Follow-Up Evaluation of Self-Directed Support Test Sites in Scotland

2 ORGANISING TO IMPLEMENT SDS

Introduction

2.1 In this chapter, we examine the post test site organisational arrangements and structures put in place by local authorities and partners to ensure increased access to SDS. This includes revisiting the theme of leadership and investigating how the local authorities were progressing SDS implementation. During the test sites, the local authorities created specialist SDS/personalisation teams and these have continued in some form, although their role and remit, as well as their locus within organisational structures and networks, had shifted since the test site period. We first revisit and summarise key organisational features of the test sites, and move on to consider how these had developed one year on. We explore perceptions of partnership and joint working, the changing role and remit of the SDS teams, the extent of SDS implementation, specifically addressing the issue of the integration of SDS and DPs.

Test Sites

2.2 This section begins by summarising the main elements of organisational structures operating during the test site period before examining how organisational arrangements and resources developed in the follow-up period.

Table 2.1: Summary of key test site structures, approach and reach

	Dumfries & Galloway	Glasgow	Highland
Structure	Personalisation Team managed by Senior Social Work Manager for Wigtownshire. Reporting to Executive Group and multi-agency Personalisation Programme Board	SDS Team managed via Head of Mental Health and Adult Support & Protection and Assistant Director of Social Care, Reporting to Health and Social Care Policy Development Committee	SDS Team managed by Head of Children's Services Reporting to SDS Project Board mainly of local authority staff
Approach	Part of existing plans to implement Personalisation; Community development; organic; bottom-up; Developed separately from DP	Built on IB Pilot in East Glasgow with people with learning disabilities; Partnerships with voluntary organisations Developed separately from DPs	Specifically aimed to increase number of DP recipients; Significant number of one off payments Developed separately from DPs
Reach/scope	Adopted open criteria with test site initially covering Wigtownshire but covering whole of region before end of test site	Targeted at people with learning disability in East of City but expanded before end of test site	Targeted at young disabled people in transition. Not geographically focused

2.3 Details of the SDS or Personalisation Team established by each test site were given in the previous report and so will not be repeated here (Ridley et al, 2011). In short, the composition and role of teams differed across sites, although each had created a project manager role. These specialist teams had been both instrumental in developing new SDS systems and provided expertise and assistance to frontline staff. Some had been directly involved in assessments alongside frontline staff (Dumfries & Galloway and Glasgow) and others, being more of a resource for care managers and others to draw upon in implementing SDS (Highland). During the test site, the SDS teams piloted new ways of working and were centrally involved in creating, and fine tuning, assessment and resource allocation processes. Indeed a significant proportion of staff time had been spent on this. Notably, all 3 teams had been set up in parallel to existing arrangements to deliver DPs, and at the end of the test site declared their intention to integrate these functions/processes.

2.4 The test sites started from different points, and while the intention in Dumfries & Galloway was to build on a strategy for personalisation, and in Glasgow to promote SDS starting from an initiative about IBs, Highland specifically planned to increase the number of DP recipients. Although it had been the Scottish Government's intention that the test sites would be local authority wide, the focus was on particular geographical areas. Furthermore the reach of initiatives was limited to specific target groups except in Dumfries & Galloway.

Transition from Test Site

2.5 During the follow-up period, all 3 local authorities were engaged in programmes of major reorganisation and modernisation of social care services with SDS being central to these programmes. These changes can be seen as enablers and/or barriers to the wider implementation of SDS, particularly in the context of significant budgetary constraint on public services. In Highland, a key change was the integration of Highland Council and NHS Highland services through a partnership agreement^[1], while in both Glasgow and Dumfries & Galloway major structural reorganisation of social work departments into localities and/or under new responsibilities was taking place.

2.6 Even prior to the end of the test site, integration of local authority and NHS services was a major preoccupation in Highland, which various stakeholders including senior management considered, had slowed down the processes of cultural change needed to implement an SDS approach. Furthermore, it was suggested that underlying differences between approaches, practices and culture in health and social care were challenging to the implementation of SDS. In Dumfries & Galloway and Highland, stakeholders involved in the roll out of SDS identified that a period of reflection, of taking stock, happened immediately following the test site.

