Draft Self-directed Support Statutory Guidance on care and support

Section 5: Support Planning

This section deals with support planning. It identifies the core requirements for a good support plan and it addresses the question of personal risk and resources. It clarifies the choices that should be made available to a person as part of the support planning process along with the additional information and support that should be provided as part of this process.

5.1 General guidance on support planning

41. The support plan should be developed in line with the statutory principles in Section 1 of the 2013 Act and in line with this guidance. The plan should cover certain key aspects such as the personal outcomes which help to shape the plan, the resources (both financial and non-financial) which will help to meet those outcomes, the choices available to the supported person to arrange their support and all associated information. Table 6 provides some "key ingredients", developed from the point of view of the supported person.

Table 6 - Support Plans: key ingredients

The people and things that are important to me	The main risks and how we will manage them	The people who can help me to achieve my outcomes
Where I can go for information and support	My personal outcomes	The things (knowledge, funding etc.) that will help me to achieve my outcomes
The things that I can do	How I will arrange my support

42. The support planning process - the act of considering the outcomes and pulling together a plan - can make a significant difference to the person's life. In light of this the support plan should be developed in a collaborative way. A good support plan will demonstrate a link between the individual's eligible needs, their outcomes and the support required to meet those needs and outcomes. It will be written in language that the supported person understands. It will be presented in a way that is engaging and helpful to the supported person as they embark on their pathway through support. It may include pictures alongside text.

43. The support plan may be developed in any type of format but it should be framed in such a way that it can be used as a living document. It should focus on what the person wants to achieve with the right help, rather than simply putting arrangements in place to stop things from getting any worse. It should be capable of acting as a reference point for the supported person, the professional, the provider and, subject to the person's wishes, other important individuals in the person's life. The parties involved should be able to return to the plan, review the plan, add to the plan or make changes over time.

Further guidance and hyperlinks:

Institute for Research and Innovation in Social Services, Reshaping care and support planning for outcomes
http://content.iriss.org.uk/careandsupport/assets/html/intro.html

5.2 Risk

44. Risk assessment and risk management are critical to the role of the health or social care professional. The identification and management of risk is fundamental to any assessment and support planning process.

45. It can be difficult for some individuals to appreciate or recognise the risks associated with their support. In light of this the personal risks to the individual (distinct from organisational risk to the local authority or Health Board) should be considered in collaboration with the supported person. The supported person should be fully involved in considering their risks and how they will be managed. The principles of involvement, informed choice and collaboration are helpful aids to this approach. If the supported person identifies the key risks alongside the professional then both parties will have a better awareness of the relevant risks and both parties will be better placed to manage those risks. Where the supported person has difficulty in understanding or identifying their personal risks, the professional should seek to involve others who can assist in the task.

46. The two parties should take a proportionate approach, spending appropriate time on those risks that carry the greater potential impact or likelihood. The professional should seek to enable positive, informed and proportionate risk taking. They should consider the risks of not acting as well as the risks of choosing a particular support option. They should also review and monitor the person's risks and they should encourage the supported person to undertake this task alongside other important individuals in the person's support plan.

Further guidance and hyperlinks:

Social Care Institute for Excellence (2010), Enabling risk, ensuring safety: Self-directed support and personal budgets
http://lx.iriss.org.uk/sites/default/files/resources/report36.pdf

The Knowledge Network - Implementing Self-directed Support - Personalisation - Risk Enablement
http://www.knowledge.scot.nhs.uk/home/portals-and-topics/self-directed-support/implementing-self-directed-support/risk-enablement.aspx

Simon Duffy & John Gillespie (2010) Personalisation and Safeguarding Discussion Paper
http://www.in-control.org.uk/media/52833/personalisation%20safeguarding%20discussion%20paper%20version%201.0.pdf

5.3 Resources

47. The "resource question" should not be about financial resource - money - alone. The professional should consider all of the possible resources available. The main types of resources that the professional and user will wish to explore are:

• the person's attributes and assets (their skills, knowledge, awareness, background, decision-making skills and contacts);
• the person's well-being and inner strength;
• the person's extended family, close friends, work colleagues and community;
• the budget or funding which the person can access to meet their eligible needs;
• the professional's knowledge, expertise, background and contacts;
• the local resources, shops, health and education services, community facilities (libraries, sports centres, community "hubs" etc.), and;
• any other sources of information, advice and support available to the supported person.

