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

5 GUIDANCE - ELIGIBILITY AND ASSESSMENT

5.1 Section 4: Eligibility and Assessment looks at assessment, its basis in social care legislation, its purpose in day to day practice and its place in the supported person's pathway. The legal basis for assessment and the purpose of assessment are set out in this section.

5.2 Guidance on determining eligibility for support includes eligibility criteria and the role of the professional and local authority in applying this criteria via the assessment. There is guidance on the detailed exploration of the person's needs and on the general principles for assessment given in the 2013 Act (Collaboration, Involvement and Informed choice).

5.3 The Exchange Model of Assessment is described and illustrated, showing how the views of all involved can be brought together and the personal outcomes (things that matter to the supported person) identified.

5.4 The differences between Service led assessment and assessment based on personal outcomes are detailed and challenges in moving to an outcome based approach are addressed. There is also short description of self-assessment.

5.5 The final part of this section sets out three main products expected from the assessment process: the assessment; the support plan; and the actual support provided to the individual.

Question 3a: Was this section of the guidance clear and easy to understand?

5.6 Sixty-eight respondents yes, it was clear and easy to understand. Eight respondents said no and 68 did not reply.

Question 3b: How useful did you find this section of the guidance?

5.7 Most of those who answered felt it was quite useful (53). Twelve thought it very useful, 15 said not very useful and 2 said it was not at all useful. The remainder (62) did not give an answer to this question. The table below shows the results.

Table 5.2 Usefulness of Section 4 of the guidance

Respondent group	Very useful	Quite useful	Not very useful	Not at all useful	No response
Individuals (21)	3	2	-	1	15
Local authority (24)	2	15	5	-	2
Community Health Partnership (4)	-	2	-	1	1
Health Board (2)	-	1	-	-	1
Voluntary sector organisation (57)	5	18	8	-	26
Private Sector organisation (2)	-	1	1	-	-
Professional or regulatory body (8)	-	4	-	-	4
Support & information/Advocacy (16)	1	6	1	-	8
Other (10)	1	4	-	-	5
Total (144)	12	53	15	2	62

Question 3c: Do you have any further comments on this section of the guidance?

5.8 Comments were noted in 98 responses. As can be seen by the introduction to this chapter, Section 4 contains guidance on a wide range of topics and, while many respondents supported the section and the guidance contained in it, there were also many issues which they wanted to see addressed.

5.9 Several respondents commented that this section is too long, contains too much jargon and is rather disordered.

5.10 Other comments included the need for greater detail, especially on definitions, and several respondents felt that examples or case studies would be useful.

5.11 There were also comments that the language of the support plan was unfamiliar compared to the more traditional language of a care plan. One local authority commented: "A shorter version demonstrating the thread linking assessment to support planning would make this more meaningful." Others suggested streamlining or removing detail about the eligibility framework, support planning and assessment.

5.12 Respondents gave some suggestions on how to shorten the section and these included splitting it into two separate sections, one on assessment and one on eligibility. There were also various suggestions for re-ordering the section; some respondents included their own example of the section as they felt it should be laid out.

5.13 General comments on this section included suggestions that the title should be reversed to read Assessment and Eligibility as, respondents felt, this was the correct order. A local authority said: "the purpose of assessment is to determine the person's eligibility for support. This should be reflected as an outcome of the assessment and, therefore, the section on eligibility should follow the section on assessment". Several respondents commented that putting eligibility before assessment runs contrary to an outcomes approach.

5.14 A small number of respondents mentioned the need to give estimates of how long an assessment process is likely to take, this could perhaps be illustrated by graphics or pictures. The need for interim support while the assessment is taking place was also mentioned as was the possibility of an indicative budget, which would be especially useful for young people moving to adult services to allow them to plan their care choices.

5.15 Respondents pointed out that the section seems only to refer to adults and asked that this be clarified. For example, several organisations across groups made a similar suggestion: "If this section is specific to adults this should be explicit. If it intended to be reflective of assessment generally it should include references to GIRFEC, carers assessment etc" (local authority).

5.16 A small number of respondents, mainly from voluntary organisations, felt that the SHANARRI indicators for children could be placed in this section.

