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

EXECUTIVE SUMMARY

Background

The 10-year national plan for self-directed support (SDS) (Scottish Government, 2010) aims to bring SDS into the mainstream of social care and increase the number of people directing their own support, including the number doing so via Direct Payments (DPs). If enacted in 2013, the Social Care (Self-Directed Support) (Scotland) Bill will make offering SDS the duty of local authorities. In 2009, the Scottish Government selected 3 local authorities to act as test sites - Dumfries & Galloway, City of Glasgow and Highland - to trial targeted activities to address 3 themes as part of its investment in promoting SDS. The 3 target themes - leadership and training; cutting 'red tape'; and bridging finance - were based on key issues identified by past research. The test sites were funded between January 2009 and March 2011.

Evaluation of the SDS test sites, demonstrated that local authorities face a number of challenges in implementing SDS and achieving transformational change (Ridley et al, 2011). Another study (Rummery et al, 2012) of the macro level financial and economic evidence on costs, benefits and impacts of increasing SDS in Scotland, concluded that while implementation remains an area of contention, the cost of further uptake does not differ significantly between SDS and more traditional services.

A number of commentators, including ADSW (2009), argue that the change needed will be transformational for the work of those at the frontline of providing support and services, as well as for the structures and systems of service delivery in local authorities and other sectors. Directors of Social Work from the 3 test site local authorities giving evidence to Scottish Parliament in May 2009 identified what they called the "seismic change" required, and referred to the inevitable slow progress in terms of numbers opting for SDS initially (Scottish Parliament, 2012).

Evaluation of the local authority test sites established that those accessing SDS packages were positive about the choice and flexibility offered, although it was unclear whether this was solely as a result of SDS or the greater levels of support and funding made available during the test sites (Ridley et al, 2011). Access to SDS increased particularly among people with learning disabilities, the main target group of at least 2 of the test sites. The study found that the test sites took longer than anticipated to get established - recruiting staff, raising awareness, training and setting up SDS systems, and providing support - and that numbers of people accessing SDS were relatively low across the 3 areas. It concluded that significant time and investment in infrastructure was required to implement such a major policy initiative.

The fieldwork for the evaluation was completed in March 2011 just as the test sites were building momentum and as new SDS systems were starting to see progress. By the end of the 2 year period, the 3 local authorities had resolved to move towards full implementation of SDS with support from senior management. Follow-up work was subsequently commissioned by Scottish Government to examine progress and developments in implementing SDS in the test sites in the intervening 12 months i.e. from 1^st April 2011 to 31^st March 2012.

Purpose of the study

The overall aim of this follow-up evaluation study was to assess the continuing and longer term impacts of the interventions employed in the SDS test sites, and to build on the previous evaluation (Ridley et al, 2011).

Its objectives were to assess the continued uptake; to identify the activities to further promote and increase awareness of SDS; and identify system wide change within the test site local authorities. Additionally, the study looked at the extent to which innovative and creative practices developed during the test sites had continued, and the shift towards greater involvement and co-production in social care on a wider scale. Further, given the wider financial context of resourcing social care, the study sought to gain understanding of how this was impacting on implementing SDS.

Methods

Using the original evaluation of the test sites as its baseline, the study collected information about developments and progress over the time period of 1 April 2011 to 31 March 2012. Four main methods were used to build as comprehensive a picture as possible within a short timeframe as follows:

• Interviews with local stakeholders in each area (including staff and managers from the local authority, third sector organisations, advocacy and service user organisations) - 40 interviews involving 67 key stakeholders.
• Cohort information collating data about access to SDS and types of SDS packages - information analysed about 1,011 new SDS packages.
• Information from local documents including Social Work Committee reports, leaflets and promotional materials, including a 'mystery browser' exercise of local authority SDS websites.
• Questionnaire survey of care managers and other social work staff involved in community care assessment - 213 responses, 43% response rate.

Key Findings

Organising to Implement SDS

• 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 DPs 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.