48. Where the person is eligible for support, the authority will wish to consider a fair and transparent means by which to determine the appropriate level of funding. Section 4 of the 2013 Act refers to a "relevant amount" and defines this as the "amount that the local authority considers is a reasonable estimate of the cost of securing the provision of support for the supported person."

49. There is no single approach to "resource allocation" prescribed in law, nor any single method recommended by Scottish Government. Some authorities may wish to adopt an equivalence model where they determine the cost of the service to be arranged and then provide the equivalent amount as a budget for the supported person to control. Others may wish to adopt a Resource Allocation System where they gather information about the person's outcomes, allocate points to those outcomes and, on the back of this process, allocate a level of funding. Alternatively, decisions about budgets may be made by professional judgement alone or on a case-by-case basis.

50. The important point to bear in mind is that while systems and tools can be useful aids, they are no substitute for the skilled judgement of a social work or health professional. The authority must ensure that the approach taken to the allocation of resources is both fair and transparent. They should take steps to involve user and carer groups in the development of any methodology used to define or determine budgets for individuals. Regardless of the specific approach to allocating resources, the professional should take steps to inform the person of the amount of support available under each of the options.

51. In terms of the application of any methodology, the authority should ensure that professional expertise is brought to bear in order to determine the appropriate level of financial resource to meet a person's eligible needs. Authorities, and professionals on their behalf, have a responsibility to ensure that the nature and level of support meets the person's eligible needs. The approach to defining the budget should be rational and it should be transparent and the final support defined in the support plan should be sufficient to meet the needs identified as eligible in the assessment.

5.4 The choices that must be made available to the supported person

The Social Care (Self-directed Support) (Scotland) Act 2013 contains a range of choices that must be available to a supported person as part of the assessment and support plan process.

The main legal references covered in this section are:

• Sections 1 and 2 of the 2013 Act - the general principles that must guide the professional when they undertake the assessment and when they provide choice to the supported person
• Section 4 of the 2013 Act - the options that must be made available to the supported person
• Sections 5, 7 and 8 of the 2013 Act - the way that the choices must be offered to the supported person

The statutory principles in the 2013 Act

52. The professional should ensure that the statutory principles contained in Section 1 of the 2013 Act lie at the heart of their approach to assessment, support planning and review. Self-directed support is not about cutting people loose or leaving them to get by on their own. It is not simply about "the money" or providing that money to the person. It is about developing solutions together, recognising that a supported person's support is their support, a means by which to achieve their outcomes and to have control over their life. Overall, the professional should view self-directed support not as a particular mechanism or a the provision of money to the individual, but as a collaborative approach to assessment and support planning.

"Self-directed support is real social work": a view from a social work professional

The social work profession is defined as "promoting social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being… its purpose is to enable all people to develop their full potential and enrich their lives".

It is helpful to think about self-directed support in the context of the profession it has evolved through. The early origins of this concept stem from disability rights activity through the 1960's to 1980's. However, since then the emerging legal duties and professional practice have been the responsibility of social workers.

Assessment focused on outcomes restores the therapeutic role of social work, the importance of relationships, and supporting people to find their own solutions. This therapeutic role for social workers is enabling real choice and control for people as well as common sense plans that are more effective than many of the services we have traditionally relied on.

Front line workers should embrace self-directed support - and the principle of choice to individuals - as a way to deliver good outcomes. Decision making devolved closer to workers will empower people and evolve and develop choice as the norm and not the exception.

The options

53. The 2013 Act contains 4 options that must be made available to the supported person as part of the assessment process. The options are:

Option 1 The making of a direct payment by the local authority to the supported person for the provision of support.

