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

Workers are confident and valued

People who work in health and social care have increased skills, knowledge and confidence to deliver self-directed support and understand its implications for their practice, culture and ways of working.

Progress to date
The implementation of self-directed support has led to a positive shift towards outcomes-focused and relationship-based work. This has been achieved through investment in training and a growing cultural shift in social work and social care in many areas towards engaging in outcomes-based conversations, increasing personalisation and a recognition of the importance of involving the supported person in support planning. This work is closely aligned to Social services in Scotland: a shared vision and strategy 2015-2020.

"We’re taking it right back to how we did it 20-30 years ago, looking at community now and individuals’ assets and only using statutory services to plug any kind of major gap… whereas before a lot of people were coming from an age where we just did everything ‘for’ and we built up a bit of an expectation." Social Work Scotland research participant

Social workers in children and families services have found self-directed support a natural fit with existing policy and practice in many areas. For social workers in most adult settings, and particularly in older people’s services, the self-directed approach involves major cultural change. There is, however, variance across the country, and some adult services (for example learning disabilities) already work to personal outcomes, an important part of implementing self-directed approaches.

The full benefits of flexibility, choice and control for supported people are only realised when there is leadership at every level. Research on Frontline and Citizen Leadership by the Scottish Social Services Council ( SSSC) highlighted the different approach to leadership required for embedding self-directed approaches to social care and informed the refreshed Social Services Leadership Strategy. Published in 2017, the vision of the strategy is for the workforce to recognise, understand, develop and use their leadership capability to contribute to service design and delivery that meets the personal outcomes of people using support.

This emphasis on service redesign is evident in a few areas and providers who are in the early stages of exploring new models of community-based care such as the Buurtzorg approach or supporting small scale local developments (including but not restricted to micro-enterprises) in rural communities. Initial results are positive, although still at developmental stage. Scottish Government funding has enabled some of this work and evaluated other aspects of it, encouraging the learning to be shared nationally.

Significant challenges in recruiting sufficient social care workers to meet need were described by almost all areas in SWS’s study, particularly in care at home in rural areas.

"We are managing to continuously grow and recruit and a lot of that growth has been… in these smaller communities where people have a sense of identity [and] care is something they can do within their own communities… Many of these people are not looking for full-time jobs."
Social Work Scotland research participant

Workers receive clear and consistent information, training and capacity building in supporting and delivering self-directed approaches
At national level and under Scottish Government funding, the SSSC established and chaired a self-directed support Workforce Project Board in 2013 and led a programme of activity organised around eight thematic action inquiry work streams. The work streams delivered a wide range of products to address key issues identified by the workforce as impacting on implementation. The SSSC also facilitated action inquiry at a local level with ten partnership areas in 2015-2016. Approximately 180 participants gained relevant knowledge and skills relating to self-directed approaches and evidenced changes to behaviour and practice.

SWS found that local training in the 14 areas they explored had been targeted towards supporting redesigned social work assessments. All participants in their study reported investment of Scottish Government funding in training and supporting staff to have more “good conversations” with supported people, or in similar assessment skills.

Training that has been successful in embedding self-directed approaches and positively received seems to have been mandatory for both staff and managers; based on values rather than processes; described in terms of best social work practice and focused on supporting practitioner understanding of outcomes. Successful training programmes had an in-house and on-going commitment, were delivered in partnership with the third sector, often involved supported people and were responsive to new challenges.

The ways in which training has been approached varies between the areas examined by SWS. Some left participation in self-directed support training optional for staff or outsourced training, which often seemed to have been less positively received. However, some outsourced training from expert organisations was very highly rated – the Thistle Foundation’s Good Conversations training, which some areas had adapted, was described very positively, as was In-Control’s training on outcomes.

