Transforming social care: Scotland's progress towards implementing self-directed support 2011-2018

Supported people have more choice and control

Citizens are engaged, informed, included and empowered to make choices about their support. They are treated with dignity and respect and their contribution is valued.

Progress to date
The move towards choice and control for supported people within social care is one that is driven by the voices of supported people themselves. Self-directed support arose from the independent living movement, and is part of an international move towards not just personalisation of services, but greater control over care and support funded by the state.

The number of people accessing social care through self-directed support (all options) increased to 83,770 during 2016-2017. This represents around 70% of all eligible social care clients in that period.

Substantial work has been required to support the general public, a wide range of related professionals, and senior decision makers to understand what the changes mean for them. The activity noted below is in addition to the awareness raising work that Authorities (used throughout this document to mean local authority/integrated authority as appropriate) have undertaken directly with social work and social care staff, related professionals across health and social care, communities and supported people using Scottish Government and their own funding.

An initial platform for shared understanding was created by the collaborative development under Scottish Government funding of a suite of national guidance to provide practical and stakeholder-specific information to supported people, carers, personal assistants, practitioners and supporting staff. A “one-stop-shop” website has been established to provide information for the workforce, interested parties such as carers and people using social care.

There is a high value placed on opportunities to come together and share best practice or collaboratively explore areas of challenge. This has resulted in current areas of Scottish Government funded activity, such as a focus on developing an accessible and legally compliant Option 2 contract that areas may choose to use and build upon (work currently in progress).

Increased public understanding of self-directed approaches
Substantial work has been done under Scottish Government funding to raise national awareness about the changes to the delivery of social care and support. Since 2015, more than 12,000 people have received information on self-directed support through organisations funded under the Scottish Government’s Support in the Right Direction funding alone. This is in addition to the many websites, videos and case studies aimed at different segments of the population (including in British Sign Language) also created under that funding.

In 2015 and 2016, Self-directed Support Scotland successfully delivered a programme of awareness raising and communications. This included two Self-directed Support Awareness Weeks, roadshows, and substantial social media activity. This work is now aligned with the broader What Matters to You campaign, covering health and social care.

Around half of the total investment from the Scottish Government (£35 million) went directly to local authorities to support the transformational changes in systems and culture required. Each area developed its own implementation of self-directed support, building on local circumstances and strengths, and ensuring flexibility to respond to local demand. Some areas (including East Dunbartonshire, Fife, Perth and Kinross, the Scottish Borders) have chosen to invest in broader public awareness of social care as a means of empowering individuals to think about support before they need it, and to be able to access support when necessary.

Increased understanding within statutory and partnership settings
Fundamental changes to the way in which social care support is conceived can only be delivered with the full scale involvement of all necessary stakeholders. This includes those responsible for strategic planning and the purchase of services within Authorities, finance and internal audit staff, legal professionals, IT, and a wide range of other complementary working roles across statutory, third and independent sector settings. Change encompasses community organisations, advice organisations, scrutiny bodies such as the Care Inspectorate and Healthcare Improvement Scotland ( HIS). It affects the way in which the quality of services and support is understood and the kind of data that supports such an understanding.

To support the development of a shared understanding, many areas have used Scottish Government funding to create implementation teams and boards. Progress has been made at national level, with many of the key drivers shaping the strategic landscape now aligned to support this shift. These include the new Health and Social Care Standards, scrutiny methodologies and workforce registration, as discussed later in this report.

There remain differing interpretations of self-directed support approaches between Authority areas, between services, and between teams. Participants in Social Work Scotland’s research held strong views on the spirit of the legislation, but framed those views in a variety of ways. Some areas had prioritised community capacity building in their approach, recognising the need for a range of supports, while others employed a more rights-based focus on control over support through the four self-directed support Options.

More high quality advice and advocacy available
Since 2015, £2.9 million per annum (almost a third of national funding) has been directed to 36 independent support organisations under the Support in the Right Direction ( SIRD) Fund. This recognises the key role advice and advocacy play in supporting people’s journey through social care and builds on earlier iterations of the Fund which ran from 2011-2015.

In the three years to March 2018, projects have reported on delivery with over 12,000 people. This includes direct client support work (intensive work to identify personal outcomes, develop support plans and put them into action with a wide range of client groups) and awareness raising with affected groups. Projects have developed self-directed support information materials and engaged strategically to embed self-directed support as the mainstream approach to social care.

Service users have highlighted the impact support has had on their health and well-being, with the most commonly reported outcome that “People feel listened to, supported and less stressed”. Funded projects also report that their activity is helping to increase equality of access to self-directed support and increase personal aspirations, leading to an increased sense of choice and control.

A Review of Independent Support in February 2018 based on projects funded 2015-2018, found that, almost without exception, users were very positive about the quality of support. It found that without the information and support received, some people would either have given up on applying for a social care budget or would have chosen a different Option. Users felt that this support was critical in obtaining good outcomes. There were also examples of projects equipping people with the skills or tools that would help them manage their own, sometimes quite complex, support packages, for example support with payroll and employment responsibilities.

The projects have helped people to develop creative and flexible solutions for their care and move away from traditional models of service delivery. The majority of projects provided some form of brokerage support, working directly with people receiving a social care budget to identify appropriate support and services. The review found a broad consensus across projects, service users, Authority staff and national stakeholder interviewees around the value of this type of work.

Although much of the SIRD funded work has been with people who are applying for, or already have, a social care budget, many projects have also been working with people with social care needs (particularly older people) who are not currently eligible for a budget but who would benefit from support to help them access community organisations or other forms of advice. This preventative activity has a high value for the system as a whole.

Over the life of the 2015-2018 SIRD programme, projects have reported more success when they work effectively within the local context they are operating in. Projects make the most significant impact when relationships are strong with local partners, and with social work services in particular.

Social Work Scotland ( SWS) found that in the areas they studied, the work of third sector partners (more broadly than SIRD funded projects) is highly valued by statutory staff and supported people, particularly in enabling supported people to choose a direct payment under Option 1 and in educating the public on self-directed approaches.

Authorities and providers have an enhanced understanding of how self-directed support can work for more people
Additional work has been undertaken under Scottish Government innovation funding to explore the way in which specific client groups can be better supported. Project focuses included older people, people experiencing substance misuse, homelessness, people experienced in the criminal justice system, minority ethnic communities, people with sensory impairments, carers, and mental health, among others.

While knowledge is increasing, the finding is often that more specialised areas of work are dependent upon the broader understanding and practical changes being embedded across the whole of social care, including finance, procurement, and audit systems. Until these changes are fully operational, further impact on specific groups may be limited.

Choice and control for people in care homes

The Self-directed Support (Direct Payments) (Scotland) Regulations 2014 currently prohibit people living in care homes from choosing Option 1 (direct payments). Two small scale pilots in 2015-2017 explored whether increased choice and control could lead to better outcomes for older people living in care homes, using small additional payments to individuals on top of standard fees.

Analysis of the findings shows that by engaging in a collaborative, person-centred process, the projects have been able to create real change in people’s lives that improved outcomes. For some people use of Option 1 (a direct payment) was critical for this. For others, good conversations and involvement in outcomes-focused planning was effective in itself.

This is a complex area which Scottish Government and COSLA have committed to exploring further.