2.7 Even before the end of the Glasgow test site, the Council had embarked upon an ambitious service change programme to implement SDS across adult care services and of service modernisation^[2]. Culture change was seen to be critical to realising these intentions. Despite its early strategic start, the scale of the programme suggests an elongated and stressful transition period. SDS policy and strategy matters have been a focus of the Council's Health and Social Care Policy Committee since the dissolution of the 5 Community, Health & Care Partnerships (CHCPs) in 2010 with subsequent restructuring^[3]. Another area of change relates to the Council's charging policy for non-residential services^[4]. Those interviewed in Glasgow described the situation after the test site as "an endless series of meetings" for staff at all levels of the Council and across partner agencies, all of whom were said to be spending much more of their time on SDS, reflecting the scale, complexity and phasing of the programme of implementation.

2.8 In contrast, interviewees from Dumfries & Galloway reported a "hiatus" in the months immediately after the test site. Modification to the strategic infrastructure supporting development of personalisation in the local authority meant that for a short while the Personalisation Team became the hub of activity on personalisation. The Programme Board set up under the test site was disbanded after March 2011. A key shift had been the transfer of responsibility for leading implementation from a centralised Executive Group and Personalisation Board to 4 Locality Teams. Social Work was also restructuring its service along 4 related activity streams - integration; community engagement; personalisation; and early intervention. The focus on enablement and early intervention and prevention was identified as enabling a move from crisis only responses. Whilst this restructuring was perceived as complementary to promoting SDS, there were at least two key stakeholders who commented that this was in parallel to, and had slowed the pace of, SDS implementation.

Implementing SDS

2.9 Evidence gathered through interviews as well as documentary analysis showed that in all 3 sites there were determined attempts to embed SDS as the mainstream approach in social care as a result of the test site activity. Rolling out personalisation across Dumfries & Galloway was said by the Personalisation Team and senior management to be the way Social Work was moving forward now and in the future^[5]. A high level of commitment to the SDS agenda from elected members, Chief Executive and the Director of Social Work in Dumfries & Galloway was commented upon by several interviewees. However, despite reports of strong strategic leadership from the top and support from the Personalisation Team to develop new approaches, it was remarked that SDS was "still not on a lot of managers' radar" and that some were not even aware of the national SDS Bill. In the midst of a broader 'change agenda', personalisation was described by some of those more closely involved as "drifting", which suggests the need for more joined up polices and legislation. These broader concerns appeared to leave the Personalisation Team feeling isolated during the transition period. Without this team, some remarked that SDS would have "died a death". Indeed, other stakeholders saw the team as very important and one senior manager described them as "tireless in mentoring, enabling, facilitating" the SDS agenda forward.

2.10 In Glasgow, where SDS was promoted with high level corporate support, SDS was perceived by many of those interviewed including those in the third sector as a "top down development" with the SDS and Finance Teams being valued key resources for implementation. "Whole systems change in adult services towards personalisation" was typical of how most interviewees described the change that had taken place in social care services since the test site. Yet whole system change was not perceived by all stakeholders in a positive light, with communications highlighted as being problematic (SCSWIS, 2011). Social workers and care managers responding to our survey stated that SDS had become the default position of the local authority to the extent that opting in was not a choice. The scale of implementation of new SDS systems was said to have been a "jolt to the system" and a "huge journey" for many including the finance team who had had to increase in number in order to process the high volume of cases. The financial framework, governance and legal processes, as well as information technology (IT) had all faced major challenges. Third sector organisations have been forced to change rapidly too, for example, Glasgow Centre for Inclusive Living (GCIL)'s role had widened beyond physical disability to assist people with mental health problems and other disabilities. Service providers have been required to establish new internal systems and liaison arrangements and keep up-to-date with sometimes fast changing elements of the SDS process to meet targets.

2.11 The scale, direction and momentum of change to implement SDS in Glasgow were highlighted as major issues inhibiting positive implementation. Frontline workers stressed the pressure they faced to rush through assessments to meet targets. The pace of the SDS implementation programme was also criticised by various third sector providers and interest groups working across different client groups, who felt that the shift to SDS was being progressed too fast. While many recognised that the Council supported personalisation in principle, some perceived financial objectives rather than values to be a key driver of the time-scale, particularly given the Council's expectations of a 20% redirection of resources. It was also emphasised that compared with the test site period there was insufficient scope for creativity and choice in support arrangements. These concerns encouraged the Council to establish an independent scrutiny panel which has met 3 times, to address concerns about the programme, aspects of the process, as well as positive outcomes. For example, a city-wide network representing social work service users' interests, affirmed their appreciation of the rollout of SDS and referred to SDS as "working well" in terms of increasing choices for people previously on DPs^[6]. However by March 2012, the Council had agreed an amendment to a motion put by the Green Party to stop or slow down the SDS roll-out, whereby the Council recognised "overwhelming concern" from service users, carers, and staff, and accepted the need for a "full and open review"^[7]. Additionally, the Council committed to reviewing its communications and commissioning strategies in regard to SDS and to maximising consultation on these^[8].

