism and accuse me of dinosaur tendencies. I call it genuine and respectful care, and I do not want to use social work service users in a crude social experiment simply to prop up a discredited but still-fashionable ideology.

Alison Napier is a senior social worker in the north of Scotland. In this article, names and situations have been changed.