Self-directed Support Implementation Study 2018: report 4

2. Research findings: SDS Change Map

Theory of Change for self-directed support

A key aspect of this work was an Evaluability Assessment of self-directed support. To achieve this, an SDS Change Map was created based on Theory of Change (ToC) workshops with participants from local authorities, providers, carer organisations, national bodies and disabled people’s organisations; and refined through further discussions with the Research Advisory Group (RAG) for this project.

In creating the outcomes, the participants were asked to ensure that they were clear; concise; related to the Implementation Plan for 2016-18^[7], the Social Care (Self-directed Support) (Scotland) Act or the guidance; and that the outcome could feasibly be evidenced either through monitoring or evaluation.

The SDS Change Map (Figure 1 below) provides an outcomes framework for major changes that need to happen in the journey towards self-directed approaches being fully embedded as the mainstream approach to social care. The Scottish Government will use the map as a basis for ongoing monitoring and evaluation of implementation and it offers a useful conceptual framework for planning, designing and reviewing social care provision. The map complements and reinforces the outcomes and statements set out in the national Health and Social Care Standards.^[8]

The SDS Change Map is discussed in more detail in Report 1.^[9] It consists of three tiers:

• the overall vision (people’s social care and support outcomes are met);
• the four key outcomes (numbered 1 to 4); and
• a set of intermediate outcomes (numbered 5 to 17) that need to be in place for the key outcomes and overall vision to be achieved.

Figure 1: The SDS Change Map

The first two key outcomes in the SDS Change Map relate to supported people. They reinforce that the discussions during the initial assessment for social care and regular reviews should form the foundation of an effective approach to social care. This engagement process should follow the accepted ‘good conversation’ model detailed in ‘‘Talking Points: Personal outcomes approach”^[10] which identifies what should be discussed, how the conversation should be conducted, who should be involved and what should happen.

The third key outcome focuses on workers who are involved in any aspect that affects the delivery of self-directed approaches to social care. To achieve outcome 3, workers must have the skills, knowledge and confidence to engage with and support people effectively and in a clear and consistent manner. Crucially they must be enabled to utilise these skills for decision-making with autonomy.

The final key outcome (4) has a series of intermediate outcomes that will help to create the conditions in which supported people can exert choice and control over their social care and support.

It requires the commitment of senior managers and leaders to change a number of systems and processes that influence how self-directed support is experienced. The systems need supportive and proportionate procurement and commissioning approaches, which are: 

• flexible - able to respond to the changing needs and situation of supported people;
• proportionate - the administrative time and effort is proportionate to the scale of cost; and
• outcomes-based – focusing on the outcomes to be achieved for the supported person as opposed to a process that people or workers should follow.

In order for the social care and support providers and workforce to deliver the best possible care and support, discussion and involvement in decision making across all sectors is crucial. Although there may be elements of competition involved – which may become more noticeable if funding reduces – the need was identified for the changes to be reflected in cross-sector relationships that are stronger in terms of trust and collaboration.

Use of the SDS Change Map 

The SDS Change Map, which will evolve over time, provides a simple outcomes framework to articulate major changes that need to happen in the move towards self-directed support being fully embedded as the mainstream approach to social care delivery.

The outcomes in the SDS Change Map shaped the discussions in the area case studies (see Report 3) and informed the evidence assessment for self-directed support (see Report 2).