2.12 The Council's leadership is therefore, fully aware of these reactions and has confirmed its commitment to personalisation and to engaging in dialogue with the trade unions and providers to improve communications, and made some notable adjustments such as slowing the programme and publicising Scrutiny Panel minutes. Providers also reported that the Finance and SDS teams have worked on adjustments to address issues faced and raised. It should be noted that the concerns highlighted about the speed of the programme reflect the findings of the recent study by the Social Value Lab (2012). One year after the test site, Glasgow had therefore has established a number of mechanisms for consultation, dialogue, reflection and problem-solving including: a Progress and Process meeting of social work staff and managers; other meetings with providers; as well as the Scrutiny Panel. In addition its Communications Strategy is undergoing review.

2.13 The stated overarching policy direction in Highland was that SDS was the anticipated approach throughout the organisation^[9]. Commitment to implementing SDS was perceived to come from the top, and as in the other areas was reliant on the work of the small dedicated SDS Team to 'spread the word' and lead change towards self-directed and outcomes-based assessment. Several stakeholders including senior managers in Highland, and those directly involved in implementing new SDS systems, commented that senior management "get SDS", and emphasised the helpful leadership from the top to ensure implementation. The impression gained from stakeholder interviews was that the momentum of change had definitely increased since the test site and the focus of the approach had shifted from a targeted group to encompass broader adult care groups and older people. However, survey respondents from Highland reported the lowest average inclusion of clients opting for SDS (8%) in their caseloads, as well as having the lowest engagement of care managers in the survey on account of the survey not being relevant to them. This would suggest that the reach of SDS implementation was somewhat slower than anticipated.

Joint/Partnership Working

2.14 A feature of the test sites was that inter-agency and partnership working was common, particularly with voluntary sector learning disability providers, in the strategic development and practical implementation of SDS. However, since the test sites, various stakeholders interviewed suggested that effective partnership working had declined. In some cases, mechanisms and structures for strategic involvement of different stakeholders created during the test site no longer existed. Third sector interviewees in Dumfries & Galloway, particularly those involved in advocacy, pointed to a decline in meetings about SDS with the Council post test site in contrast to when they had been part of the Personalisation Programme Board. The voluntary sector had thus been proactive in developing forums and support to promote SDS in Dumfries & Galloway such as the Special Interest Group (Learning Disabilities) set up by Action for Real Change Scotland (ARC) in collaboration with Turning Point, Capability and others. A positive development since the test site was that there was now voluntary sector representation on the Council's Adult Protection Committee. Also, good joint working links with providers and advocacy organisations were in evidence in respect of individual cases and developing support packages.

2.15 The Social Care Ideas Factory (SCIF), an umbrella membership group for providers in Glasgow, was said to be actively involved in taking SDS forward through partnership working, driving initiatives such as trades swapping, strategic information provision, training and consultations. However, some providers did not feel fully or well represented. Although there were many tiers and types of meeting including regular meetings with commissioners, finance staff and the SDS Team, and Council officers' attendance at collective meetings of service users, providers felt increasingly excluded from strategy development since the test site. Just as in the other 2 sites, third sector providers in Glasgow commented that partnership working between providers and the Council was not working as well as in the past - "it's become about 'them and us'", and others said "joint work is patchy" and " we don't have a shared vision and approach". More recently new consultation mechanisms were being established between the Council and providers^[10].

2.16 Involvement of service users and carers in the strategic development of SDS was generally felt by voluntary organisations, including advocacy services, to have been disappointingly slow. While this applied in Glasgow, it emerged that there was increasing dialogue between the Council, carers and disability organisations over SDS, and as highlighted earlier, a city-wide service user network stressed its partnership working with the Council. One advocacy organisation that had built up expertise in representing people in Phase One of the SDS implementation programme felt that dialogue with the Council had improved through this experience, while others had not yet developed a strategy for advocacy in the area.

