Self-directed Support Implementation Study 2018: report 4

1. Introduction

Background to the report

The purpose of this report is to summarise research that the Scottish Government commissioned into self-directed support. As well as this overview, there are three reports, which separately detail the main components of the study. These and the study objectives are outlined further below.

The implementation of self-directed support (SDS) in Scotland has led to a major shift in how social care and support are conceptualised and how related services are delivered. SDS is now the mainstream approach to social care delivery in Scotland. At its core are the principles of choice, control and flexibility for supported people to pursue personal outcomes they have identified through open, informed discussion with professionals. It demands a new approach to providing support in a way that focuses on the needs and priorities of supported people. The Scottish Government needs to understand what progress is being made to ensure that the principles of self-directed support are fully embedded in practice and reflected in experience. It is important that there is evidence about: the short, medium and long term consequences of the policy for individuals, the workforce and services; ;, changes in service procurement and the care market; the costs and benefits involved; and the impact on – and implications for - the wider system. In November 2017, the Scottish Government commissioned a consortium of Blake Stevenson Ltd, Rocket Science and the York Health Economics Consortium (YHEC) to conduct a study of the implementation of self-directed support, which will contribute to and help to shape ongoing national monitoring and evaluation. This short report summarises the key research findings from this study.

Context

The Scottish Government launched Self-directed Support: A National Strategy for Scotland (SDS Strategy)^[1] in 2010. The strategy set out the Scottish Government’s aim to mainstream a self-directed approach to the delivery of care and support. This formed part of a wider shift towards personalisation, co-production and assets-based thinking in social care, in contrast to the case management approach brought in by the NHS and Community Care Act 1990. The Health and Social Care Standards, which came into effect in 2018, also reflect the personalisation of care.

Self-directed support represents a change in the relationship between supported people, commissioners and providers, with more choice and control given to individuals and more flexibility required of providers and commissioners. It encourages more creative solutions than those seen as traditional solutions in the health and social care services. This has entailed a significant cultural shift for some support services, from making decisions for supported people to making decisions with people.

Self-directed support was given a statutory footing with the Social Care (Self-directed Support) (Scotland) Act 2013 which was implemented from 2014. The legislation requires local authorities to offer individuals a range of options when they are thinking about how to meet their social care outcomes and health and social care services. These options are:

• Option 1: The individual or carer chooses and arranges the support and manages the budget as a direct payment;
• Option 2: The individual chooses the support and the authority or other organisation arranges the chosen support and manages the budget;
• Option 3: The authority chooses and arranges the support; and
• Option 4: A mixture of options 1, 2 and 3.

Each local authority is responsible for setting local eligibility criteria for access to social care services, based on national guidance produced by the Scottish Government and COSLA. Local authorities assess people’s needs in partnership between the assessor, the person with social care needs and, if appropriate, a family member or carer. Anyone assessed as being eligible for social care can expect to have a discussion with their social worker about the personal outcomes they want to achieve, what support they need to reach these, how much control they would like over arranging and managing their support, and which self-directed support option they wish to pursue.

“The Self-directed Support Strategy Implementation Plan 2016-2018” states the current priority is to “consolidate the learning from innovative practice and the application of guidance; and to embed self-directed support as Scotland’s mainstream approach to social care.”^[2]

Transforming Social Care: Scotland’s progress towards implementing self-directed support, 2011-2018”^[3], published in August 2018, further describes the wide-reaching implications of self-directed support and the significant investment of finance, time and effort which has already taken place.

Audit Scotland also published a progress report on self-directed support implementation in 2017.^[4] The report noted that the pace of mainstreaming self-directed support in social care has varied across the country and for different groups of people, which made it difficult to draw conclusions about the implementation “progress” at a national level. The report did find that many people are being supported in new ways, although more information and guidance are needed to help individuals make informed decisions.

The progress report acknowledged that these changes to service provision came at a time when public sector budgets were under significant pressure due to the ongoing financial constraints, while there are increasing expectations and rising demand for health and social care services, and when there are social care workforce shortages. All of which have contributed to a slower than expected speed of implementation of social care options and, in some cases, this has resulted in the limited choices for supported people.

Audit Scotland also identified that the integration of health and social care has likely further slowed the pace of self-directed approaches being mainstreamed.^[5]

The research project

The purpose of this study was to contribute to improved understanding of the impact and effectiveness of self-directed support at a national level, with a focus throughout on engagement with users of social care, their families/carers, and the people responsible for frontline delivery. It will inform the Scottish Government’s plans for future monitoring and evaluation of the policy.

Due to the differences in the extent to which self-directed support has been fully embedded in practice across the country, and some inconsistencies across the social care data collated nationally from local authorities, the project focused on understanding the current situation and certain topics in more detail rather than being a full evaluation of self-directed approaches.

The project was delivered through three inter-connected parts:

• A: an Evaluability Assessment of self-directed support;
• B: research on the economics/resource implications of self-directed support; and
• C: research on Option 2 in practice.

The Evaluability Assessment was initiated by conducting Theory of Change (ToC) workshops to create the SDS Change Map. This provides a simple outcomes framework for major changes that need to happen to move towards self-directed approaches being fully implemented as the mainstream approach to social care delivery.

After building the SDS Change Map, an assessment of existing evidence helped to create a revised set of research questions for future monitoring and evaluation as well as looking at how to evidence and understand economics/resource implications of self-directed approaches. The final part of the study involved case studies from six areas that consider the local context and individuals’ and providers’ experiences of self-directed approaches in practice, with a focus on Option 2.

Research outputs

Four papers have been produced to detail the methodology and findings of the Self-Directed Support Implementation Study 2018:^[6]

• Report 1: The SDS Change Map;
• Report 2: Evidence assessment for self-directed support;
• Report 3: Self-directed Support Case Studies; and
• Report 4: Summary of Study Findings and Implications (this report).