Option 2 The selection of support by the supported person, the making of arrangements for the provision of it by the local authority on behalf of the supported person and, where it is provided by someone other than the authority, the payment by the local authority of the relevant amount in respect of the cost of that provision.

Option 3 The selection of support for the supported person by the local authority, the making of arrangements for the provision of it by the authority and, where it is provided by someone other than the authority, the payment by the authority of the relevant amount in respect of the cost of that provision.

Option 4 The selection by the supported person of Option 1, 2 or 3 for each type of support and, where it is provided by someone other than the authority, the payment by the local authority of the relevant amount in respect of the cost of the support.

54. All of the choices must be described to the supported person. A key challenge for the professional will be how to relate the options to the supported person and how to make them "come alive" to the supported person.

Option 1: the direct payment

55. Option 1 is a direct payment. Under a direct payment the supported person - or an organisation or individual identified by them (a so-called "third party" direct payment) - receives the sum of money into a bank account. The supported person, either on their own or with support, can then purchase support. The supported person can use the resource in whichever way they wish, provided that it will secure the provision of support agreed with the professional and provided that it meets the outcomes contained in the support plan. Certain choices, such as the decision to become an employer, will only be available under the direct payment option. However a supported person can also use their direct payment to purchase a range of services that might otherwise be available under Options 2 to 4. For example, a direct payment can be used to purchase services from a registered care provider or from the local authority itself. In short, option 1 describes the maximum flexibility but also carries, potentially, the maximum responsibility.

Further guidance and hyperlinks:

Section 9 in this guidance provides further guidance on direct payments.

Option 2: the supported person directs the available support

56. Option 2 describes an arrangement where the individual selects the support that they want and the local authority - or subsequently a provider on their behalf - makes various administrative arrangements on the supported person's behalf. Unlike the direct payment there is no requirement for the funding to be provided directly to the individual as a cash payment. The budget provided to the person is, in effect, a virtual budget. Typically, the individual will be informed of a resource that will be made available to deliver their support plan. The resource can remain with the local authority or it can be delegated to a provider to hold and distribute under the individual's direction.

57. An example of an arrangement under Option 2 is the Individual Service Fund. Under an Individual Service Fund the authority identifies a financial resource and the supported person then directs that resource choosing the support that they would like. The local authority can transfer the resource to one or more providers on the individual's behalf. The individual can then direct how that resource is used. They can ask for the budget, or portions of the budget, to be directed to other providers within the overall framework of support.

58. Arrangements under Option 2 should provide a further degree of choice, control and flexibility beyond what would otherwise be available under Option 3 (arranged support). The supported person should be firmly "in the driving seat" working alongside the professional to direct their support. The arrangements should be designed and operated in such a way as to give the supported person much greater control over their support and a practical means by which to exercise this control. The arrangements should make it straightforward for the supported person to exercise control over their support, to secure their preferred support and to make adjustments to their support quickly and efficiently. Though the authority is not obliged to make arrangements as set out in this guidance, there are very few limits to what can be done. The key limitation is that a person cannot use Option 2 in order to employ their own staff.

Option 3: the local authority arranges support for the supported person

59. Under option 3 the professional, in collaboration with the individual, selects the appropriate support and then makes arrangements on the supported person's behalf. In contrast to option 2 the individual steps back somewhat. They choose to leave many of the detailed minutiae of decisions to the professional. This may be described as "arranged service provision" or "direct services". In very basic terms, the local authority is providing or arranging services on the supported person's behalf. The individual is not seeking direct, on-going or day-to-day responsibility for planning and controlling how the available resource is used.

60. Large numbers of individuals will continue to select their support under Option 3. However, the principles of choice and control, collaboration and involvement should continue to hold for individuals who make this choice. The relevant authority should seek to ensure that the services provided under Option 3 are as flexible as possible and ready to adapt to the desires of the individuals who use them. This should involve the necessary workforce education and development, ensuring that those who provide care and support do so in line with the values outlined in this guidance.