5.17 Other specific groups were mentioned and these included deaf people and deaf children, people with Parkinson's disease and people with autism. The specific requirements of these groups need to be considered within the assessment process to ensure they are properly supported to engage with the process. Communication methods, assistive technology and interpretation services and specialist approaches, among others, need to be considered within the assessment process. There was a comment that the range of eligibility criteria should be examined to ensure that people with autism or Asperger's Syndrome are included, as currently many fall outwith the criteria even though they have support needs.

5.18 There were also suggestions that the fluctuating or degenerative nature of many mental health and physical conditions should be recognised; Parkinson's and Motor Neurone Disease were specific areas of concern.

5.19 Respondents were also concerned that people who are in recovery may not be included, even though they need on-going support or support in the case of relapse. A voluntary organisation also commented that "people at an early stage of developing a problem with drugs/alcohol also need access to support and it would be counterproductive to wait until an individual had deteriorated in order to be able to provide support. The need for the protection of funding for early intervention/recovery support for people with substance problems is therefore indicated".

5.20 There was concern, mainly from voluntary organisations, that the connection between eligibility criteria and outcome-led assessments is based on the initial threshold for support rather than outcomes. Respondents felt there should be more focus on outcomes and there was a suggestion, from a voluntary organisation, that this could be achieved through approaches such as the Talking Points Approach which has demonstrated the positive effects of person-centred discussions on individual outcomes.

5.21 There was also concern over a lack of consistency across local authorities in respect of assessments and eligibility criteria. One voluntary organisation reported: "A couple of years ago we undertook a study of EC [eligibility criteria] in Scotland and discovered that there was not even a common understanding about what these terms applied to - some councils viewed them as referring to "risk", others saw them as an overall judgement of "need". We welcome the development in England of a move to a single definition of EC with clear definitions and a minimum standard for when people can expect support". There was a call for a Scottish standard and for a standardised assessment tool.

5.22 Several respondents pointed out that the eligibility criteria currently used pre-dates SDS and asked whether this reference would change. A local authority and a professional/regulatory body commented that the eligibility criteria as described is not, in any case, accurate in relation to the 2009 Eligibility Guidance. In addition, the 2009 guidance was mandatory for older people but optional for those aged 18-64.

5.23 Many, especially voluntary organisations, welcomed the focus on the needs of the individual over budgetary considerations, the commitment to involving individuals and their families and carers and the guidance that local authorities 'should publish the eligibility criteria/framework and it should do so in a clear and transparent way'.

5.24 However, several respondents wanted to see national guidelines or minimum standards in order to avoid a postcode-lottery of care and support provision and problems when a supported person moves from one area to another with different criteria. There was also some concern that preventative support in particular may suffer from reducing budgets. Several voluntary organisations expressed concern that there is no direction given to local authorities in appropriately resourcing care and support.

5.25 There were comments that the guidance could remind local authorities of the need to conduct an Equality Impact Assessment when reviewing or changing eligibility criteria and to make these criteria publicly available. There were also comments that the guidance should make it clear that eligibility criteria should reflect the statutory principle of participation and a right to an ordinary life.

5.26 Local authorities raised a variety of other points and these included concern that "the guidance fails to properly acknowledge the over- riding statutory duty of care that falls to local authorities". There was also concern that local authorities may struggle to achieve everything in this paragraph because of "the current spending review, fiscal pressures and overarching policies including Welfare Reform".

5.27 Respondents welcomed the assertion that the supported person and professional will work together. It was suggested that there should be training to assist professionals in thinking innovatively.

5.28 There was some support for the use of the Exchange Model but also comments that it should place more emphasis on views and wishes of the user being paramount.

5.29 There were calls for the guidance to highlight the potential for a conflict of interest when providers help with self-assessment. The need for independent support was stressed to ensure that the organisations or people supporting the self-assessment have no self-interest in the outcome.

5.30 There were also comments that the term self-assessment could be misleading; a local authority commented said it "could lead to the expectation that the assessment is complete without the input from a health or social care professional. There is certainly a great deal of benefit to be gained from individuals preparing for the "supported assessment" and we would want to encourage them to do so but care should be taken when deciding on the terminology used for this".

5.31 Support to take part in a self-assessment was seen as vital but respondents stressed that it must be made clear this will contribute to, but will not replace, the full assessment.