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

3 PROMOTION & AWARENESS OF SDS

Introduction

3.1 The wider implementation process had major implications for promotion and raising awareness, not only of the ethos and values of personalisation, but also about new systems and mechanisms for promoting SDS to service users, carers and staff. Therefore, this chapter explores the extent and impact of promotion, awareness raising and training for staff in the year since the test site. It is important to note that our inability to access the wider population of care managers in Glasgow prevented any direct comparison between sites of the impact of the Council's attempts to raise SDS awareness amongst frontline staff. This is because all the staff we were able to survey in Glasgow had received some training in personalisation, and were therefore, by definition, more likely to report increased awareness.

Approaches to SDS Promotion

3.2 In Dumfries & Galloway, the Personalisation Team took on much of the role of keeping momentum up post test site, a process they described in terms of revisiting and reinforcing SDS values within frontline teams. A wide programme of information and awareness raising sessions with locality managers and staff were organised across the site, though it was reported that when these were not mandatory, some meetings were poorly attended. Case work reviews tended to be used as a vehicle for raising awareness although this was seen as an 'ad hoc' approach. In one of the localities in Dumfries & Galloway, 'champions' (e.g. administrators, care managers, team managers) were identified by the local authority in each office. In addition, workshops were delivered to service users and carers to raise awareness, including local drop-in sessions. Collaboration was evident with the third sector though an 'open dialogue' approach. A number of voluntary organisations who were members of the Special Interest Group (learning disabilities) set up by Action for Real Change Scotland (ARC) ran two conferences in March and September 2011 to raise awareness among third sector employees.

3.3 In Glasgow, an extensive, wide ranging and active promotion of SDS continued after the test site period. There was notable partnership working between the Council and specific organisations such as SCIF who had held many events such as information days to inform service users and carers about SDS, circulated Council updates to providers, and produced newsletters. One provider held briefing sessions for service users and carers and employed a consultant to support staff to engage with SDS; another appointed a lead officer to promote SDS and continue joint working. Council representatives also attended various information days initiated by provider agencies and service user organisations (e.g. GCIL, GAMH, Disability Alliance etc.). From February 2012, Glasgow launched a specific initiative to engage mental health service users in SDS. This involved briefing providers and meetings with service users and carers (via GAMH). There were also some outreach efforts by the SDS team to raise awareness amongst BME communities. In addition, the Council has developed a new accessible Citizens Portal information project and was developing a comprehensive intranet site including guidance on the process and accessible information about SDS for staff.

3.4 Whilst Highland appeared to have taken a more cautious approach to implementation more generally, they also initiated various promotional activities. This included awareness raising sessions held across Highland for local authority staff in all adult care teams. It was decided to abandon the notion of SDS 'champions' within teams as it was felt there was too much responsibility invested in one person and instead to instigate a broader and on-going process of training. The SDS team was viewed as a vital resource in Highland and the team worked closely with a voluntary organisation, Health & Happiness, in promoting SDS to service users and carers across the Highlands. Some senior managers felt their more cautious approach related to delays in getting resource allocation systems (RAS) in place and wanting to 'wait and see' if demand arose first, leading to a potential 'chicken and egg' situation. Specifically, there was a lack of promotion of SDS to some service user groups (e.g. mental health service users) for whom SDS was seen as less relevant and, therefore, not prioritised. Some promotional activities focused on collaborative working with health care professionals with a view to developing SDS support for long-term care provision and re-ablement. As a result, 2 health staff had been seconded to the SDS team at the end of the follow-up period to raise awareness and promote SDS to healthcare professionals. At the time of evaluation, this initiative was in its infancy.

Impact on Awareness

3.5 Care managers and third sector organisations reported increased awareness about SDS in each of the sites. Most staff and providers had attended promotional and information events and these were generally experienced as helpful in raising awareness. However, there were some discrepancies in different areas and across different service user groups. Whilst awareness of SDS appeared to have risen across all service sectors in Glasgow, there was greater variation across service user groups and areas in Highland and, to a lesser extent, in Dumfries & Galloway. For example, not surprisingly given its lack of priority, there was less awareness about SDS amongst mental health service users in Highland.