Option 4: "mix and match"

61. Option 4 - a combination of two or more of the options - recognises that some people will be happy to take on some control but perhaps not the full control that comes with a direct payment. This is a "mix and match approach", ensuring maximum flexibility in the options available. This option may be attractive to people who would like to experiment with the direct payment or individual service fund approach for a small aspect of their support or for a small portion of their outcomes.

Professional discretion to limit the choices available to individuals

62. There are two circumstances where a supported person's range of choices may be limited in some shape or form by the professional.

i) Discretion to refuse a particular option under the 2013 Act

63. The first area is where there is a legal restriction on the professional's power to offer the option as described in Section 4 of the 2013 Act. This is where the law simply does not allow the professional to offer any choice in the first place. Published alongside this guidance are [draft] Regulations which define specific circumstances and persons where the professional cannot offer a direct payment. Please see the draft Regulations for a draft list of circumstances and persons deemed ineligible for particular options within the 2013 Act - in this case the direct payment option only.

ii) Discretion in relation to whether a particular type of support is appropriate to meet the assessed needs/agreed outcomes for the person

64. A separate matter is where the professional believes that a particular form of support (as opposed to the mechanism for delivering that support) will not meet the assessed needs of the individual. This is a situation where it is the professional's considered opinion that the decisions that the person is taking under their particular option are failing to meet their assessed needs.

65. This discretion - sometimes known as a "duty of care" discretion - stems from the authority's power under Section 12 of the 1968 Act. Section 12 allows authorities to secure the provision of support (referred to in Section 12 as "facilities") which they may consider "suitable and adequate". For clarity, the professional cannot refuse a particular option under the 2013 Act (i.e. the mechanism under which the care is provided). What they can do is use the discretion available under Section 12 to refuse to fund a particular type of support.

66. Professionals must exercise their "duty of care" discretion to refuse to fund a particular type of support with great care and only where it is clear that the support choices in question will fail to meet the supported person's eligible needs. The professional should explain why a particular type of support will fail to meet the supported person's assessed needs, and they should seek to agree alternative forms of support under the options available via the 2013 Act. As with any key decision about a person's assessment or support plan, the professional should takes steps to inform the person of their right to complain about the process used to arrive at any decision. They should inform them of their right to take their complaint to the Public Services Ombudsman once they have exhausted the local authority complaints procedure, and to judicial review if necessary.

Further guidance and hyperlinks:

Self-directed Support in Scotland website - Professionals
http://www.selfdirectedsupportscotland.org.uk/professionals/

Scottish Government (2010) Self-directed support: A National Strategy for Scotland
http://www.scotland.gov.uk/Publications/2010/11/05120810/0

5.5 Information and support

67. Section 9 of the Self-directed Support Act 2013 requires the professional to ensure that information and appropriate "signposting" advice is provided to individuals to help them to make an informed choice. Section 9 accompanies the earlier Section 1 within the 2013 Act, which provides the general principle relating to information and support.

68. Section 1, sub-section 3 of the 2013 Act states:

(3) A person must be provided with any assistance that is reasonably required to enable the person-

(a) to express any views the person may have about the options for self-directed support, and

(b) to make an informed choice when choosing an option for self-directed support.

69. Section 9, sub-section 2 of the 2013 Act states that:

(2) The authority must give the person-

(a) an explanation of the nature and effect of each of the options for self-directed support,

(b) information about how to manage support,

(c) information about persons (including persons who are not employed by the authority) who can provide-

(i) assistance or information to the person to assist the person in making decisions about the options,

(ii) information about how to manage support, and

(d) in any case where the authority considers it appropriate to do so, information about persons who provide independent advocacy services (within the meaning of section 259(1) of the Mental Health (Care and Treatment) (Scotland) Act 2003 (asp 13)).

70. Section 9 also requires the authority to give the explanation and information required by subsection (2) in writing and, if necessary, in such other form as is appropriate to the needs of the supported person to whom they are given.

What should this mean in practice?

71. Sections 1 and 9 mean that the professional must provide any assistance that is reasonably required to enable the supported person to express a view on the choices available to them, and to make an informed choice in terms of the four options. The advice to the supported person should be impartial, balanced and well informed. The emphasis throughout should be on supporting an individual to make an informed choice.

