Direct payments have moved to the heart of the government's drive for increased user choice. At the same time, implementation has remained disappointing. This article explores the demand, supply and related factors associated with patterns of local variability in uptake and intensity of care package provision. Statistical analyses are conducted for key client groups – people with physical disabilities, older people, people with learning disabilities and people who use mental health services – using data for England from 2000–01 to 2002–03. The results suggest that direct payments variability reflects a complex array of factors, both within and beyond the control of local public actors. In particular, while local policy preferences appear to shape the extent of direct payments growth, the results also demonstrate that understanding levels of activity requires attention to local circumstances.

I see direct payments, personal cash budgets, and other ways of extending choice and control as key to developing social care for the twenty-first century (Parliamentary Under Secretary of State for Community Care, Department of Health, 2004).