Social Care (Self-directed Support) Bill: Final Business and Regulatory Impact Assessment (BRIA)

No financial costs.

Reputational damage to the Government - stakeholders requested legislation and are supportive of it. It is also a manifesto commitment. The framework is a fundamental part of any legislation.

None - there will be no legal provision for self-directed support

This option gives rise to a range of costs associated with transforming culture, systems and approaches to social care provision.

The framework of informed choice and control comprises the main duties within the Bill and looks to facilitate a shift to self-directed support. Academic research supports the view that, in the long term, this shift is expected to be broadly cost-neutral. However, there are significant short term costs associated with the shift to self-directed support, falling within

• transformation (local authorities);
• transformation (care and support providers);
• workforce development (including training directly related to the Bill and wider training/awareness raising associated with self-directed support policy and practice); and
• information and advice.

Of these, only workforce development costs are considered to be a direct cost arising from the provisions - all other costs are considered to arise indirectly, from the wider self-directed support strategy.

Estimating short term costs, particularly those around transformation, involves uncertainty, as they are sensitive to a variety of circumstances. However, the Government has come to best estimates based on the available evidence and has identified a significant transformation budget to meet them. Over the 4 years 2011/12 - 2014/15, projected allocations are as follows:

• transformation (local authorities) £24.12m;
• transformation (care and support providers) £7.1m;
• workforce development £3.77m; and
• information and advice £7m.

The pace of change is important and impacts on the costs involved. Change is already happening in the world of social care and support but it is slow. The Bill aims for significant change but must balance this with cost and effectiveness. A period of 3-5 years for implementation of the Bill is considered to strike this balance.

Strategy workstreams will seek to address issues around workforce, communications and support services, as well as wider issues which the Bill does not address, such as eligibility criteria and outcome-based assessment.

A more detailed breakdown of the costs of this option can be found in the Financial Memorandum which accompanies the Bill and is published on the Scottish Parliament website.

A significant body of research evidence has concluded that people using self-directed support can achieve a better quality of care and support and an improvement in the outcomes which they achieve. Informed choice and control are key to this. Benefits can be identified to:

• Individuals, who can enhance their health and wellbeing through exercising greater choice and control over their support. Self-directed support can encourage and sustain independent living (the principle that all disabled people have the same freedom, choice, dignity and control as other citizens at home, a work and in the community), foster better engagement with the community and provide a greater sense of citizenship. In addition, unpaid carers can benefit indirectly when the person they care for has greater choice and control over their support.
• Local authorities and providers, who have a close interest in delivering high-quality services which respond to and meet individual needs. Self-directed support enables people to have the support that they want, and when and where they want it. It focuses on maximising individual choice and control, eliminating waste and providing a system that is accessible and better suited to the needs of the whole person.
• The public sector as a whole, where good quality, well targeted support can help to reduce pressure on the health sector and those parts of social care services which deal with crisis or emergency assistance. This supports Scottish Government targets for the NHS, and fits with the aims to stay healthier longer and to tackle health inequality.

A framework which ensures informed choice and control achieves the Government aim of making self-directed support available to all yet imposed on no-one.

This option would be likely to considerably increase the costs set out above, as more people would be on direct payments, the most active form of self-directed support. Direct payments require local authorities to have cash available to pay out to individuals - this option, focusing on direct payments rather than any other choice, would therefore require them to have potentially huge amounts of cash available, meaning they will need to liquefy existing assets. This would be much more difficult for local authorities to implement and would have knock-on implications for existing services and those who wish to carry on attending them. It may also be distressing for individuals who find themselves with a direct payment without really wanting one, by virtue of default or confusion, and for carers on whom the burden of managing direct payments may be placed if a supported person is not capable of doing so.

This option therefore carries the significant risk of alienating key stakeholders, who may feel that the agenda is moving too fast. This option was consulted on but rejected by the majority of respondents in favour of a more balanced spectrum of options.

This option has the potential to achieve many of the changes above, by considerably increasing the numbers of direct payments. It would be popular with some stakeholders who, in the light of the struggle that some people currently have to get a direct payment, see this as the only way to ensure that people can be guaranteed one if they want it.

Minimal. This would apply only in a small number of circumstances and would not assist the majority of carers.

In addition, support to carers is already a routine and ongoing cost for local authorities, although it may not be recorded as such. Any spend therefore does not represent increased an financial requirement but a transfer between service types.

Limited. This option allows the local authority to help some carers but limits their flexibility to do so and does not support the preventative agenda. This may in fact be a step back from the current situation, where local authorities already provide support to carers on a flexible basis.

However, any support to carers to help them continue in their caring role can help to avoid or minimise costs that might otherwise have to be borne by the state.

Support to carers is already a routine and ongoing cost for local authorities, although it may not be recorded as such. Any spend therefore does not represent increased an financial requirement but a transfer between service types. The Scottish Government estimates that such transfers may equate to between £2.1 and £5.8m per annum.

Carers centres may face increased demand for their services, if more carers look to them for advice and support. They will be able to access the Government funding allocated to advice and support (mentioned under framework provisions, option 2) to help them manage this demand.

