Self-directed support strategy 2010-2020: implementation plan 2019-2021

Leaders and systems

Senior decision makers and systems create the culture and conditions for choice and control over social care support

• Statutory authorities undertake effective strategic planning for improvement
• Communities and supported people shape the planning, commissioning and monitoring of support, and are enabled to create and sustain the full range of community resources
• Decision making structures enable a creative, flexible and timely approach to the delivery of support
• Procurement and commissioning processes promote a diverse range of flexible, personalised and creative support
• All contractual and monitoring arrangements between local authorities, providers and supported people are flexible, proportionate and outcome-based
• The relationship between public, independent and third sector health and social care organisations is trusting and collaborative

Scotland is integrating health and social care so that people have access to the services and support they need, so that their care feels seamless to them, and so that they experience good outcomes and high standards of support as described in the Health and Social Care Standards: my support, my life.

We are also looking to the future. Integration requires services and support to be redesigned and improved, with a strong focus on prevention, quality and sustainability. We will continue to maintain our focus on reforming and improving people's experience of care.

National developments since 2016

• In 2017-2018, 70% of people using social care made choices over their support^[1].
• The recent Review of Progress with Integration of Health and Social Care covered many of the areas of the Change Map and should be read alongside this Implementation plan.
• A human rights-based approach is now encouraged across procurement activity, and with specific reference to health and social care, under the Procurement Reform (Scotland) Act 2014, and the Guidance on the Procurement of Care and Support Services 2016 (Best-Practice).
• Social Work Scotland expanded on this approach in Self-directed Support and procurement best practice: Key points and myth busting.
• Personal care is now free at the point of use for people under 65. Adults assessed as needing personal care will not pay charges for it, regardless of their income or assets.
• A model contract for Option 2 support (the person directs the support and the budget is held by a third party) has been developed through CCPS. This aims to be as short and accessible as possible while meeting minimum legal requirements, and is available as a template that can be adapted and changed to suit local needs.
• Increasingly, areas are working collaboratively with communities, partners and workers to shape pathways into and around social care within an integrated landscape. Those areas which have formally adopted a Community Led Support model are beginning to see significant reductions in waiting lists and times. Key factors for success include devolving financial decision making to community teams and frontline practitioners, leading to timely decisions; and staff and communities developing solutions together.

In Falkirk, the local authority is in the process of developing a points based resource allocation system based on outcomes, so that every person assessed as eligible for social care support will receive a clear indicative budget.

• Social Work Scotland will work with local authorities and senior decision makers to design and test a framework of practice for self-directed support across Scotland. This will identify shared challenges and include approaches to assessment and resource allocation. It will produce greater consistency in experience for people, making it easier for supported people to move from one area of Scotland to another. Local flexibility will ensure authorities can work with their communities to develop systems that suit local strengths and needs, particularly in remote and rural areas.
• Scottish Government will continue to invest a total of £3.52 million per year into local authorities to move their social care support towards a self-directed model. Scottish Government and COSLA will gather evidence against the change map on the impact and learning gained from this investment to inform future work at local and national level.
• Healthcare Improvement Scotland will work in eight HSCP areas to develop a Community Led Support approach to health and social care based on good conversations and what matters to people.
• Scotland Excel will continue developing a national framework agreement for both purchased and commissioned care and support services. This will increase consistency in the way in which support is commissioned, purchased and delivered across the country, and will strengthen the focus on person-centred and outcomes-focused practice.
• Coalition of Care and Support Providers Scotland (CCPS) will support contracting authorities to improve the way they enable a range and diversity of providers and types of support. Better commissioning and development of the provider 'market' will increase the choice and diversity of provision available for supported people.
• CCPS will promote and develop social care provider led collaboration through the Building Collaboration Fund. Better collaboration leads to more co-ordination of services and a more seamless experience for people who use support.
• Option 2 of self-directed support (the person directs the support and the budget is held by a third party) will be the focus of dedicated activity designed to resolve some of the implementation challenges systems and workers have experienced.
  • CCPS will continue to promote their suite of resources for implementing Option 2.
  • In Control Scotland will facilitate practical demonstration work in six local authority areas to develop and embed Option 2 as a practical choice for supported people, including carers.
• In Control Scotland will work with leaders, managers and practitioners to take forward a programme of activity around self-directed support in children's services to encompass the wider group of 'children in need' as well as disabled children and their families.
• Healthcare Improvement Scotland and the Care Inspectorate will continue to embed the Health and Social Care Standards across the health and social care workforce, with a particular focus on engaging with health regulators to raise awareness and increase the focus on person-centred support.
• COSLA and Scottish Government will work with partners through the Charging Guidance Working Group to revise the existing national guidance on Charges Applying to Non-residential Social Care Services so that it further reflects the move to an outcomes-focused approach and personal budgets for care support.
• The Scottish Government and the Care Inspectorate, working closely with the Scottish Social Services Council, will review care service definitions as set out in the Public Services Reform (Scotland) Act 2010 to ensure that definitions are less restrictive and better enable the more flexible and holistic approaches that are increasingly being adopted across health and social care.
• In addition to the actions noted above, the recent Review of Progress with Integration of Health and Social Care and the commitments within it will contribute towards the achievement of the Leaders and Systems outcomes of the change map. The most relevant commitments are reproduced on the following page.

What national partners will do 2019-2021 to support leaders and systems

All commitments from the Ministerial Strategic Group for Health and Community Care's Review of Progress with Integration of Health and Social Care are interconnected and of relevance to social care. The following are most relevant to this implementation plan. All commitments will be completed in 2019-20.

All leadership development will be focused on shared and collaborative practice.

An audit of existing national leadership programmes will be undertaken by the Scottish Government and COSLA to identify gaps and areas of synergy to support integration of health and social care. Further work will be delivered on cross-sectoral leadership development and support.

Relationships and collaborative working between partners must improve.

Statutory partners in particular must seek to ensure an improved understanding of pressures, cultures and drivers in different parts of the system in order to promote opportunities for more open, collaborative and partnership working, as required by integration.

Relationships and partnership working with the third and independent sectors must improve.

Each partnership will critically evaluate the effectiveness of their working arrangements and relationships with colleagues in the third and independent sectors, and take action to address any issues.

Improved strategic planning and commissioning arrangements must be put in place.

Partnerships should critically analyse and evaluate the effectiveness of their strategic planning and commissioning arrangements, including establishing capacity and capability for this. Local Authorities and Health Boards will ensure support is provided for strategic planning and commissioning, including staffing and resourcing for the partnership, recognising this as a key responsibility of Integration Authorities.

Effective, coherent and joined up clinical and care governance arrangements must be in place.

Revised statutory guidance will be developed based on wide ranging consultations with local partnerships, identifying good practice and involving all sectors. The key role of clinical and professional leadership in supporting the IJB to make decisions that are safe and in accordance with required standards and law must be understood, coordinated and utilised fully.

A framework for community based health and social care integrated services will be developed.

The framework will be key in identifying and promoting best practice in local systems to clearly illustrate what good looks like in community settings, which is firmly focused on improving outcomes for people. This work will be led by Scottish Government and COSLA, involving Chief Officers and other key partnership staff to inform the framework.