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

6 PERCEPTIONS OF THE IMPACT OF FINANCIAL CONTEXT

Introduction

6.1 Since the test site period, local authorities have faced increasing challenges due to the wider financial context and its impact on budget allocations to local authorities by central government. Therefore, it was important to find ways of assessing the impact of this situation on SDS implementation. This chapter draws upon the views of the range of stakeholders consulted but specifically draws on our survey of care managers because this enquired explicitly about their perception of whether budget cuts had impacted on SDS. This was necessary as they are at the frontline of service delivery and because their views do not appear to have been obtained in Scotland as elsewhere^[16]. We have supplemented this data with information gathered from other stakeholders and official documentation provided by the sites.

Overview

6.2 There was some disparity in perceptions about the relationship between SDS and the wider financial context across the 3 sites. Senior managers in all sites stressed that SDS was being pursued on principle and to achieve better outcomes for people, and that the policy was not a response to the serious and persistent financial constraints on local authorities. However, some managers referred to how advocates of the personalisation movement had stressed this can generate positive lower cost options with potential for savings. This led to potential tensions and conflations between the two agendas of personalisation and cost savings. Senior managers tried to keep the two policy agendas separate and were keen to stress that the cost savings agenda had not negatively impacted on SDS. If anything, they stressed that SDS was a more creative way of utilising public money. However, care managers' responses illustrated more conflicting opinions and some were more ready to see SDS as part of a wider cost cutting agenda.

6.3 Care managers were asked if they thought SDS was being used to make budget cuts. It is hard to make any assessment about the strength of feeling in Highland because the overall response rate was low – nearly a quarter of respondents did not answer the question and of those who did the largest proportion of respondents (39%) felt that they didn’t know or were unable to comment. Although in Dumfries & Galloway, a similar proportion felt that they didn’t know/couldn’t answer (34%), of those that gave a view there was a much stronger sense (54%) that SDS was not being used as a mechanism for making cuts. In stark contrast, we had a far higher response rate in Glasgow overall, with the majority of those respondents expressing the view that SDS was being used a mechanism to make cost savings (81%).

Table 6.1: Care managers’ opinion about whether SDS is being used as a way to make budget cuts

Local authority	Being used to make budget cuts	Not being used to make budget cuts	Don’t know/unable to comment
Highland (n=31)	29% (9)	32% (10)	39% (12)
Dumfries & Galloway (n=56)	13% (7)	54% (30)	34% (19)
Glasgow (n=104)	81% (84)	13% (14)	6% (6)

*Figures do not always sum 100% due to rounding

6.4 Views were also sought about the impact of the financial situation on SDS. In Glasgow there was a very clear majority view from care managers that cuts in public expenditure was adversely affecting SDS/Personalisation (91%). In Highland and Dumfries and Galloway respondents were less able or willing to express a view on this (45% and 53% respectively). However, in Highland, despite an overall low response rate, 45% of those who did answer this question thought that budgets cuts were having an adverse effect on SDS.

Table 6.2: Care managers’ opinions about whether cuts in public expenditure have adversely affected SDS/Personalisation

Local authority	Cuts have adversely affected SDS/Personalisation	Cuts have not adversely affected SDS/Personalisation	Don’t Know
Highland (n=31)	45% (14)	10% (3)	45% (14)
Dumfries & Galloway (n=55)	20% (11)	27% (15)	53% (29)
Glasgow (n=106)	91% (96)	3% (3)	7% (7)

*Figures do not always sum 100% due to rounding

6.5 Despite these differences, however, in all 3 sites there was an evident conflict between the 'aspirational' promotion of SDS and budget-led constraints which were seen as limiting what could be achieved for individual service users. Some stakeholders felt that 'aspirational' and 'idealistic' promotion of SDS can unrealistically raise service users' and carers' expectations of what is possible in terms of choice and control. This was seen as compromising the ability of SDS to deliver on the broader aims of the Independent Living movement, on which it draws its legitimacy. This, in turn, has implications for longer term sustainability.

6.6 In relation to the shorter term sustainability of SDS support packages post test site, from the information provided, we can report the following:

• In Dumfries & Galloway, out of the original 35 people with personalisation packages during the test site, one person has now moved from the area, and one person has died. 32 of the personalisation packages remain the same, while one has increased.
• In Highland, of the 40 test site cases, 6 carried forward to continue with SDS, 4 were existing DPs that were involved with the test site pilot, 21 were one-off payments, one was a hospital case and 8 chose not to continue with SDS.
• We did not receive any information about the 57 test site cases in Glasgow.