2.17 It appeared that the role of advocacy in regard to personalisation was emergent and re-active, and somewhat under-developed in Dumfries & Galloway. The lack of a user-led support organisation such as a Centre for Independent/Inclusive Living as operates in Glasgow was noted by stakeholders as a significant gap in Highland. In Dumfries and Galloway, Direct Inclusive Collaborative Enterprise (DICE) was established with Scottish Government funding to address this gap. In Highland, an SDS user network that was at an early stage of development at the end of the test site was said not to have progressed much in the following year. Reasons posited included the difficult logistics of remote rural areas with more people from Inverness participating than other areas: carers being unable to participate due to pressures of the caring role; and service users and carers not perceiving participation in such a network as valuable. What had been highly successful, however, was implementation of Community Connector posts across Highland in 8 areas. These were posts tasked with working with communities to promote SDS and to focus on developing community capacity. As will be noted in a later chapter, the Health and Happiness organisation, commissioned to support individual planning and employ Community Connectors, was an important part of Highland's promotion and implementation of SDS.

SDS/Personalisation Teams & Role

2.18 In all 3 local authorities a specialist SDS or Personalisation Team had been retained post test site. Composition of the teams was, however, different. Dumfries & Galloway was the only test site to have retained the same team managers throughout and incorporated new staff roles for example, Neighbourhood Link Workers, local area coordinators and development workers from the short breaks team. In contrast, both Glasgow and Highland SDS teams had had a change of team manager/lead either just before or immediately following the end of the test site, and were primarily comprised of experienced social workers or social care workers. In Glasgow, members of the team had clear geographical responsibilities but this was less so in the other areas.

2.19 Comments were made by various stakeholders about the demands made on small specialist teams in moving from targeted pilots to mainstreaming SDS. Local authority staff and external providers in both Dumfries & Galloway and Glasgow commented that the teams' capacities to provide support had diminished after the test site due to their increased coverage and related demands. However, in Highland comments typically emphasised how the team had gone from strength to strength post test site, partly as a result of merging with the DP Team in April 2011. However, increased take-up is likely to place additional pressure on this team. Whereas the Dumfries & Galloway and Glasgow teams had been well established during the test site, in Highland the team had been consolidated in this follow-up period, which appeared to have improved staff morale and increased its effectiveness overall.

2.20 During and after the test sites, the specialist teams provided training, mentoring and support to frontline staff implementing SDS. Support generally meant encouraging and facilitating the development of new practices and approaches. However since the test sites, the teams have varied in the level of direct involvement with individual cases, including in assessment, that is, in the extent to which they were strategic and/or operational. For instance, the Personalisation Team in Dumfries & Galloway remained directly involved in individual cases, while the Glasgow team's role evolved from having had a limited involvement in care management alongside their wider role in supporting care managers to being predominantly about supporting care managers with new systems and approaches. This included support with completing SDS forms and IT systems.

2.21 A central role identified by all the teams was delivery and coordination of training on SDS approach and systems more of which is covered in the next chapter on promoting SDS. This could range from brief awareness raising sessions to staff and service users to delivering training on the In Control approach alongside external consultants. Additionally, some mentioned SDS staff increasingly undertaking a 'troubleshooting' role, for instance, in Glasgow the team were frequently asked to be involved in particular cases and/or to attend Risk Enablement Panels (REPs) which focus on complex cases and concerns arising through the support planning process^[11]. The increased frequency of REP referrals during the initial phase of the Glasgow rollout (the learning disability provider pathway) skewed organisational resources (personnel and time) but are reported to have declined since the care management pathway was embarked on. The Glasgow City Council's own Scrutiny Report reported that only a few of the 800 service users currently going through the learning disability care management pathway had been referred to REPs^[12]. It also emphasises that Social Work is committed to ensuring regular reviews of support/care plans.

2.22 Specialist teams, particularly team managers, provided strategic input and consultancy on SDS: a role they undertook during the test sites. In acknowledgement of this, management of the team in Dumfries & Galloway had been split between strategic and operational management, and the roles of both team managers in Glasgow and Highland were now described as developmental (including systems, procedural framework, initiatives; responsive internal consultancy re SDS process; on-going support to care managers/ assessors on SDS process; training; participating in relevant joint meetings and joint working) rather than operational. The role was also defined as a mediating role between policy and planning and operational staff. While there were benefits from having an established team, it was suggested by senior management and the teams themselves that as social work teams become increasingly skilled in supporting SDS, the role for a specialist team would diminish. However, they found it difficult to predict when this might be as they were still very much in demand.

2.23 Frontline workers responding to the survey expressed some confusion over their own role in relation to the specialist team in promoting SDS, although most understood the teams' support role in helping to mainstream SDS. Personalisation champions had been identified in one of the locality teams in Dumfries & Galloway. This was presented as a positive development, though some frontline workers were concerned that some staff had been reluctant volunteers who were not experienced or confident enough to be effective. Champions were also trialled in Highland but this was abandoned as it was felt that too much responsibility for SDS was invested in individuals. In Glasgow, the roll-out meant that engagement with SDS and links with the SDS team were increasingly dispersed within area teams.

