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

Systems are more widely understood, flexible and less complex

Authorities and social care providers have proportionate, person-centred systems and participatory processes that enable people who receive care and support to live their lives and achieve the outcomes that matter to them.

Progress to date
Successful implementation of the legislation requires extensive partnership working between Authorities, delivery partners, supported people and communities. As Audit Scotland recognised, there is limited evidence of large scale system change as yet, but even within the context of the current tight fiscal environment, substantial progress has been made in some areas.

Many factors impact on the design and implementation of systems supporting the delivery of social care. Authorities are responsible for a wide range of such systems, some of which may be inter-dependent (such as initial assessment and calculation of a budget). Systems relevant to social care may include:

• Initial assessment and review
• Eligibility criteria for accessing social care support
• Resource allocation (i.e. setting a budget whether using equivalency, resource allocation systems or something else)
• Charging and contributions policies
• Authorisation processes for budgets and packages
• Performance data/reporting
• Audit procedures
• Commissioning and procurement practice
• Risk management
• IT systems to support some or all of the above

The reduction of bureaucracy remains an aspiration but is proving difficult to address. System “ownership” is often diffuse, with multiple stakeholders having an interest and responsibility for underpinning IT platforms sitting in a different place. There is renewed interest in taking a “systems thinking” approach and considering these challenges as facets of wider project planning, rather than addressing aspects in isolation.

Where there is national evidence of systems change at local level, it is most frequently in addressing the challenge of adapting IT systems to cope with more creative assessments, co-produced support plans, and personal budgets. Even where IT systems have been adjusted away from recording hours and a focus on “time and task” to reflect new approaches, the processes underpinning the data can remain complex.

Once support is agreed and in place, there are growing efforts to reduce the administrative demands on supported people and third sector support organisations under Option 1 (direct payments), and on providers under Option 2 (person directs the support, budget held by a third party) in terms of providing receipts and an audit trail.

Many areas are moving towards the use of a payment card for individual budget or support fund transactions, and seeking to minimise active reporting by individuals. East Ayrshire provides support from their own specialist Finance Officers who will make home visits and sit with supported people to help them to do their direct payment returns.

CIPFA Guidance
In 2014, the Chartered Institute of Public Finance and Accountancy were commissioned by the Scottish Government to develop a national financial management framework to support the implementation of self-directed support across Scotland. As well as the core guidance, a package of professional training and support was provided to enable professionals to understand the background to the changes and to implement the modernised financial framework.

Standards and scrutiny support self-directed approaches
In recognition of the changing landscape, in 2014 Scottish Ministers committed to review the 23 National Care Standards. The new Health and Social Care Standards, entitled ‘My Support, My Life’, were introduced on 1 April 2018 and apply to planning and commissioning as well as to the delivery of services and support. The Standards seek to provide better personal outcomes for everyone and to ensure that the basic human rights we are all entitled to are upheld.

The new Standards are wide reaching, flexible and are focused on the individual experiences of people using support. They are underpinned by five principles: Dignity and respect; Compassion; Be included; Responsive care and support; and Wellbeing. In addition to shaping inspection and scrutiny, they should be used to continually improve the quality of services across health, social care, early learning, childcare, children’s services, social work and community justice.

The Care Inspectorate and HIS now take the new Standards into account when carrying out their inspection and quality assurance functions, and when making decisions about registered health and care services.

Regulation of the workforce
The SSSC revised the Codes of Practice for registered workers and employers in 2016. These changes aim to reflect personalisation, promote leadership in practice and support the rights of people who use support to control their lives and make informed choices about the support they use.