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

3 GUIDANCE - THE SUPPORTED PERSON'S PATHWAY

3.1 Section 2 of the guidance, The Supported Person's Pathway, presents a table detailing seven steps that a supported person will follow; their pathway to access care and support; and gives a short description of each step. These steps are:

• Step 1: "I need support"
• Step 2: First Contact
• Step 3: Eligibility and assessment
• Step 4: Support Planning
• Step 5: Decision Time
• Step 6: Support
• Step 7: Monitoring and Review

3.2 This section also provides a table summarising the roles and responsibilities of the supported person, their carer, their support provider along with various managers, advisers and officials within relevant organisations such as the NHS or local authority.

Question 1a: Was this section of the guidance clear and easy to understand?

3.3 More than half of all respondents (80) said yes, this section was clear and easy to understand. Two respondents said no and the rest (62) did not give a definitive answer.

Question 1b: How useful did you find this section of the guidance?

3.4 Respondents were asked to say whether they had found the section very useful, quite useful, not very useful or not at all useful. The table below shows that many of those who gave an answer said that it was quite useful (50). A smaller number said it was very useful (30). Two respondents said it was not very useful and one, an individual, said it was not at all useful. Sixty-one did not specify.

Table 3.2 Usefulness of Section 2 of the guidance

Respondent group	Very useful	Quite useful	Not very useful	Not at all useful	No response
Individuals (21)	4	2	-	1	14
Local authority (24)	9	12	1	-	2
Community Health Partnership (4)	1	1	1	-	1
Health Board (2)	1	-	-	-	1
Voluntary sector organisation (57)	9	22	-	-	26
Private Sector organisation (2)	1	1	-	-	-
Professional or regulatory body (8)	2	2	-	-	4
Support & information/Advocacy (16)	1	7	-	-	8
Other (10)	2	3	-	-	5
Total (144)	30	50	2	1	61

Question 1c: Do you have any further comments on this section of the guidance?

3.5 Ninety-three respondents answered this question and while many respondents voiced support for this section, most comments related to omissions, additions and changes.

3.6 Most points described below were raised by a small number of respondents as, on the whole, different respondents commented on different parts of Section 2.

Section 2

3.7 Several respondents made general supportive comments; some simply said that this section is clear or helpful.

3.8 Respondents, across various groups, identified a number of other issues that they would like to see addressed or included in Section 2. These included:

• Emergency intervention
• Contingency planning
• Forward plans
• Conflict resolution
• More information on eligibility criteria and on why criteria is localised
• Recognition "that there will be 'reasonable adjustment' for the needs of individuals who have particular and sometimes unseen communication needs (voluntary organisation commenting on people with autism)
• The need for a clear and comprehensive understanding of each individual's circumstance, experience and/or condition (especially with regards dementia)

3.9 There were also comments, from a local authority and voluntary organisations, that the pathway is very adult-focused and should be extended to include the needs of children and their families. One voluntary organisation pointed out "It is not clear from the guidance how the SDS model aligns with proposals in the Children and Young People Bill. As guidance refers to the Children and Young People Bill, it is likely to need updated when the Bill is enacted in 2014 to explain the named person provision, the single child's plan and the array of changes to the planning and delivery of children services that will arise from the raft of applicable legislation currently being progressed in Scotland".

3.10 Another felt that the role of education and third-sector organisations in supporting children and families should be made clearer in the guidance.

3.11 Commenting on the transition between child and adult services, a voluntary organisation saw the need for children to be included throughout the full document as "the pathway for a young person leaving children's services into adult services is a very different experience if the young person has been introduced to the ideas of choice and control as from already existing SDS services". This respondent included a rewritten pathway reflecting this point.

3.12 A private organisation also commented on transitions, particularly that from child to adult services, and asked that an additional stage be inserted relating to additional support needs at transitions.

3.13 While one voluntary organisation made positive comments about the move to outcomes based assessment, other respondents commented on the need for a greater focus on outcomes. One local authority suggested: "that the 'person's support plan' should be referred to more simply as the 'person's plan'. This would assist with the shift away from inputs and process to a focus on outcomes".

3.14 There were also comments, primarily from voluntary sector organisations, on the need for a culture change in order to ensure that self-directed support succeeds. This should include reference to Article 8 of the European Convention on Human Rights (a right to respect for private and family life, home and correspondence). Emphasis on provision of support at each stage of the process was of particular importance.

3.15 Financial issues were mentioned by a small number of respondents from various groups. In particular, in the area of substance misuse, there were comments on the need for block funding for voluntary services dealing with people with substance use issues who may be unwilling or unable to access support through their local authority social work services.

The Supported Person's Pathway

3.16 A small number of respondents saw a need for a step pre-stage 1 "which reflects the requirements of local authorities to promote awareness of the rights to request assessment and support. For an individual or a carer to get to the stage that they recognise that they 'need support', they must first know that a) support is available, and b) know where they can go, and who to make contact with". (voluntary organisation)

3.17 Several organisations, mainly from the voluntary group, wanted to see support organisations included in the first two steps as: "The earlier an individual has access to support, the better the outcomes are likely to be." (voluntary organisation).