Impact on Dumfries & Galloway

6.7 A complex and evolving picture emerged of the impact of financial constraints on the implementation of SDS in Dumfries & Galloway. In this site, there was evidence of sustainability in terms of personalisation packages post test site. Whilst there were undoubtedly concerns about budget savings as elsewhere, this appeared to have been managed in a way that resulted in less negative associations being made between SDS and cost-cutting than in either of the other 2 sites. In the early days of the test site period, the Council had initiated a day service closure and this had been negatively associated with personalisation. Yet, since then, despite the financial context, it was generally felt by care managers responding to the survey and other key stakeholders we interviewed, that implementation was kept within the spirit of SDS. Despite this, however, there were concerns expressed by different stakeholders about future eligibility for social care, as well as about the ability of the Council to sustain innovative packages at the same budget levels in the longer term.

6.8 Senior managers and others referred to efforts to concentrate on outcomes rather than the financial aspect during assessments, and the need to apply an holistic framework focusing on prevention and early intervention. However, it was reported that one of the 4 localities was only providing services for those deemed in 'critical' need. In this respect, despite the local authority's overall clarity about eligibility for support, it appeared that some areas were operating stricter eligibility criteria. In addition, there was some concern expressed that both financial constraints and mixed messages were impacting on decisions around access to personalisation.

6.9 In the 2013/14 starting budget there was a stated focus on protecting services, but this was coupled with recognition that it would be hard not to reduce frontline services. It was also suggested that adopting more creative approaches had the potential to achieve 'no cost - low cost' solutions by making more of personal and community assets. There was more focus on giving responsibility to provider organisations to make savings and this might be seen as merely shifting the responsibility for making savings elsewhere. Indeed, many providers were concerned about the impact of the current climate, and team managers were responsible for declaring monthly budgets and explaining any over-spend, which also placed pressure on them.

6.10 There was a sense amongst care managers that packages tended to be sufficient to meet assessed needs, at least at the moment. However, the Personalisation Team managers were concerned that an overarching focus on saving money will inevitably impact on personalisation. In response, they were attempting to link personalisation to early intervention and prevention and attempting to build a longer term vision about capacity building and developing community resilience.

6.11 During the test site period, some care managers were of the impression (though this was inaccurate) that personalisation packages were paid out of a 'ring fenced' budget and sensed that this was no longer available as personalisation has been rolled out. This meant that personalisation funding was now perceived as 'competing' with the rest of the social care budget. The Personalisation Team noted with some frustration that some care managers still thought this was the case and tried to use personalisation as an 'add on' to prop up traditional care package.

6.12 Concerns were expressed that future packages will not be as generous or flexible with pressure to make cost savings, and potential changes made to eligibility criteria. Indeed, one area was reported as only providing support for those deemed in 'critical' need, and there was a specific concern expressed that service users who had benefited from a personalisation package during the test site would no longer be eligible post test site (i.e. if they were in a 'lower' eligibility banding). Furthermore, some independent organisations involved in supporting service users in support planning reported that final budgets were significantly lower than that identified in the support plan and were being appealed.

Impact on Glasgow

6.13 Stakeholders interviewed in Glasgow stated that the Council was explicitly aiming for a 20% 'redirection of resources'. Furthermore, since 2007/08, there had been around 25% reduction in the number of full time equivalent staff^[17]. As a result, care managers reported feeling under pressure, not only to make significant target savings, but to do this in parallel with a fast-paced move towards implementing SDS. There was consensus amongst care managers and third sector providers that these factors had created a "negative context" for implementation of SDS. It is worth noting that these were not new concerns but had been highlighted earlier by the SCSWIS scrutiny report (2011). Nonetheless, despite slowing down the process in response to these criticisms, the Council recognised that perceptions of SDS as a cost cutting measure would be hard to reverse.

6.14 Whilst there were concerns in all sites about the gap between an 'idealistic' promotion of SDS and the reality of what is possible in a challenging financial context, this concern was especially acute in the care manager responses from Glasgow. Consequently, there appeared to be a strong perception amongst staff and the public that SDS was primarily 'about cuts'. Tellingly, one respondent referred to SDS in Glasgow as being about "rationalisation, not personalisation", and this sentiment was echoed in many care managers' accounts. Providers generally felt that what was often referred to as the 'Glasgow approach' to SDS has become more cost-based and constrained since the test site period.

6.15 Senior managers were aware of these concerns and this had prompted some adjustment to the programme. Some felt that the impact of dialogue has prompted benefits and that the programme should, for example, allow more transparency and clarification of available resources; increase sustainability; enable creativity; realise savings and so enable new demands to be met. Indeed some senior managers, as well as other local authority staff, saw SDS as a way of actually mitigating the effects of budget reductions because it actually generates more economic packages.

6.16 However, the majority felt the situation to be damaging. For example, a consultation event with Learning Disability Alliance Scotland and Unison advocating concerns from members highlighted the negative impact on service users, the voluntary sector and workers and potential effect on quality of support and risk. The pressure for costs savings was also impacting on providers and some speculated that this situation may lead to mergers which would ultimately decrease the range and choice of services. Additionally certain providers who had long pursued person-centred approaches at low cost reported that SDS as implemented actually reduced flexibility of support.

