Self-directed Support Implementation Study 2018: report 4

5. Conclusions and future implications

The SDS Change Map provides a simple outcomes framework to articulate the main changes that need to happen to embed self-directed support fully as the mainstream of social care in Scotland. It provides a conceptual and practical basis for mapping, tracking and learning from major policy and service; for visually representing the logic or theory of change that underpins self-directed support; and for checking whether and how actions are contributing to intended changes and outcomes.

The assessment of the evaluability of self-directed support looked at published previous evaluations of similar system-wide policies and data currently collected in Scotland. The case study research also identified potential evaluation design challenges.

The evidence from the literature review highlighted that evaluation of similar policies has been challenging - particularly economic evaluation - and almost entirely qualitative. The literature review found no evidence that anyone had ever evaluated the equivalent of the “good conversation” which is central to the delivery of self-directed support. Several of the evaluations identified highlighted the need to be able to monitor change over time for individual supported people, their carers and families, and service providers and the need for longitudinal research.

Current routine data collections are not sufficient to monitor or evaluate against the SDS Change Map, so it is recommended that:

• longitudinal research is undertaken with people receiving social care starting from the time of initial assessment;
• a survey is undertaken of workers across social work and providers who deliver social care;
• a slightly expanded version of the Self-directed Support User Experience Survey is used to include a high-level question on social care outcomes;
• a survey is conducted of independent and third sector organisations who hold service contracts with statutory services; and
• a reporting requirement should be introduced for local authorities to evidence and self-assess their approach to strategic planning and how they are facilitating creative solutions to achieve individualised outcomes.

Economic evaluation will remain a challenge with no quantitative counterfactual^[19] possible and as such should focus on the time taken by staff in local authorities to enable choice and control, which could provide information to consider alongside outcomes data collected in an expanded SDS User Experience Survey.

The case studies revealed many of the same issues as the literature review, notably the challenge of economic evaluation and the need for longitudinal research. The case studies provided a depth of information that would be valuable to the evaluation of specific aspects of social care, but the resource intensity required for case studies means they could be difficult to include as part of ongoing evaluation and monitoring.

The case studies identified that uptake of the four options in a local authority is not a suitable proxy for full and genuine implementation based on the fundamental principles of self-directed support. Although the four options are a gateway to choice and control, what is potentially more important is:

• the quality of the social care assessment and reviews, including a genuinely “good conversation”;
• the degree to which there is a focus on the supported person’s outcomes;
• budgets being available to meet these outcomes;
• the availability of local providers and other resources; and
• the enabled creativity and authority of supported people, social workers and the care market to find solutions to meet those outcomes.

Any future evaluation will need to focus on these elements, alongside cost-effectiveness, in order to understand whether and how the principles of self-directed support in Scotland are being realised in local practice and delivering the intended outcomes of the policy and legislation.