A more detailed breakdown of the costs of this option can be found in the Financial Memorandum which accompanies the Bill and is published on the Scottish Parliament website.

This option supports carers to help them continue in their caring role, which can help to avoid or minimise costs that might otherwise have to be borne by the state.

This option provides a legal basis for what local authorities are already doing, whilst giving them flexibility and discretion to determine the best use of scarce resources. It allows them to help prevent or delay deterioration in a carer's ability to cope, thus preventing or delaying more expensive interventions.

This is a significant extension to existing practice, which may place high levels of demand on local authorities to fund support, which they may not be able to meet. A duty would create an entitlement to support which does not currently exist and may lead to a significant 'woodwork effect' as carers who do not currently receive any support come forward once there is a formal entitlement. This is likely to be on a lesser scale to Free Personal Care, but may still be significant - approximately 1 in 8 of the Scottish population is a carer and therefore potentially eligible.

Local authorities would incur costs in coping with increased demand. They would also require eligibility criteria and guidance which in practice may reduce access to support to all but the most in need - this would reduce the ability of local authorities to support low-level preventative interventions.

Increased costs would also be likely to arise through increased take-up of carers assessments. It is difficult to judge how many more might be required, but as an assessment is the route to support, it is reasonable to suggest that this might be significant.

This option recognises the importance of carers and the value of their role.

It supports carers to help them continue in their caring role, which can help to avoid or minimise costs that might otherwise have to be borne by the state. It allows them to help prevent or delay deterioration in a carer's ability to cope, thus preventing or delaying more expensive interventions.

No financial costs.

Reputational damage to the Government - stakeholders requested legislation and are supportive of it. It is also a manifesto commitment. Not consolidating and modernising the duties in relation to direct payments in the Bill would fail to address the issue of duties being spread across different pieces of legislation - in fact it would make it worse.

None - duties in relation to direct payments would remain unchanged, unclear in places and spread across different pieces of legislation.

Minimal. For the most part, the consolidation and modernisation of existing legislation has no cost, except in terms of staff resource, and this would be restricted to legislation relating to direct payments.

Contained within this section of the Bill are regulation making powers. The extent of any regulations to be laid has yet to be determined but may include:

• The ability to employ a close relative in certain circumstances. This simply replaces costs that would otherwise be incurred through the provision of services.
• The ability to choose whether to receive a direct payment gross or net. Payments on a gross basis incur administrative costs to local authorities. However, for most people net payments are more convenient and it is not anticipated that significant numbers will choose to take a payment gross. Therefore, the cost impact is assessed as minimal.
• Direct payments for residential accommodation. This may have some effect on the National Care Home Contract. However, any regulations on this matter would need to be consulted on and known far enough in advance for negotiations to take them into account.

A more detailed breakdown of this option can be found in the Financial Memorandum which accompanies the Bill and is published on the Scottish Parliament website.

Modernising and consolidating legislation makes it more user-friendly for supported people and their carers. Much of the existing law on direct payments is over 15 years old. Bringing it together in one new Act and updating it provides clarity to all who need to refer to it.

This would be an extremely lengthy and complex process, and therefore potentially very expensive for the Scottish Government, local authorities and the wider support sector in terms of staff resource. Social care legislation is wide-ranging and wide-reaching and the results of such a review cannot be predicted, meaning that potential costs are unknown.

This would allow policy-makers, professionals and supported people to ensure that all social care legislation is fit for purpose and to introduce modern social work ideas and terminology.

No financial costs.

Reputational damage to the Government - stakeholders requested legislation and are supportive of it. It is also a manifesto commitment. This area was a key concern of stakeholders, who wanted to see some action on it.

None - retains the status quo for now, which may please some and will save on training and awareness raising costs. However, health and social care integration is a key manifesto commitment for the Government and doing nothing would be ignoring the inevitable, as well as failing to take the opportunity to ensure that self-directed support is embedded in any future changes..

Costs are associated with the training and awareness raising implications amongst NHS staff, particularly those who are most likely to undertake social care assessments, or joint assessments, under the delegated power. Unlike local authority staff, no prior knowledge of self-directed support can be assumed and therefore awareness raising will need to address their specific needs and take account of the cultural shift requires. Development of relevant modules is already underway. Costs for delivery of the training are estimated at £0.73m.

A more detailed breakdown of the costs of this option can be found in the Financial Memorandum which accompanies the Bill and is published on the Scottish Parliament website.

This ensures that self-directed support is part of social care assessments, whoever carries them out. It is also compatible with the future intentions of the health and social care integration agenda and the forthcoming Bill - this is an amendment that should not need to be changed in that Bill. Although it is not as clear a statement of intent as option 3, statutory guidance accompanying the Bill would be able to expand on the intentions behind this provision.

Costs would be associated with training and awareness raising amongst NHS staff, as above, but it would also require additional awareness raising for local authority staff.

The forthcoming Health and Social Care Integration Bill, whose content is currently being discussed, will address the joint working issue and therefore a provision like this risks becoming obsolete very quickly if the new Bill makes different provision.

This would be a vey clear message to stakeholders that the Government is serious about encouraging joint working between the NHS and local authorities.