72. The professional should explain the options in a clear and accessible way. They should tailor any communication to the communication needs of the individual. They must provide the individual with an explanation of the "nature and effect" of the options available to them under the law. This means that they should seek to explain the basic characteristics of the options available to the supported person. In particular, they should seek to describe the distinctions between the different options. They should approach this task using terms that the supported person can engage and relate to, and they should attempt to make the options tangible and real to the person.

73. In addition, the professional must provide the supported person with information about how they can manage their support after they have made their initial choice. This is particularly important in relation to the direct payment option, where the supported person may be considering taking an active role in directing their support. Clearly, there are practical limits to this duty. For instance, it would be disproportionate (and potentially unhelpful to the individual) for the professional to explain every detailed employment responsibilities at the point where the person is considering the direct payment option.

What should the organisation (the authority/health board) do to ensure a good mix of information and support?

74. In order to discharge its obligations under section 9 of the 2013 Act, the wider authority will wish to consider the appropriate mix of information and support options available in their local area. Table 7 below lists some of the key forms of information and support.

Table 7: Examples of information and support

Basic information and advice	Basic information direct from the professional about: * the choices available to a person and the opportunities and responsibilities that come with each option; * how to understand and navigate the processes that surround assessment, support planning and review, and; * where to go for further detailed or technical advice and support. Leaflets and information in accessible formats Case study examples showing how the various options work Accessible information in a variety of formats
Mentoring and peer support	Information and support from people with personal experience of care and support or directing their own support Mentoring for support planning Contact details for mentoring networks
Support and information services	Organisations that are independent or semi-independent from the authority. This may include "in house" support and information services or it may include user-led or peer support organisations.
Brokerage	Specialist support to people to plan, procure and manage their own support arrangements under the direct payment option.
Independent advocacy	Advocacy services to make sure that people's voices are heard (individually or collectively) during all stages of the care and support pathway
Training	Training to individuals or voluntary or independent sector organisations in: * care and support pathways and key stages such as assessment, support planning, managing your support and review * disability, diversity and equality * confidence and assertiveness

Sources of information and support out-with the authority/health board

75. The professional should point the supported person towards other sources of information out with the authority. This may include independent organisations or user-led organisations such as centres for independent living, specialist support organisations with an expertise in the individual's particular support needs or disability, or organisations with expertise in supporting specific client groups. In addition, it may include organisations with a general role in support and assistance to citizens.

The role of user-led support and information organisations

User-led support and information organisations operate on a peer support model. They offer a unique contribution, helping disabled people to understand their options to relate to the needs of others in the same situation. Their staff and volunteers may have personal experience of care and support services. It is this experience which helps to inform the design and delivery of support services, leading to high quality, relevant and appropriate information and support.

Further information is available from the Self Directed Support Scotland (SDSS) website www.sdsscotland.org.uk

Advocacy and advocacy services

76. In addition the professional, where they consider it appropriate to do so, must provide the supported person with information about independent advocacy services. Advocacy services provide a unique role in terms of helping people to navigate and make their choices. The professional should seek to use their discretion and to signpost the person to advocacy services in all instances where they consider this appropriate.

Further guidance and hyperlinks:

Self-directed Support Scotland
http://www.sdsscotland.org.uk/

Scottish Government (2005) The New Mental Health Act: A guide to independent advocacy: Information for Service Users and their Carers
http://www.scotland.gov.uk/Publications/2005/12/02144347/43475

Scottish Independent Advocacy Alliance
http://www.siaa.org.uk/

Scottish Government (2012) A Right to Speak: Supporting Individuals who use Alternative and Augmentative Communication
http://www.scotland.gov.uk/Publications/2012/06/8416/0

Further links (including a guide to professionals, user's guide and carer's guide) to follow.

Draft Statutory Guidance on Care and Support

Consultation Questions

Section 5: Support Planning

This section of the guidance covered:

• general guidance on support planning
• risk
• resources
• the choices that must be made available to the supported person and
• information and support