3.6 In Highland, although 72% of care managers responding to our survey felt that their understanding of SDS had improved in the last year, almost 20% still felt that it had not. In contrast, 83% of respondents in Dumfries & Galloway and, perhaps not surprisingly, 90% in Glasgow felt that their understanding had increased. However, in both Dumfries & Galloway and Highland, 22% of care manager respondents still reported not having any service users opting for SDS/personalisation.

3.7 Increased SDS awareness among social workers in Glasgow was not wholly viewed as positive as it was accompanied by a sense that the SDS agenda had been pushed too quickly and that it displaced other important activities. In addition, there had been opposition and associated bad publicity about the perceived constraints on service users' and carers' choices about SDS itself. In sum, the Council's policy to use SDS as the primary route for access to support for specified groups, coupled with a 20% resource redirection strategy, was interpreted by many stakeholders as a cost-cutting agenda.

SDS Information

3.8 Whilst general awareness about SDS had increased substantially across all sites since the test site period, there was some variation in perceptions about the suitability of the information provided. In Dumfries & Galloway, general awareness had increased but there was dissatisfaction about the specific information provided. For example, care managers largely felt the information received in relation to personalisation was inadequate; 51% felt they did not have enough information and skills to access personalisation; and only 25% thought there was sufficient information available for service users to access personalisation. In particular, some care managers and third sector organisations perceived the information as somewhat confusing, unclear, inconsistent and even contradictory at times. Some mentioned that there were still no local information sheets available for potential service users and that a "Guide to Support, Services and Individual Budgets" that had been commissioned and drafted by another Council team had not consulted with third sector providers.

3.9 In contrast, in Highland a higher proportion of care managers (52%) felt that the information provided to service users was suitable. However, some care managers, providers and local advocacy organisations felt the information was sometimes out of date. Some of the local provider organisations also expressed confusion about the lack of clarity regarding the SDS process.

3.10 In Glasgow, care managers tended to report that whilst they had sufficient information to access SDS, the information provided to service users and carers was not adequate. This perception may relate to the issues discussed later about the perceived gap between what service users were told about SDS and the reality of what was possible, given the local context of implementation. In addition, care managers raised some concerns that the information made available to service users did not make it clear that they would have to make a contribution to SDS funds and this caused stress and confusion. Despite efforts to increase awareness about SDS amongst BME communities, some third sector organisations reported that this did not always reach the range of different BME communities (and languages) in the area.

3.11 In both Highland and Glasgow, some care managers and representatives from third sector organisations felt that information tended to be pitched more appropriately to people with learning disabilities and, whilst useful for these service users, this was not suitable for other groups such as those with mental health problems and older people. Our 'mystery browser' exercise generally supported these perceptions. For example, we found the information available on the Highland and Glasgow Council sites to be highly accessible and coherent with information leaflets for service users and carers easily available. In contrast, unlike the other 2 sites, we found it hard to locate any information on SDS or personalisation on the Dumfries & Galloway website. Our interview with members of their Personalisation Team confirmed that this was work in progress.

Training Issues

3.12 At the end of the test sites, system improvements were suggested by service users, carers and care managers and there was consensus on the need to improve training of frontline workers in new systems to increase access to SDS. Most staff in the 3 sites had now taken part in some form of SDS related training. There appeared to be the most comprehensive and intensive training programme delivered across Glasgow to a wide range of staff including care managers, team leaders, middle and senior managers and administrators on personalisation and In Control '7 steps' delivered by the SDS manager with an In Control Consultant. This included a full 3 day training programme and an additional 3 full days of IT training for outcomes based support planning. A wide variety of SDS-related training has also been on offer to other organisations such as SCIF and Enable. Whilst our survey of care managers in Glasgow specifically focused on care managers who had received personalisation training, of our wider sample of respondents in the other sites, 70% in Highland and 71% in Dumfries & Galloway stated they had received relevant training.

