Independent information and support services funded by the Scottish Government: review findings

1. Introduction

Background

Independent information and support are essential for people to be informed, empowered and supported to make decisions about their social care and fulfil their personal outcomes. Activities include supporting people through an assessment for, or a review of, a social care budget; brokerage to identify the right support and creative alternatives; awareness-raising; community capacity-building; and training and personal development. This document presents findings from an evaluation of projects funded to deliver such activities under the Scottish Government’s Support in the Right Direction ( SIRD) Fund.

This funding has been part of a wider package of investment around the transition to self-directed support between 2011 and 2017. The implementation of self-directed support as the norm in social care practice represents one of the most significant and complex changes to social care provision for a generation and is one of the key policies underpinning delivery of the 2020 Vision for health and social care integration and the Health and Social Care Delivery Plan. ^[1]

“The Implementation Plan 2016-18, for the Self-directed Support Strategy 2010-2020” ( COSLA and the Scottish Government 2016), seeks to deliver four strategic outcomes, these being that:

• Supported people have more choice and control;
• Workers are confident and valued;
• Commissioning is more flexible and responsive; and
• Systems are more widely understood, flexible and less complex.

Local authorities have a duty to assist people to make an informed choice about their support and must provide details about independent information, support and appropriate advocacy organisations. ^[2]

To ensure appropriate, high quality support is available, the Scottish Government invested in two programmes for 2015-2018:

• The Support in the Right Direction ( SIRD) Fund is focused on ensuring people are supported in setting their personal outcomes and able to make informed decisions.
• The Innovation Fund enables third sector social care providers to deliver flexible and creative support and promote culture change through the workforce, including outcomes related to support for clients and budgeting.

The Scottish Government has made a commitment to monitor, understand, and, where needed, review self-directed support implementation and to report on progress towards intended outcomes at the national level. This independent review of the SIRD Fund is in line with this and fulfils a specific commitment in the SDS Implementation Plan 2016-2018, to evaluate how independent information and support help and enable people to achieve personal outcomes, to be in control of their social care and to make their own decisions about social care. The findings from this review are expected to inform decisions about future funding of such services.

This review builds on previous work for funders and commissioners of social care by Evaluation Support Scotland (2015a, 2015b) on what works in independent support and on ongoing project monitoring by Inspiring Scotland.

Study objectives

The overall objective of this study was to provide an external review of projects supported by the Scottish Government through the SIRD Fund. The focus was on what has worked well and what has not worked well, with the original research objectives being to:

• Define and assess the effectiveness of SIRD projects, within the local context, in meeting the outcomes of clients, establishing the differences these services have made to the decisions of individuals about their social care options and, in particular, whether it helps individuals to access a budget in the first place and make better use of their allocated budget for support;
• Assess the cost-effectiveness, quality and the short-medium term sustainability of different forms of services exemplified by SIRD projects, setting out the implications in relation to future funding options for such services and for Scottish Government funding decisions in 2017/18;
• Identify characteristics, based on all of the research activities, of different kinds of successful, sustainable models for independent support;
• Gather evidence and explore ongoing challenges and barriers for impactful and sustainable independent support, and suggest ways in which they might be addressed;
• Provide an overview, based mainly on desk research, of the wider independent information and support landscape in which to contextualise SIRD; and
• Document and explain wider benefits for services and the health and social care system arising from the benefits experienced by clients (e.g. by reducing an individual’s need for a formal support package and so reducing or changing the level or nature of demand; supporting prevention; empowering people to challenge policies which do not promote self-directed support).

The primary focus of the review was on SIRD Fund projects. However, a small number of Innovation Fund projects have been involved in the delivery of information and support and hence were included within the study.

Research approach and challenges

The research was carried out between June and November 2017. The approaches used included:

• Review of project data and information. This included a wide range of information supplied by the Scottish Government and Inspiring Scotland, including performance monitoring data and reports.
• Interviews with representatives from local authorities. Telephone interviews were undertaken with representatives from six local authority areas (Aberdeen, Argyll and Bute, East Ayrshire, Fife, Highland and Shetland). Each area was asked to nominate suitable interviewees, which included self-directed support leads and those with management responsibility for adult care, learning disability and children’s services. Please note that for the purposes of this study local authorities were included because of their key role within Health and Social Care Partnerships and as the body responsible for assessing social care needs in their area. A total of 14 interviews were carried out.
• Key stakeholder interviews: A small number of unstructured key stakeholder interviews were carried out. Interviewees included representatives from the Care Inspectorate, Health and Social Care Alliance Scotland, Healthcare Improvement Scotland, MECOPP Carers Centre, Scottish Personal Assistant Employers Network ( SPAEN), and the Self-Directed Support Practice Network.
• Interviews with the SIRD projects. An interview was carried out with one person or a small number of representatives from all but one of the projects. ^[3] Interviews were either face-to-face or carried out by telephone. They were semi-structured and tended to last for around 90 minutes. The themes covered during these interviews are set out as Annex 1 to this report.
• Survey of those using services. Projects were asked to issue an invitation to complete a short electronic or paper-based survey to service users who have an approved social care budget. Two versions of the survey were created, one for those who are responsible for decision-making about their own budget and one for those holding responsibility for someone else’s budget. A total of 92 surveys were returned, 59 from those who have responsibility for their own budget and 33 from those who have responsibility for someone else’s budget. The survey results are set out in Annex 2.
• Interviews with clients. In addition, the study team spoke with 88 people who had used or are using a SIRD service. Of these, 32 people were identified through the survey and a further 56 people were recruited directly through SIRD projects. The interviewees recruited directly through the SIRD projects were made up of 25 people with a social care budget and 31 people without.

A total of 148 people who had used one of the SIRD projects told us of their experiences and gave us their views. Of these, 116 people have a social care budget themselves or manage a social care budget for someone else. Around 3 out of 4 of this group have gone down the Option 1 route (see below). The remaining 32 people spoken to do not have a social care budget. Their feedback is used to inform the analysis throughout this report and as noted above, the results from the service user survey can be found at Annex 2.

When considering their views of the process of exercising choice and control and choosing self-directed support options, it is important to acknowledge that the group of service users who contributed to this research were all in contact with one of the SIRD projects. In many cases, one of the main reasons for making contact was because of concerns about the way local social services were handling their case; this is reflected in the strength of some people’s views. However, these views may not be representative of all those who have applied for and/or are in receipt of a social care budget. As the focus of the study is on those who have used the SIRD project, its design did not include people who may have been through assessment or review for a budget, and may have a budget, but have not come into contact with one of the projects. The views of this latter group of people may or may not reflect those who did access independent information or support through one of the SIRD projects.

The study looks at the work of the SIRD projects through the experiences of those using the projects, and from the perspective of those working in the projects and other key stakeholders, including local authorities. It offers a diversity of voices shaped by individuals’ personal or professional experiences of social care and of independent support. Service users were often very frank in their comments and had a very understandable focus on their own experiences. Project interviewees also tended to be focused very clearly on the experiences of their service users, staff and their project more widely. Very much reflecting their duties and responsibilities, local authority respondents tended to focus on wider, whole-system issues, including the overall package of advice and support required in their area.

This has been a challenging study for a number of reasons. As discussed further in the next chapters, the type of work being done and the local authority contexts in which projects are operating are both very diverse. In some instances, the operating context and the focus of the work being done has evolved during the funding period. Also, although a wider range of monitoring data and progress reports is available, as discussed further at Chapter 9, some of the data cannot be used for comparative purposes. In essence, it is not clear that all projects are recording their activity and outcomes in the same way. There is also very limited information about the service users who have been supported by a SIRD project in project monitoring data.

As a result, it has not been possible to fully address all of the original research objectives. In particular, a robust assessment of cost-effectiveness of the work undertaken by the SIRD projects has not been possible. However, the significant body of primary and secondary data available to inform the study findings has supported an in-depth analysis of what the experiences of the SIRD projects, and critically those who use them, suggests about the provision of social care-related information and support into the future. This is the main focus of the analysis presented in the remainder of this report.

Reporting

The terminology used in this report is in line with the standard usage unless otherwise stated. In particular, the report references the four self-directed support options for getting support. These are:

• Option 1: A Direct Payment (a cash payment).
• Option 2: Funding is allocated to a provider of the person’s choice (sometimes called an individual service fund, where the Council holds the budget, but the person is in charge of how it is spent).
• Option 3: The Council arranges a service;
• Option 4: The person chooses a mix of these options for different types of support.

It is also important to note that not everyone receiving information and support from one of the SIRD projects will need a formal support package or be in receipt of a social care budget. This group of clients will be referred to as non-budget holding clients for the purposes of this report.

Please note that when the report refers to SIRD projects it should be taken as including those Innovation Fund projects which have been included in this study.