6.17 Sixty four per cent of care managers in Glasgow reported that the SDS panels did not approve the funding requested for individual care packages. This was significantly more than in the other sites where the majority of respondents felt they either did not know or could not comment. In Glasgow, however, a number of respondents felt that the panels were more focused on costs and budgets rather than on meeting assessed needs. As a result, a majority of care managers (59%) felt that support packages were insufficient to meet needs and it was becoming harder for people to access services generally, unless they have very high needs.

6.18 In addition, many care managers felt there was little opportunity for funding the types of social care that had been talked about when SDS was first introduced and promoted. Instead some specifically commented they felt funding was limited to personal care and support relating to 'life and limb', rather than facilitating social inclusion, community activities etc. Whilst packages approved during the test site included equipment and the scope for 'positive alternatives' to traditional provision, many felt there was far less scope for these now. Indeed there was concern expressed that packages that had been developed during the test site would be cut during the review process.

6.19 In addition, some referred to the pressure to change providers to reduce costs. Some Glasgow providers and advocacy organisations pointed out that local commissioning has required providers to adopt standardised rates which prevented flexibility and choice. For example, they reported that there was now only one rate for sleepover and 2 day time rates, regardless of need, whereas there used to be different levels depending on what was required (e.g. 3 levels of sleepover rates). This meant that some people were unable to maintain their support arrangements, especially if their needs were more complex.

6.20 These perceptions were echoed in a focus group conducted with a group of service users and carers through the Glasgow Centre for Inclusive Living (GCIL). Many of the participants were in the process of having their support package - that had been agreed during the test site period - reviewed. Although the outcomes of these reviews had not yet been decided, they expressed disillusionment and despondency about the situation.

6.21 A number of care managers also felt that the perception of an intrinsic link between budget savings and SDS had not been helped by the introduction of stringent financial assessment for determining client contribution to social care as part of new SDS processes during the test site. There was also concern around changes to welfare benefits which would affect people's ability to pay any contributions. As a result, there were reports from care managers of service users disengaging with SDS entirely. In addition, and in this context, the pace of implementation seems to have meant that workers, service users and carers have not been afforded sufficient time and space to engage with the process fully enough, and to provide the necessary support to do assessments in a person centred and self-directed way, thereby undermining the very foundations of the stated policy objectives.

Impact on Highland

6.22 As in the other sites, senior management tended to assert that the financial situation was not negatively impacting on SDS. Indeed, SDS was often seen as "positive way of managing budget cuts" and "cost effective spending". A number of those interviewed made a direct contrast with how they perceived the situation to have been managed in Glasgow.

6.23 Care managers in Highland were less vociferous in their criticism than those in Glasgow, but they did express concerns about the impact of the financial situation. Although most care managers stated they could not answer questions regarding the impact of the financial situation on SDS in Highland, 45% of those who did feel able to comment one way or another, felt that the financial situation had adversely affected SDS, and 30% felt SDS was being used as way to make cost savings. In addition, some care managers specifically referred to the problem of 'top slicing' 20% off requested amounts/assessments. These reductions were deemed necessary in order to make 5% savings on infrastructure costs and 15% efficiency savings. In addition, some stakeholders referred to costs for providers' hourly rates being reduced, resulting in a perception that cuts have been 'passed on', for example, to voluntary sector providers. As a result, some of these organisations felt that the public perception of SDS was that "it's about cuts".

6.24 Having said that, the majority of care managers (who felt able to give a view about the level of agreed care packages) felt that the packages agreed were currently sufficient to meet needs. However, there was disquiet regarding budget constraints making it difficult to get funding approval for more aspirational needs. Therefore, like in the others sites, there was an evident conflict between the aspiration of SDS and budget led constraints. As a result some expressed resentment about the money spent on promoting and implementing SDS at the expense of direct services and care packages.

Summary/Key points

• Perceptions of the immediate impact of the financial situation post test site differed across sites.
• We were unable to ascertain whether official eligibility criteria operated for social care services in either Glasgow or Highland. In light of the stated aim of increasing transparency, this lack of information is a concern.
• Eligibility criteria adopted by Dumfries & Galloway demonstrated a more holistic approach, focusing on early intervention and prevention. However, some parts of this region were operating stricter criteria.
• Whilst financial constraint was a huge challenge in all 3 areas, the consequence of Glasgow's strategy of coupling the agenda to reduce expenditure with a fast roll out of SDS, had resulted in front-line social work staff feeling under pressure, with a knock on effect on the quality of SDS assessments, levels of involvement, choice and control and staff morale.
• Short term sustainability since the test site varied across areas - while the majority of personalisation packages set up under the test site had continued in Dumfries & Galloway only a minority in Highland had continued, and whether, or to what level, packages continued in Glasgow is not known.
• Longer term sustainably is even more challenging, especially staying true to the ethos of independent living and maximising choice and control which motivated users and carers demand for SDS in the first place.
• How this situation is managed has implications for how SDS is promoted to the public and service users (i.e. from its current focus on aspirational and transformational 'success stories').