PART 1: THE BASICS OF SELF-DIRECTED SUPPORT FOR CARE MANAGERS
What is self-directed support?
1. Self-directed support in Scotland is part of the mainstream of social care delivery, targeted at empowering people. It is part of creating a healthier nation with stronger and safer communities and is key to achieving a fairer and wealthier Scotland. It puts the principles of independent living3 into practice and enables people to be active citizens in their communities. Like the social model of disability4, it is about reducing or removing the physical, organisational or attitudinal barriers that people may experience in the world around them. It is about flexibility, choice and control and having a decent quality of life. It is ultimately about promoting confidence and wellbeing for those with an assessed need.
2. Self-directed support builds on the platform provided by direct payments legislation and the rights enshrined in the Disability Discrimination Act (Scotland) 2003. It is used instead of, or in addition to, support services that the local authority might otherwise have provided. It can buy support for a person to live in their own home, such as having a bath or getting washed and dressed. Out of the home it could be to support an individual in college, or to enjoy leisure pursuits more. It may also be used to pay for someone to provide care and support to enable them to take a short break with the person. A person on self-directed support can buy this from a service provider such as a care agency or voluntary organisation, a local authority such as their own or a neighbouring one, or by employing personal assistants ( PAs). In summary, it is an opportunity to meet the assessed needs of the whole person in creative and flexible ways.
3. This means that assessment of need is no longer about which service a person should be referred to, but about individualising the support a person can receive, including offering eligible people self-directed support. Scotland's Changing Lives5 agenda further reinforces the need for self-directed support as part of new social work strategies that better take account of individual's needs and models are still evolving.
4. What is required is major service redesign so that resources and support can be allocated on a truly individual basis. Whilst this type of provision is developing across the UK, individual budgets are already a reality for some Scottish local authorities. This is because different pots of money are brokered by care managers and can be combined into one bank account.
5. The funding sources consist of local authority budgets that may include Supporting People 6, funding for equipment and temporary adaptations, and other DWP benefit streams such as the Independent Living Fund ( ILF) 7 and Access to Work 8. Health money may also be included. Self-directed support does not affect any other state benefits that an individual may be receiving. But like any other care service provided by the council, they will be means tested to see whether they should be expected to make a contribution towards the total cost of their care. Self-directed support does not put an individual at an advantage over other people who have requested services: the same prioritisation and eligibility is applied whether for self-directed support or arranged services.
6. An individual does not have to use self-directed support if they do not want to. It may not be right for everyone. Sometimes even small adjustments to arranged services can make the service more personalised for an individual so that they do not feel they need the full range of self-directed support. Similarly, individuals on self-directed support can revert to arranged services of they choose to.
'Kirsty has Huntington's disease which affects her mobility and speech. She also experiences occasional problems with choking.
She now has 6 personal assistants providing cover from 8.00 am till 10.00 pm 7 days a week with her partner covering the overnights.
She has found many advantages with self-directed support as it has allowed her greater flexibility and freedom in how she lives her life. She bakes, and with a new wheelchair, she can now go out in the car for day trips.
She says: 'Fantastic scheme, makes our life so much easier, can't praise it enough. Help from our local support organisation is only a phone call away at all times.
Who can get self-directed support?
7. The following groups of people are eligible for self-directed support:
- Disabled 9 adults assessed as requiring community care services, including housing support services
- Disabled 16 and 17 year olds assessed as requiring community care services, including housing support services
- Disabled people with parental responsibility to purchase the children's services their children have been assessed as needing
- Parents and people with parental responsibility for a child in need (under the age of 16) who has been assessed as requiring children's services
- Parents and people with parental responsibility for children whose health or development may be impaired or below a reasonable standard without services from the local authority
- Disabled adults and 16 and 17 year olds to purchase housing support services
- Older people aged 65 years and over who are assessed as needing community care services due to infirmity or age
- Attorneys and guardians with relevant powers can receive self-directed support on behalf of people who are unable to give consent to arranging their own services
- Those community care service users aged 65 or over who are accessing Free Personal and Nursing Care can arrange for the personal care element of the package to be received as self-directed support, see section 14.
8. Annex B describes the legal basis of eligibility. It also describes the groups of people who at present cannot receive self-directed support under certain mental health or criminal justice legislation.
How to set up self-directed support
9. The care manager will need to spend time with a person to work in partnership to find out what support they need and what it is possible to provide. They can give a person the information they need about the assessment process, including self-assessment. Some local support services are also able to spend time with individuals to prepare them for the assessment so that they can get the most from it. They may also be able to get support from a peer group who already have self-directed support and know how things work in practice. At the end of the assessment of their needs the individual and the care manager will agree a personal care plan which sets out how those needs will be met.
10. If a person decides to try self-directed support, their care manager can arrange for the allocation of a budget. This is sometimes called an individual budget ( IB) because it is for the person's sole use and to arrange for their support needs. Their care manager brokers this budget and will make clear what they can spend money on. The individual will also need to show the council that the support they want to buy meets their assessed needs, and must have a separate bank account for their individual budget. The person will need to show how they are spending the money by recording it in various ways and by keeping bank statements and receipts on request. Lots of people get a book keeper to help with this, or use a local pay roll service to help with paying any staff they employ.
11. There are local authority funded local support services in most parts of Scotland that can work through the paperwork with the person and help them manage. They can offer practical support, for example, with buying an individualised service from a service provider. Or if a person is unsure of the idea of recruiting and employing their own staff, the support services can help with this. