Self-directed Support: Practitioners Guidance

Monitoring and reviewing

There is a duty on the practitioner to offer the person the four options for all new presentations of eligible need and for those whose circumstances are due to be reviewed from 1st April 2014. This review will require to consider risk, capacity and any changes which impact on current support plan.

In order to ensure practitioners discharge their duties under the Self-Directed Support Act, monitoring and reviewing processes must be guided by the statutory principles:

Participation & Dignity; Involvement; Informed Choice; Collaboration.

Local authorities have a duty to undertake reviews where support is provided to meet eligible need and as a response to a significant change in circumstances. Frequency will be guided by risk and other factors.

Monitoring

• monitoring of the support plan is essential to ensure the plan is being implemented as agreed and to allow for any minor adjustments to be made as appropriate.
• the amount of contact required with the individual, their family, carer or any other organisations will be determined by the level of need and risk and contribute to the on-going process of assessment and analysis. This will have been openly discussed and agreed at the support planning stage.
• monitoring informs the review process so that the information contributes to an understanding which can support people to make the best use of the resources available to them.

Reviewing

• review of the support applies to all four options under the SDS Act. Review involves re-evaluating whether the plan is achieving the agreed goals and outcomes set out in the support plan.
• it should focus on the agreed outcomes and consider with the person and other involved parties including the provider, the extent to which the support has achieved the outcomes.
• the views of the person with regard to such issues as – the support provided; feeling safe in their home and local community; their level of social inclusion; their personal development; and/or any caring roles they undertake – should all be explored and changes to the support plan discussed and agreed.
• when the supported person is a child/young person, the well-being indicators (SHANARRI) should be used as a framework for monitoring and reviewing.
• the Act makes it clear that the local authority and the supported person have the right to request a review of their selected Option under the SDS Act if there is a change in the supported person’s circumstances/if there is evidence that outcomes are not being met as anticipated.

At each review, the four options must be offered formally again, even if there are no changes required. How this is evidenced, it must be considered by the practitioner and included in local review recording process. It may be helpful for the practitioner to see reviews as a natural extension of support planning. At any time, the supported person can ask to change their option (which should be dealt with by the same process as they made their previous choice) or they may ask for their assessment, support plan, or budget to be reviewed.

Monitoring and Reviewing: Considerations for

Practitioners

• monitoring of the support, its purpose and aim (ensure outcomes are being met) should be clearly understood by all and evidence active participation (this should be referenced within the support plan).
• the level of monitoring should relate to the scale of the support and the complexity of the outcomes identified. Reassure people – it is ok not to get the plan right every time; professionals need to adapt and change too.
• the supported person and contributors to the plan should be clear about how to raise concerns, give feedback if the plan is not progressing or highlight concerns.
• for many, a goal will be to enable an individual to become less dependent on formal support and more engaged in and part of their communities. The monitoring and reviewing process should help to explore this on an ongoing basis.
• the monitoring and reviewing process is as important as the assessment and support planning stages and requires the same principles and approach applied as with the initial pathway.
• practitioners should continue to adhere to local policy, procedures and guidance in relation to monitoring and reviewing.
• preparation – ensure you have planned sufficient time to engage and seek the views of those involved within the support plan.
• the most up-to-date support plan needs to form the basis for the review; the review should be responsive to the inevitable change and fluctuation that exists so that support can be offered more flexibly and proportionally.
• some issues shouldn’t wait for a review to be addressed.
• along with independence and choice comes responsibility – it is reasonable for practitioners to ask people to account for how they have spent their money in achieving their support plan outcomes, but to do so in a sensitive way. During this process individuals and professionals may need to to question the quality of support and information, or their level of funding or explore the choices that are being made and for both parties to develop a refreshed plan of support. The development of a good working relationship with all involved will allow for constructive, open and honest conversations to take place as appropriate when this topic requires discussion.
• who else needs to be involved in the review – this should be considered under the guidance of the person where possible? If other professionals need to be involved – for example within a child’s plan – the reasons for this should be fully explained to all involved.

Organisations

• Is review data influencing service design and commissioning strategies given that it reflects the views of people who use or need support?
• Have you got systems that schedule reviews and prompt when timescales approach?
• Are payments made in accordance with required legal and procedural guidance adopted locally?
• Is there a policy for review?

Evelyn’s story

Evelyn is 23 years old and lives with having fragile ‘X’ syndrome. This affects her in many aspects of her life and means that she can struggle to achieve a level of independence without support. Evelyn can struggle with communicating and developing relationships, her co-ordination is poor which can result in accidents. She finds sequencing tasks and problem- solving difficult without guidance and support from others. Evelyn is extremely vulnerable to exploitation by others and she is unable to identify risks and is extremely susceptible to coercion from others.

Evelyn lives at home with her parents who both have significant health needs themselves and despite their commitment to continue to provide care and support for Evelyn the family have been assessed as requiring support to help maintain Evelyn in the family home.

Evelyn had been assessed as requiring some weekly support to promote social inclusion and this had been provided by a local agency who receives block funding from the council to provide this kind of support. Evelyn had also been assessed as eligible for respite and had visited a number of local respite units but Evelyn and her parents felt this was not appropriate for Evelyn. Using a self-directed support approach to planning, we were able to agree that Evelyn could access a flexible budget to support short breaks that would meet the family’s need for respite. For a period of time this worked well and Evelyn went on a number of short breaks with a family friend and also with support from a support worker from the care agency that she was linked with. Evelyn would, with support, identify a break and was fully involved with planning this. Her budget was held by the social work department and administered to the family or to the travel company when required to purchase the break. Evelyn’s aunt provided her support by accompanying her on her trips and all her accommodation and expenses were paid for using Evelyn’s respite budget.

During a review the success of the support plan revealed that the provider agency were not able to provide the flexibility that Evelyn required, they often cancelled support or sent an unfamiliar person to support Evelyn. There were also restrictions about the activities they could support Evelyn with and with the use of their car for activities further afield which limited Evelyn’s choices. In partnership with social work, Evelyn and her mum were supported to explore Option 1 (direct payment). This gave them the opportunity to employ two Personal Assistants. Evelyn and her mum were fully involved in the recruitment of two women of similar age to Evelyn with similar interests who could support her to achieve her goal of social inclusion. Evelyn’s mum helps oversee the financial responsibility and receives good support from the local authority’s specialist SDS team. They also use the services of a local payroll agency and are extremely pleased with the flexibility this arrangement has given them. Evelyn and her mum feel very much in control in directing her own support.

Evelyn has used the support of her personal assistants to help her gain confidence in using public transport, visiting friends, taking up classes in her local area and securing two volunteering roles in her local community. Evelyn continues to use her personal budget to help her to achieve her agreed outcomes and Evelyn has developed unintended skills from the process i.e. planning and organisational skills as well as increased confidence and IT and literacy skills. Her mum has also grown in confidence in her role in overseeing the direct payment and her own self-esteem has improved as a result.