3.13 Despite this, a large proportion of care managers across all sites still felt they did not have the relevant skills to access SDS. For example, 56% of care managers in Dumfries and Galloway, 47% in Glasgow and 47% of respondents in Highland did not feel suitably trained, and many still felt that they lacked sufficient training and guidance about how to implement SDS/personalisation (especially regarding criteria and the process of actually putting a package together). As a result, some care managers in Dumfries & Galloway wanted to attend training that was being provided by one of the third sector organisations. This situation appeared to be due to a number of factors such as:

• Training received not being comprehensive or long enough to address the complexity of the process and the different needs of clients.
• A perception that the process and criteria for access had changed since initial training was conducted. Since then some suggested there had been changes in eligibility criteria which affected people's access.
• There had been inevitable adjustments to systems and related guidance with a time-lag to these revised procedures being accessible and this created frustration and confusion.
• The style of training was questioned by some care managers who experienced the training as being overly positive and unrealistic and/or based on a negative critique of social care professionals, rather than being positive, practical and enabling.
• Continued misperceptions about SDS. For example, in Dumfries & Galloway the Personalisation Team expressed some frustration that care managers still seemed to think that there was a specific 'personalisation fund' and therefore viewed SDS as an 'add on' to traditional care packages.

3.14 The momentum of on-going change in systems, alongside the training agenda led the SDS teams to provide on-going consultancy/ secondary support services for area teams across sites. For example, in Glasgow, the SDS team is available during the week for consultation and assistance and every week each area link worker from the SDS team spends time in their main contact area. Whilst this situation worked well, it was felt that a half day a week in situ was insufficient time to support their increased case load. In Dumfries and Galloway the Personalisation Team focussed on one-to-one support and mentoring activities and bespoke group training for staff as well as training for providers.

Promoting SDS in a Harsh Context

3.15 Most stakeholders appreciated the values embedded in SDS and found the 'success stories' which characterised promotional events positive and inspiring. However, there were concerns reiterated about whether these continued to be realistic or achievable in the current climate. Essentially, there appeared to be a conflict between the aspirational nature of SDS, as emphasised in promotional material, and the limitations of the support available for people to take up these opportunities and the budget restrictions on care packages.

3.16 Whilst this was a concern across all sites, it was particularly evident in Glasgow where there was an expectation that all service users within a client group 'in scope' of the SDS programme would go through the SDS process. Here care managers felt particularly strongly about the discrepancy between how they felt the council had promoted SDS to the public (as aspirational) and how it appeared in reality to staff going through the process (as a cost-saving measure). Many staff felt this led to unrealistic expectations and put them in a difficult position when explaining to service users and carers what was actually possible within the current context.

3.17 Another aspect of promotion relates to awareness-raising re SDS with service users and carers. In Glasgow for service users with mental health issues this has been carried out via information provision and joint working with providers and collective advocacy organisations - Glasgow Disability Alliance and GAMH - during 2011 to 2012 in advance of the first phase of the programme going live. Even earlier, awareness was being raised through the process of Scottish Government consultations over the draft Bill (Rosengard Associates, 2010). There were strong indications from agency websites and our consultations that SDS was a real source of concern to many people with mental health issues, as well as to people with physical disabilities, at a time when they were facing changes to their benefits and their support arrangements were being reviewed.

3.18 In the other sites, this difficulty was expressed in relation to concerns about managing demand. In Dumfries & Galloway the Personalisation Team reported concerns about promoting SDS too widely "in case we're swamped" as a faster pace of implementation may affect the quality of the process for service users. Similarly in Highland, some care managers expressed concern that SDS might be "over-promoted" and lead to unrealistic expectations of what might be possible. This wider concern about managing demand may have resulted in a cautious approach to promoting SDS, especially to other clients groups beyond the groups targeted during the test site period.

Summary/Key Points

• 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 may therefore benefit from an individualised approach to training and/or mentoring. 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.