Draft Self-directed Support Statutory Guidance on care and support

Section 2: The Supported Person's Pathway

This section describes the supported person's "pathway" through support. It describes the core aspects of the pathway for adults, children and carers of all ages. For further guidance on children, young carers and adult carers please see section 9 in this document.

7. The supported person's pathway is their route through their care and support. The key stages will be familiar to anyone involved in social services. The professional should consider the concept of a pathway, journey or a "route" through support when they work with individuals.

Table 1: The Person's Pathway

Step 1: "I need support"

The person decides that they need some kind of support or a relative, friend or professional recommends that they contact social services.

Step 2: First Contact

The person makes contact with social care services or community health services. They can arrive at this point direct or referred on by school, housing association, family or friends, hospital, carers centre, local voluntary organisation etc. There is an initial screening to determine if the person should progress to a formal decision on their eligibility for support.

Step 3: Eligibility and assessment

This is the point where the initial decisions are made about the person's eligibility for support under the various legal obligations:

* Section 12A of the 1968 Act (the assessment duty relating to adults);

* Section 22 of the 1995 Act (the duty relating to children in need);

* Section 12AA of the 1968 Act (the assessment duty relating to carer's of adults), and;

* Section 24 of the 1995 Act (the assessment duty relating to carers of children).

Following the initial assessment of the person's eligibility for support the person's needs will be explore in much greater detail. As part of this process, the two parties - the professional and the individual - will begin to translate the initial needs into a more detailed exploration of the personal outcomes for the individual.

See section 4 of this document for further guidance on assessment and eligibility.

Step 4: Support Planning

Support planning covers a wide range of issues but will tend to include a discussion of:

• the choices available to the supported person;
• the main risks and how the supported person and others can manage those risks, and;
• the resources that will help to deliver the person's support plan.

If the supported person is a child then the process should be part of a single plan for the child. It should capture the contribution that any support assessed or provided under Section 22 of the 1995 Act will make as part of the overall plan for the child.

See section 5 in this document for further guidance on support planning.

See section 9 in this document for further guidance in relation to support planning for children and families.

Step 5: Decision Time

This describes the stage where the supported person and the professional agree or "sign off" the support plan.

Step 6: Support

This is the actual provision of support, including any steps to adapt and change what is done.

Step 7: Monitoring and Review

The update of the original assessment along with any changes to the person's needs and any changes in circumstances etc.

See section 6 in this document for further guidance on monitoring and review.

The Person's Pathway: Roles and responsibilities

8. A number of individuals and organisations may be involved in the person's pathway or will help to influence it in one shape or form. Table 2 provides a summary of the main roles and responsibilities.

Table 2: Roles and Responsibilities

Role	Responsibilities
The professional	The social work or health professional should take steps to ensure that the assessment is conducted in line with social care law. They should consider any wider legal duties beyond the duties provided in social care legislation. They should ensure that the person's support plan is comprehensive and they should ensure that it meets the assessed needs for the individual. They may arrange for some additional assistance so that the supported person can play a full part in the assessment or support planning process. They may give voice to a supported person's wishes.
The supported person	The supported person should be supported to play an active part at the centre of the assessment and support planning process. They should be supported to take an active role in all of the key decisions relevant to their support. This will include any decisions about initial eligibility or access to support, together with the planning and provision of that support.
The unpaid carer	The primary role of the unpaid carer is to provide care and support to a family member or friend. However, in addition to this they may provide a wealth of information, expertise and guidance. Carers may be guardians or attorneys for the individual's they support. Carers are also entitled to request an assessment of their own needs.
The provider	The term provider describes the organisation or individuals who provide support to the individual. The provider may be the local authority, the NHS, an organisation from the third or independent sector or a personal assistant employed by the supported person or the unpaid carer. The provider can play an important role in the assessment and support planning process.
Senior managers within the relevant organisations	Senior managers help to shape the culture and approach right across their organisations. They can take important decisions about a supported person's care and support. In light of this, they should take steps to ensure that guidance, training and general culture of the organisation is predicated on the values and principles within this guidance. They should support front line professionals/providers to work with individuals in a flexible and innovative way.
The finance manager or finance official	Finance managers and officials play an important role in determining and administering the level of spend assigned to services. As such, they should ensure that the right processes and systems are in place, and that they support the collective objectives for care and support in their local area.
Legal advisers within the local authority/Health Board	Legal advisers will provide support to social services, advising on their legal responsibilities and powers.
Those who commission services and support	Strategic commissioning describes the activities involved in assessing and forecasting needs, the linking of investment to agreed outcomes and consideration of the options available. It also describes the activities to plan the nature, range and quality of future services and the steps that are taken by the local authority and health board to work in partnership to put their plans in place. Joint commissioning is where these actions are undertaken by two or more agencies working together, typically health and local government, and often from a pooled or aligned budget. The organisations and individuals who commission services play a key role in ensuring a good range of support is made available in order to meet the needs and desires of a diverse population. See section 7 in this document for further guidance on facilitating a good range of choices for individuals. Further guidance on joint commissioning is available at: http://www.jitscotland.org.uk/action-areas/commissioning/

Draft Statutory Guidance on Care and Support

Consultation Questions

Section 2: Values and Principles