Recent national activity (2016-2018), has focused on supporting the workforce to make meaningful connections across policy and practice within the context of health and social care integration. For example, NHS Education Scotland and SSSC published a knowledge and skills framework for palliative and end of life care and related resources explicitly promoting personal outcomes approaches and articulating self-directed approaches for care planning at end of life. Similarly, Dementia Promoting Excellence highlights self-directed approaches and Making it Easier – A Health Literacy Action Plan for Scotland 2017-2025 incorporates guidance on supporting people to make informed choices around social care.

Several e-learning resources have been created for use by workers under Scottish Government funding. For example, the Open University’s online awareness resource Foundations for Self-directed Support in Scotland which has been accessed in all 32 local authority areas since its launch and completed by over 1,000 users. Those with a frontline role reported a change in their own/colleagues’ practice to bring it into line with the ethos of self-directed support.

The skills and confidence for personal outcomes, open and caring conversations, working with risk, and collaborative working were identified as priorities for adult social care by workers and employers in the 2017 Workforce Skills report. In June 2018, SSSC published an e-book learning resource for outcomes focused support planning. It articulates knowledge and skills for personal outcomes, good conversations, innovation, and creativity in support planning. The resource is open badged and learning criteria will be aligned to requirements for post registration training and learning.

Early versions of online training did not always achieve the uptake initially expected. Extensive support to embed resources once they have been developed is required, for example proactively working with statutory, third and independent sector staff to ensure materials are useable, updated and meet expectations.

Qualifying education for social workers has been reviewed and strengthened
The social work landscape has changed significantly since the last formal review of the Framework and Standards in Social Work Education. Shifts in policy, systems, demand and demographic changes caused the SSSC, supported by the Scottish Government, to initiate a review of social work education as part of a new and different approach to professional learning for the social service workforce in Scotland.

After consultation with the sector, the first phase of the review concluded that social work education is fit for purpose but faces challenges similar to the profession as a whole. These challenges were more explicitly identified in the SSSC’s Workforce Skills Report 2016-2017, which named “skills challenges and workforce issues which hinder the promotion of self-directed support” as a frequently raised issue across social service workers and employers.

The revised Standards in Social Work Education ( SiSWE – to be formally published in September, although higher education institutions are already embedding them into qualifying programmes), is one of the developments arising from the review. Specifically, the Standards have been strengthened in relation to the use of self-directed approaches; positive risk taking; personal outcomes; and participation/co-production. An increased emphasis is placed upon “strengths and assets of people and communities”. There was significant stakeholder engagement in the revisions, and in the final consultation a majority of respondents were confident that courses based on the new SiSWE will equip qualifying social workers for current practice. Other work is being undertaken to progress additional findings of the review.

Providers are better equipped to deliver personalised support
The organisations that deliver social care and support have a key role to play in offering choice and control. The Providers and Personalisation project, hosted by the Coalition of Care and support Providers Scotland ( CCPS) and funded by the Scottish Government, builds the knowledge, skills and resources of support providers to implement self-directed support. Over 90% of the 2,588 participants in the initial phase reported an increase in knowledge and understanding and had identified next steps. Topics included risk, brokerage, marketing, commissioning, procurement, regulation, resource allocation systems, Option 2, finance, relationships, social media, contracts, workforce, HR and Systems.

In 2014, a Provider Readiness Survey found that most of those responding had begun organisational change. Significant priorities for providers were changes to workforce and finance systems. Most providers felt they already delivered a high standard of personalised and outcome-focused support; staff were receiving training in self-directed support awareness and outcome-focused planning and staff contracts were being reviewed to make them more flexible.

In 2015, research was commissioned by CCPS under Scottish Government funding to identify the progress providers had made in changing their systems, workforce, finance, support provision and organisational culture for delivery of self-directed support. It also identified contextual factors that support and inhibit provider change. The research discovered a range of creative responses to the challenge of increased flexibility under self-directed approaches, such as frontline staff directly negotiating hours and timings with the supported person and their families rather than this being mediated by manager. It also identified greater service user involvement in recruitment.