Self-directed Support Implementation Study 2018: report 3

5. Midlothian

Local context

There are 90,090 people who live in Midlothian.

People in Midlothian move into a self-directed support approach to their social care when:

• existing supported people cross the threshold into the critical/substantial risk categories; or
• people approach the Council to ask for an assessment; or
• the Review Team carry out a re-assessment; or
• retendering leads to a review of the status of supported people of a particular provider.

The local authority has a policy of equivalence when offering care packages under Option 1 or 2 – in other words, supported people are offered support to the value of its cost under Option 3.  Option 1 and 2 supported people are able to make decisions about the balance between cost and quality and the outcomes they achieve.

The Council is also responding to fiscal austerity by focusing on the development of more cost-effective approaches to service delivery.

Implementation of social care and support in Midlothian

Midlothian Council has around 2,500 people in the critical/substantial risk categories that determine eligibility for social care.  Of these, 800 are under 65 and 1,700 are over 65. Most people eligible for social care access this under Option 3, and, in practice, considerable choice is available under this option because most of the local providers have contracts under Option 3.

A high proportion of people accessing social care do so under Option 2.  One of the reasons is that many supported people did not want to change provider when a provider unsuccessfully retendered for their contract to provide services under Option 3. Others have used Option 2 to move from an unsatisfactory Option 3 provider or to providers who have good local reputations.

The local authority regards the redesign of Option 3 as an important part of implementing self-directed support – in other words, they seek to ensure that the quality and responsiveness of services delivered under Option 3 are seen as appealing and closely related to the specific needs of individual supported people, as other Options.

One of the other challenges is around Option 1 when it involves directly employing Personal Assistants.  There is no requirement for PAs to undergo a Protecting Vulnerable Groups disclosure check or to be registered with the Scottish Social Services Council.  There is a shortage of PAs and, with an ageing population, this challenge is becoming more severe.  The Council has established an online PA registration scheme.  Most of those recruited have a care background but a package of training for PAs is available.

Two case studies were undertaken in Midlothian:

• Case study 8: Gerry used self-directed support Option 1 and then Option 2 to meet his care needs.
• Case study 9: focuses on a care provider’s experience of delivering services funded under Option 2 and Option 3.

Case Study 8: Gerry, Midlothian

Gerry is 26. His story illustrates the importance of the regular review of personal outcomes achieved. This introduces a check to assess how people are managing their self-directed care and support, and the flexibility needed to change options if that becomes appropriate.

Gerry has muscular dystrophy and uses a wheelchair. He has a 24/7 care package and was offered Option 1 or Option 2 (there was not an Option 3 contractor available). He originally chose Option 1 because he thought that choosing his own care provider was an attractive idea.

Gerry threw himself into selecting a provider, with active support from his mother. He met several companies but many of their hourly rates were unaffordable for his personal budget. Gerry found a new local provider and they were encouraged by their social worker to “give them a go”.

Gerry interviewed the provider, discussed his care plan and agreed a price for providing the service. The cost was slightly higher than his personal budget so he approached the local authority who agreed to fund the higher cost of the package.

The provider identified the carers Gerry needed, he then paid the provider and sent invoices to Midlothian Council, setting out the care hours that had been delivered, in order to draw down the money.

This arrangement worked well until Gerry started a full-time course at his local college. Due to the demands of the course, Gerry started falling behind with his invoicing and there were discrepancies between the provider’s record of hours of care provided and Gerry’s record of hours of care received:

“I was getting weekly phone calls chasing invoices – and because I was doing a full time college course I got really stressed”.

When Gerry was offered a place at university, he decided that it would be better for him if he changed to choosing a provider under Option 2 so that he would not have the responsibility and added pressure of managing his care under Option 1.

Moving to university still meant identifying appropriate providers and again, supported by his mum, he identified care organisations in the city and looked for those located near to the student accommodation. A pool of 50 potential providers was whittled down to 20 and then five were interviewed. He selected one of them and they used a subcontractor to provide the package of care.

Moving to Option 2 was more beneficial for Gerry. He explained, “I am able to pick who provides the care – but the payment and organisation is done by someone else”.

Gerry left university before the end of his course and moved back to Midlothian. The local authority directed him to a website of local providers and the same subcontractor was operating in the area so he was able to continue to work with the same organisation. Like many local providers, the organisation initially found it difficult to recruit appropriate carers, but they succeeded and continue to work with Gerry.

Gerry had both the time and the inclination to carry out the research on his providers under both Option 1 and Option 2 choices and he felt that, “It gave me something to do, it gave me good communication skills, and it gave me skills with money – I found it quite fun”.

However, it was time consuming to pursue his choices and it was challenging, particularly in balance with other demands such as full-time study, to control the care that was provided in a way that enabled him to pursue his personal outcomes.

Figure 4: Summary infographic - Case Study 8, Midlothian

Case Study 9: McSence, Midlothian

McSence is a locally owned and controlled social enterprise based in the Mayfield area of Midlothian. It has a number of business strands including home help, care at home and training. Their experience highlights how Option 2 not only provides benefits to individuals but also helps to support innovative small businesses.

Four years ago, following a Care Inspectorate report, Midlothian Council offered McSence a contract for a total of 50 hours a week for Option 3, which gave the local authority the ability to call on care-at-home for elderly supported people. McSence is a well-known local community organisation that offers care-at-home as well as property maintenance services and workforce training on topics like adult support and protection. It has many contacts and, as a result, when they promoted their service demand very quickly went above the 50 hours.

Their service was focused initially on their home area of Mayfield.  Most supported people also accessed McSence’s home help service, and several social workers had confirmed that supported people could switch and receive all the services from the same provider.

McSence maintained its 50 hour per week contract until a new three year framework agreement was created when three larger and longer established providers were commissioned to provide all services on the Option 3 framework. “We had existing clients and the Council sent them letters saying they would be moving to a new provider.” However, they wanted to remain with McSence and approximately 20 of the supported people switched to Option 2 so they could continue to receive care from the organisation.

The current situation is that McSence is now providing 1,000 hours of care per week in Midlothian, following their success in a subsequent tender round when they became approved suppliers again on the framework. This has meant that many of their Option 2 people have switched back to Option 3 and new supported people are also accessing services under that option.

For the business, Option 2 represents a way of minimising their risk. Their manager described, “Option 2 is a godsend as a community business – without it big players can have people write tenders and will always win – Option 2 gives small organisations like us a lot more power.” They know that if they are unable to secure a place on the framework in the next procurement round, their customer base can still be maintained under Option 2.