Promotion & Awareness of SDS

• Whilst there were continuous efforts to provide information, raise awareness and provide training about SDS in all 3 sites, a number of challenges remained.
• Paradoxically, increased awareness about SDS was coupled with uncertainties and anxieties for users, carers and agencies in the current context of implementation.
• In Glasgow, providers and social workers consulted expressed concerns about the discrepancy between aspirational presentation of SDS to service users and carers and the reality. However, where the other sites took a more cautious approach to implementation, this still left questions about how much to promote SDS more widely and how to manage any subsequent demand.
• The more SDS is 'mainstreamed' beyond the test site target groups, the more pressure there appears to be on front line services and support agencies (especially SDS teams) who are inevitably spread more thinly and this exposes lack of capacity and expertise elsewhere in the system.
• The specific focus of the test sites on particular client groups (e.g. learning disabilities and young people in transition) resulted in some of the information material not always being appropriate for other client groups.
• Whilst the majority of care managers said they had received training, their overall view was that it was still not sufficient to enable them to implement SDS effectively in the current context.
• SDS is essentially an individualised approach and therefore may require an individualised approach to training. While bespoke support was on offer from SDS teams, ensuring wide access to this for front line workers and providers would be resource intensive and remains a key challenge.

Accessing SDS

• Access and uptake of SDS had increased after the test sites, most dramatically in Glasgow.
• The sheer scale of the increase of SDS packages in Glasgow was in marked contrast to the steady growth in the other 2 sites.
• In the follow-up period over 1,000 new SDS packages had been set up, the majority (892) of which were set up by Glasgow.
• Most SDS packages in the follow-up period in Glasgow consisted of Individual Service Funds (ISF) with external providers. In comparison there were no ISFs in Highland and only a few in Dumfries & Galloway.
• People with learning disabilities were still the main client group accessing SDS across the sites (59% of all packages), although gaps in access were clearly being addressed.
• DPs to third parties were much more common in Glasgow than they had been during the test site, while a DP managed by the individual was the most frequent SDS option in Dumfries & Galloway and Highland.
• We sought information regarding whether SDS packages that were set up during the test site continued as a marker of sustainability. However, we were unable to obtain this information from Glasgow, and Highland appeared not to have developed sustainable packages (but rather focused on one-off payments during the test site).
• In contrast, Dumfries and Galloway had continued to fund SDS packages set up during the test site. This is important given the anxiety expressed by service users and carers who had benefited from SDS in the test site period about this (Ridley et al, 2011).

Systems & Processes to Implement SDS

• On-going change in assessment and resource allocation systems had persisted as a main preoccupation since the test sites in all areas.
• Key stakeholders in Dumfries & Galloway, however, stressed the cultural shift needed to implement real choice and control rather than systems being 'right'.
• Care managers were the least positive about new protocols and processes to implement SDS particularly in Glasgow.
• A key criticism of the assessment processes developed during the test sites was that they tended to be too orientated for use with people with learning disabilities and were having to be further developed.
• There was evidence of increased involvement of independent advocacy since the test sites in all areas though this was notably inconsistent, and dependent upon care managers' understanding of the role of independent advocacy as well as on the capacity and training of advocacy organisations.
• In all 3 areas, more resource allocation panels had been created to enable greater numbers of support plans to be considered and to enable decisions to be taken at locality level.
• Systems of resource allocation were a zone of high uncertainty and one of the most problematic aspects of implementation and these had not been fully resolved during the follow-up period.
• Paperwork resulting from implementing SDS had not decreased the bureaucratic burden but had rather increased it in those cases where self-assessment continued in parallel or was an addition to single shared assessment.

Perceptions of the Impact of Financial Context

• 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 of SDS support packages 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 packages continued in Glasgow is not known.
• Longer term sustainability appears more challenging and uncertain given the financial context, 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').

Conclusion

In the year following the end of the test sites, the 3 local authorities had managed to shift perceptions of SDS further towards it being seen as a mainstream approach to service delivery. Scottish Government investment in the test sites enabled new processes and infrastructure to be established and knowledge of, and expertise in, SDS to be developed. This all contributed to increased take-up of SDS during the follow-up period. However, all 3 sites faced remaining and significant challenges. For example, ensuring communications about SDS were transparent and up-to date; managing the impact of financial and capacity constraints which might compromise choice and control; and, whilst specialist SDS teams were highly valued, they were all described as stretched. The pace of implementation was found to be a significant factor influencing perceptions of the success of implementation, and high numbers of SDS packages per se were not considered to be positive when this compromised quality of involvement and co-production in assessment and support planning. More generally, this suggests the need for a wider debate and greater transparency about eligibility, the future funding of social care and how to ensure that SDS develops in line with the broader philosophy of Independent Living.