3.18 There were many comments on Step 3, mainly from local authorities and voluntary organisations. Comments included the need to strengthen this step to include an expectation that local authorities will recognise the value of all types of support services and understand the need to provide support before a 'crisis point'. Individuals also highlighted the need to consider whether the supported person needs support at this stage. The need to reference the right to independent advocacy was also mentioned, by voluntary organisations. Similar comments were noted in relation to Step 4.

3.19 Respondents, across various groups, wanted to see more focus on outcomes and to see Step 7 including a record of whether outcomes had been achieved as well as whether outcomes have changed

3.20 A small number of respondents commented on the language used in Section 2 and especially in the Supported Person's Pathway table. There were suggestions from voluntary organisations that "some of the language could be made a little brighter and more inspiring." These respondents suggested replacing 'needs' with 'needs and aspirations'.

3.21 A few respondents felt that the language was more geared towards professionals, for example: "It is important that the language and style used in this section is accessible and clear, and that people feel that this section answers some of the questions they have about self-directed support." (voluntary organisation)

3.22 The use of some specific terms was mentioned and these included:

• 'Social Services' and 'Social Care'; the difference between these may not be clear to everyone.
• The term 'provider' could be confusing as support organisations are legally distinct to providers. The term support organisations would be more appropriate.
• That the use of the word professional is unhelpful; this should be social care or health professional.
• That terms such as review or assessment would not be understood by people who do not understand the system.

3.23 Other comments included the need for the role and involvement of carers, including unpaid carers, at each step of the pathway to made more clear. A voluntary organisation suggested: "May we suggest that reference is made about support organisations near the start of the pathway to secure support in providing full understanding of the options available? Pathway appears not to mention support organisations at any point even though the Act talks about support orgs being an intrinsic part of the path".

3.24 There was also a suggestion that the role of the supported person should be more positive, reflecting that supported people understand their needs and know best what will meet these needs. A respondent from the professional/regulatory body group suggested that a column showing who may be involved at each stage would be helpful.

3.25 Several respondents commented on the linear layout of the Pathway. Views on this layout were mixed with a small number of mainly voluntary organisations welcoming the linear or stage layout; some felt that the whole of the guidance should adopt a similar style. A few of these organisations also suggested that pictures or diagrams would make the guidance more user-friendly.

3.26 However, there were concerns, from support & information/advocacy and voluntary organisations, that the process is not linear and needs flexibility, as re-assessments and reviews are required, especially for progressive or degenerative conditions. A private organisation suggested a circular diagram while a voluntary organisation suggested that: "this section uses the same person's pathway/cycle developed by the M&E subgroup. It has been proposed that this be used for the best practice guidance so for the avoidance of confusion it should be used in the statutory guidance as well".

3.27 Another issue with the stage format was raised by a private organisation; that there is no guidance on "what would happen if an individual after they had started their support plan decided that they had made a wrong or inappropriate choice". This concern applied not only to the supported person but also in the challenges this would pose for businesses providing the support.

Roles and Responsibilities

3.28 There was a large number of comments on the Roles and Responsibilities table; many of these comments came from voluntary organisations. Several respondents, across groups, said that the supported person should be placed at the start of the table.

3.29 A private sector organisation asked why the term 'professionals' only applied to statutory professionals and not to independent or third sector professionals. This respondent also commented that they "are not sure the description of responsibilities is sufficiently strong in recognising the significant culture change which needs to take place for the local authority 'professional' in order to achieve the outcomes of the Act, which in practice will mean a change in the dynamic of power and control". Voluntary sector respondents also commented on this issue, particularly in respect of the word 'may' in the responsibilities of the professional (they may arrange; they may give voice); one suggested that 'may' be replaced with 'should'. Similar comments on this issue were noted in several other responses across respondent groups. Comments on the role of the provider also included suggestions that 'can' play an important role be changed to 'should' play an important role.

3.30 A professional/regulatory respondent felt that 'professional' should be replaced by more specific terms at different places, for example 'assessor' could be used in the Roles and Responsibilities table. In relation to professionals, a voluntary organisation commented that Local Area Co-ordinators are not included. Again in relation to the 'roles of the professional, a local authority felt there needed to be reference to other legislation which needed to be taken into account such as the Adult Support and Protection Act.

3.31 The term 'the provider' was seen as potentially confusing; several support & information/advocacy and voluntary organisations suggested that should be changed to support organisations. There were also several requests for advocacy and user-support organisations to be added to the table.

3.32 While there was appreciation for the inclusion of the unpaid carers role, respondents identified a lack of clarity on the role of guardians. There was also a call for the unpaid carer section to acknowledge that these carers may be children or young people and a call to include the role of other family and friends who provide support.

3.33 The need for equality, diversity and disability awareness training, including deaf awareness, for finance managers was put forward by one voluntary organisation. There was also a call for Social Work professionals to be aware of equality legislation and human rights law in carrying out their duties.