ANNEX H SUMMARY OF RECENT RESEARCH ON SELF-DIRECTED SUPPORT
Recent research has focused on the following themes:
1. Independent living brings improvements in quality of life and emotional, physical and social health
Work by Sally Witcher (2000), Frances Hasler (2006), Riddell, Ahlgren, Pearson, Williams, Watson, and MacFarlane (2006) and Pearson, (2006) have all demonstrated the positive benefits to disabled users of the independent living that self-directed support can deliver. Other work has focussed on the benefits to older people e.g. Clark, Gough and Macfarlane (2004) and that of the Joseph Rowntree Foundation (2004 onwards).
2. Self-directed support is cost effective
Hurtsfield, Parashar and Schofield (2007) and Heywood and Turner (2007) 74 are the most recent research studies demonstrating the cost effectiveness of self-directed support. Other studies include Zarb and Nadash (1994).
3. There are recognised obstacles to overcome in local implementation
The recent Scottish Executive working group on Direct Payments for Older People ( DPOP) identified a number of contributing factors towards low uptake in many parts of Scotland, including:
- The need for awareness-raising, advice, information and training for service users through local support services
- The need for a dedicated lead officer in each local authority, staff training, and the winning of 'hearts and minds' at all service and management levels on the benefits of self-directed support
- Many local authorities have yet to fund local self-directed support schemes sufficiently, and
- Local authorities' concerns about the ability of users to cope with self-directed support, and the quality of care they may receive.
The above points are supported and further emphasised by findings presented by Riddell et al. (2006) 75 at the Scottish Parliament's Health Committee Care Inquiry 76 that looked at the effectiveness of implementation of self-directed support since enactment of the Health and Social Care (Scotland) Act 2002. This research currently provides the most up to date research picture for Scotland.
Riddell et al (2006) cite funding, training and confidence issues among users and social workers alike as current obstacles in Scotland. However they report that users' believe that self-directed support is manageable with support. Glasby and Littlechild (2001) identified availability and access to appropriate information and support and the attitudes of social work professionals who are concerned about self-directed support as factors. Pearson (2006) stresses that whilst resource constraints impact on delivery of self-directed support, there is a need for a cultural change, incorporating a shift in values and attitudes if self-directed support specifically, and user choice and control more generally, are to become a reality for recipients.
4. Best practice solutions are developing, for example, the need for local authorities to fund local support
Whilst such research raises legitimate concerns, they are largely issues concerning the processes of self-directed support which Rummery (2005) suggests 'could be fairly simply (if not necessarily cheaply) addressed'. Witcher, Stalker, Roadburg and Jones' (2000) findings suggest with the 'right approach and support, infrastructure barriers can be dismantled or, better still, prevented from arising altogether'. Riddell et al (2006) are similarly positive.
Clark, Gough and Macfarlane's (2004) best-practice solution focus recognises the pivotal role that both local authority care managers and support services have in delivery of self-directed support. They conclude that 'funding of support services should reflect their value both to users and to the local authority'.
The need to fund local support services was also a key conclusion of Riddell et al (2006) who further emphasised its importance in the spoken evidence they gave at the Care Inquiry.
Barnes, C.,McCarthy, M. and Comerford., S. (eds) (1996) 'Assessment, Accountability and Independent Living: Confirmation and Clarification of a Disability Led Perspective'. The Report of a Conference organised by Coventry Independent Living Group and Coventry Social Services Department, Coombe Abbey, Coventry, 23 - 24 May 1995 (forthcoming).
Barnes, C., Mercer, G. and Morgan, H. (2000) Creating Independent Futures: An Evaluation of Services Led by Disabled People. Leeds: The Disability University of Leeds.
Carmichael, A. and Brown, L. (2002) 'The future challenge for direct payments'. Disability and Society, 17: 7: 797 - 808
Clark, H., Gough H., and Macfarlane A., (2004) It pays dividends: direct payments and older people. Bristol: Policy Press
Department of Health (2006) Direct Payments for people with Mental Health Problems. A Guide to Action.
Department of Health et al (2006) Working Together to Safeguard Children: A Guide to inter-agency working to safeguard and promote the welfare of children.
Department of Health (2006) A Parents Guide to Direct Payments.
Glasby, J and Littlechild, R (2001) 'Independence pays? - barriers to the progress of direct payments', Practice, 14:1:55-66
Glasby, J. and Littlechild, R. (2002) Social work and direct payments. Bristol: Policy Press.
Hasler, F. (2006) 'Holding the dream: direct payments and independent living' p.285 - 292 in Leece, J. and Bornat, J. (2006) Developments in Direct Payments. Bristol: Policy Press.
Heywood, F. and Turner, L. (2007) Better outcomes, lower costs. Implications for health and social care budgets of investment in housing adaptations, improvements and equipment: a review of the evidence. Executive summary
Hurtsfield, J. Parashar, U and Schofield, K. (2007) The costs and benefits of independent living.
Land, H. (2005) 'Securing the Dignity and Quality of Life of Older Citizens'. Paper delivered at Cash and Care Conference, Social Policy Research Unit, University of York, 12-13th April 2005. Available in Glendinning, C. and Kemp, P.A. (2006) Cash and Care: Policy challenges in the welfare state. Bristol: Policy Press.
Morris, J. (2005) 'Citizenship and disabled people: A scoping paper prepared for the Disability Rights Commission'.
Morris, J. (2005 ) 'Independent Living: The role of evidence and ideology in the development of government policy'. Paper delivered at Cash and Care Conference, Social Policy Research Unit, University of York, 12-13th April 2005.
National Centre for Independent Living (2001) Direct Payments for mental health users/survivors: A guide to some key issues.
Pearson, C., (2000) 'Money Talks?: Competing discourses in the implementation of direct payments', Critical Social Policy, 20:4.
Pearson, C (ed) (2006) Direct Payments and the Personalisation of Care. Edinburgh: Dunedin Academic Press.
Riddell, S., Ahlgren, L., Pearson, C., Williams, V., Watson, N., and MacFarlane H., (2006) 'The Implementation of Direct Payments for People Who Use Care Services'. Scottish Parliament Health Committee Report SP Paper 624.
Rummery, K., (2005) 'Disabled citizens and social exclusion: the role of direct payments', paper for the Cash and Care conference University of York, April 2005.
Scottish Executive (2001) For Scotland's Children.
Values into Action (2001). Making Decisions: best practice and new ideas for supporting people with high support needs make decisions.
Witcher, S., Stalker, K. Roadburg, M. and Jones, C. (2000) Direct Payments: The Impact on Choice and Control for Disabled People. Edinburgh: Scottish Executive Central Research Unit.
Zarb, G. and Nadash, P. (1994) Cashing in on Independence: Counting the costs and benefits of cash and services. London: The British Council of Organisation of Disabled People ( BCODP).