2.24 Although there were differences in role between the teams, they had commonly experienced increased demands on their time and were now expected to work across the local authority and all client groups. As a result, the specialist teams themselves expressed feeling hard pressed at times, which was something that area team members acknowledged alongside considering them to be an essential resource.

2.25 What had shifted was the accountability and line management of the specialist SDS team so that they were now more embedded in mainstream services. In Dumfries & Galloway the Personalisation Team is managed under Frontline Improvement and tied in to the development of the 4 themes, whereas during the test site they had been aligned with just one area but spread to cover the whole region before the end of the test site. In Highland, the team is now managed within Modernisation of Services and accountable to the Change Support Team leading service modernisation rather than linked to the Children's Services Manager as it was under the test site. In Glasgow the reporting line is via the Head of Mental Health and Adult Support, to the Assistant Director of Social Care, the Strategic Head of Adult Services and Executive Director of Social Work Services who report to the Health and Social care Policy Development Committee.

2.26 The specialist teams provided useful information about SDS as well as support with SDS assessment and other new processes. As table 2.2 shows, these teams were highly valued by frontline workers in all 3 areas. This perception of the teams as a helpful and useful resource was also identified by third sector providers interviewed in all areas.

Table 2.2: Care managers' perceptions of the usefulness of SDS/Personalisation Teams

Care Managers	Helpful info from SDS team	Helpful support from SDS team	SDS team useful resource
Highland	76% (26)	79% (27)	79% (26)
Dumfries and Galloway	72% (40)	66% (37)	69% (39)
Glasgow	70% (75)	70% (75)	63% (67)

2.27 In Dumfries & Galloway, the Personalisation Team was perceived as generally helpful but recognised as overworked and under resourced to be able to offer the support needed by frontline staff. There was least satisfaction of all expressed by care managers in Glasgow which was coupled with strong opinions on the scale and pace of change. A general view was that the SDS Team was basically "spread too thinly" across different client groups. This often meant support was difficult to access and often delayed. Some specifically mentioned that their relevant SDS team member was only available one afternoon per week in their area even though SDS was taking up most of their case load now. Levels of satisfaction with the specialist team were highest in Highland, although this has to be set in the context of the survey response showing an average of just 8% of care managers' caseloads being people who had opted for SDS.

Integration of SDS and Direct Payments

2.28 Only in Highland had there been full integration of the DP team with the SDS team, which had merged in April 2011 with the DP Officer being re-designated as SDS Officer. In Dumfries & Galloway the DP Team, which sat independently from Social Work within the Benefits Maximisation section, remained distinct from the Personalisation Team although the DP Team was reported to be brought in at an earlier stage of the personalisation process when this was to involve a payment. A gradual shift was being made from 'traditional' DPs (based on assessed needs and support hours) to payments under personalisation during the test site and this had continued because DPs were seen as lacking flexibility and were not sufficiently outcomes focused. Those interviewed said there was more flexibility for people accessing DPs under personalisation because "the rules are more relaxed".

2.29 In Glasgow SDS and DP systems remained separate but the stated future intention was to fully integrate DPs within the SDS process. New service users requesting a DP are able to access this through SDS, although a senior manager reported that DPs will not be fully integrated within SDS until older people are able to access SDS. It was commented that with traditional DPs the focus was on assessing impairments and the help needed in terms of hours; SEQ assessment aims for flexibility so that service users can determine and ration their own support. However some interviewees commented that the assessment still seems to calculate support in terms of hourly rates to cover pay, on costs/training etc.

Summary/Key Points

The fast pace and momentum of change in Glasgow was in contrast to a more cautious and slower pace of implementation in both Dumfries & Galloway and Highland.

Less active partnership arrangements were described in all 3 areas by third sector interviewees who often commented that joint working at a strategic level had been better during the test site period.

All 3 local authorities had retained a specialist team to continue to be a source of expertise and support for operational staff developing new systems, and provided a link between strategic management and operations. These teams continued to be highly valued by front line workers but concerns were expressed about their capacity to cope with greater demand

Specialist teams differed in the extent to which they were developmental and strategic and/or directly involved in implementing SDS.

Only Highland had integrated SDS and DP since the test site. DP Teams in both Dumfries & Galloway and Glasgow local authorities were now working more closely with the Personalisation/SDS teams and frameworks than during the test site period.