Social Care (Self-directed Support) (Scotland) Act 2013: Draft Regulations and Statutory Guidance – Analysis of Consultation Responses

9 GUIDANCE - THE ROLE OF THE NHS PROFESSIONAL

9.1 Section 8: The role of the NHS professional clarifies what is possible under the respective legal frameworks and discusses, and promotes, a joint approach between health and social care to make use of all sources of information, resources and expertise in assessment and support planning.

9.2 Two case studies of combined packages of support are used to illustrate these points.

Question 7a: Was this section of the guidance clear and easy to understand?

9.3 Sixty-nine respondents said yes, this section of the guidance was clear and easy to understand. Six said no and 69 did not give an answer.

Question 7b: How useful did you find this section of the guidance?

9.4 The table below shows that most of those who replied said it was quite useful (48). Twelve respondents said it was very useful, 13 said not very useful and two said not at all useful. The remainder (69) did not give an answer.

Table 9.2 Usefulness of Section 8 of the guidance

Question 7c: Do you have any further comments on this section of the guidance?

9.5 Seventy-two respondents commented and while the section was widely welcomed, the main theme to emerge was that much more work is needed in this area of the guidance.

9.6 In particular, many respondents, across groups, commented on the need for this section to reflect the impact of the integration of health and social care within the guidance; especially on how this related to SDS. One local authority commented: "We would submit that the principles embedded in self-directed support require to be fully adopted by health colleagues as part of the Integration agenda and that this will require collaboration, training and a culture change within health at all levels."

9.7 Respondents acknowledged that the guidance was written before the Public Bodies (Joint Working) (Scotland) Bill was published in May 2013 but stressed the need for the Bill to be reflected in this section of the guidance. Clarity around roles and responsibilities in relation to integrated working was seen as important. The following is a typical example:

"The guidance should encourage local authorities and health boards to work much more effectively together on developing joint packages and should refer to the health and social care integration legislation as a unique opportunity to develop effective joint approaches towards SDS."
(support & information/advocacy organisation)

9.8 Related to this point, several respondents, particularly local authorities, commented that pooled budgets can work well and asked that this section include examples showing how pooled budgets work. A voluntary organisation reported: "There has been little to no evidence of the pooling of health and social care budgets locally (although if this is happening then this would likely be confined to high cost packages). Essentially local providers feel that this is still very much at an aspirational stage and not embedded in local thinking and practice". Guidance on protocols for shared funding of support packages was also seen as important. One local authority commented:

"As it would appear that there is no intention to provide bridging finance to enable that shift over time from public to more personally sourced provision, public bodies will require to reprioritise current commissioning and provision arrangements to meet the demands of SDS. Perhaps this is something that could be taken forward through the development of joint commissioning strategies and therefore also joint budget setting arrangements."

9.9 Another raised the issue of charging, saying: "One of the major complexities in developing jointly funded packages of support is the issue of charging; services provided by the NHS being free at the point of delivery, whilst local authorities have the power to charge for support with the exception of free personal and nursing care. No reference to this issue is made in either section 8 of the guidance or paragraph 149, which deals with charging. This is a significant omission."

9.10 Guidance on funding including timescales and how, and from which department, funding will be released was requested.

9.11 A support & information/advocacy organisation, however, felt that this section focuses too much on "the financial aspects of joint working, rather than emphasising the complementary roles of NHS and social care professionals in working with individuals to plan care packages".

9.12 Several respondents, across groups, identified areas that they felt were missing from this section; they wanted to see reference in this section to multi-agency or joint assessment, Single Shared assessment, NHS Continuing Care, the role of the NHS in delivering on the SDS agenda and the equality strategy.

9.13 The need to reference the personalised health care agenda was also noted in a number of responses. There were again calls to include guidance on children and young people.

9.14 There were comments, from a number of voluntary organisations, that the information for NHS professionals is rather limited and "doesn't really add anything to the role that NHS should undertake within the SDS process and in terms of personalisation." A CHP commented on the need for the section to focus more on the social care functions that can be transferred to the NHS and also on how this would be achieved.

9.15 Implications for health staff were also mentioned, one health respondent, while welcoming the opportunity for health staff to undertake SDS assessment, commented that there would be an impact on training and support for the health staff undertaking assessments.

9.16 A small number of respondents commented on the need for this section to be rewritten in plain English or for more definitions to be included.

9.17 A support & information/advocacy organisation commented on the need to avoid duplication. Its members "told us that it was unacceptable to have to tell the same story to several professionals" because they have moved services, because they did not always deal with the same person or because more than one professional was involved. These service users "want the guidance to say there should be a single point of contact within the local authority, and that contact should be made easier overall".

9.18 The need for training and support for carers in relation to SDS was re-iterated by a voluntary organisation while another wanted to see more emphasis on mediation support and dispute resolution.

9.19 There was also a comment, from a voluntary organisation, that the "whole of this section reads as though it refers only to those with physical problems". And while some respondents welcomed the "excellent" examples given, there were comments that the case studies given relate only to those with physical disabilities; examples for Mental Health & Learning Disability were requested.