SECTION 9: FINANCING SELF-DIRECTED SUPPORT
171. Financing self-directed support should be part of mainstream funding activity at local authority level. The key message is that over time the resources need to follow the policy of enabling more people to manage their own support.
172. Local authorities will require to establish specific plans and take-up targets to significantly increase the number of people on self-directed support year on year to meet projected demand. Local resource allocation models need to be developed to fund self-directed support using existing budgets, transferring funding to self-directed support from equivalent care services. The strategy for carrying this out should also be explicitly established and discussed with service providers and local support services to ensure transparency and enable them to plan future services.
173. Experience has shown that financial management of self-directed support is potentially easier where there are more flexible and user-focussed approaches in all services through:
- budgets devolved to a local level
- higher levels of external spot purchasing/contracting
- a user focus to care planning and individualised service delivery, and
- established individual budgets.
Recommendations for longer term financial planning
174. Most of the funding for self-directed support will require to be found from existing budgets, and the ways to do this successfully will include:
(i) Incremental resource virement
175. On a year on year basis local authorities should organise their budgets so that a percentage of their existing budgets for traditional services can be moved to fund self-directed support. Systems need to be set up to change staffing establishments or reduce purchasing budget levels incrementally to enable virement of funding into the cost centres which finance self-directed support. The release of resources from home care, purchasing budgets and spot contracts needs to take account of the present and projected demand for self-directed support. The strategy for achieving this should be explicitly established and discussed with service providers and local support services.
(ii) Broader service strategies for change
176. It is more difficult to release funding from buildings-based services, and services which are the subject of block contracts. Individual self-directed support packages may be difficult to fund from any one fixed service, so what is needed to finance self-directed support schemes is a planned change in the balance of funding, shifting a proportion of budgets from fixed services to more flexible purchasing budgets.
177. Buildings-based services and block contracted resources may require an overall re-provisioning strategy that might include targeting specific numbers or groups of service users. It will take account of the effect on care standards and unit costs. The potential to release finance incrementally from building-based resources will require finance managers to draw on the experience they have gained over the last 20 years in shifting the balance of care from institutional resources across wide areas of service. For example, partial leaseback from building-based services may provide an option for release of funds in some cases. There may be opportunity to use long-term care budgets where self-directed support is seen as a cost effective way to support people in their home environment and so keep some people who wish to avoid it, out of care home provision.
178. Block contracts give service providers valuable security in developing and managing resources, but this approach can also run contrary to an individualised approach to support. Whilst block contracts will remain an important feature of the care market, local authorities and providers need to review their block contracts and make adjustments within the spirit of the direct payments legislation. This includes block contracts for housing support under Supporting People funding.
Extra resources for self-directed support
179. Self-directed support is a means to individually purchase the support that would otherwise be arranged by the local authority, so it must be met from existing overall resources. However, in recognition of additional costs incurred whilst self-directed support schemes are developed in tandem to arranged services, the Scottish Executive allocated an additional £1.8 million expenditure during 2006 to Scottish local authorities and £2 million annually thereafter to bring self-directed support fully into mainstream provision. This is to be used to fund:
- local support that where possible is independent and user-led
- self-assessment and care management training for individuals on self-directed support and their PAs, and
- a designated local authority lead officer to take forward local roll out of self-directed support, including training of local authority colleagues: care managers, area managers, finance managers, and directors of service.
Mainstreaming local authority funding of support organisations
180. Funding of local support should be part of mainstream financing activity at local authority level and is one indicator for assessing local authority performance under the Joint Performance Information and Assessment Framework ( JPIAF) 49. The level of investment in a support system will partly depend on the type of service provided. It also needs to be proportionate to the expected number of people on self-directed support.
181. Local authorities are expected to fund essential training for users and PAs. To strongly encourage take-up of these training opportunities, local authorities should fund user training separately from the hourly rate for support, whether by ring-fencing funds per individual, or funding provided via the local support organisation. Individuals on self-directed support should understand and fulfil the training obligations placed on them. Such training should be accompanied by a voluntary code of practice established for individuals through partnership working with peer-led support organisations.
Long term best value and quality of life
182. Local authorities are required to operate within the principles of cost effectiveness and long-term best value. Both cost and effectiveness need to be assessed, and effectiveness needs to take account of the quality of life of the user in the short and longer term.
183. Research suggests that on average self-directed support packages are cost effective when compared to other forms of home or residential care if the full cost of each is taken into account, including administrative and other general overheads that may require careful attention to provide a true cost 50. There may be start up costs for setting up a self-directed support package, especially if the person decides to employ their own staff, which may decrease once arrangements are in place. But even if this necessitates a slightly higher initial investment, there may be savings achieved in the longer term, such as diminishing the need to enter a care home.
184. Long-term benefits are not just about money. Financial prioritisation and local community care planning should recognise and place true value upon the independence and empowerment of service users, with care managers and support staff working in partnership with the individual so that they are able to take control of their support arrangements to the extent that they feel best suits them. This is in line with Social Work ethics, SSSC Codes of Practice and the International Federation of Social Work 51. Those on self-directed support, their care managers, carers and other support staff, attest to the value it can add in terms of flexibility, choice, control and social inclusion. It delivers the means to live life in a more spontaneous manner. Equity and budget control may require some cost ceilings but judgements of long term best value should take account of individuals' quality of life and allowance be made for exceptional circumstances.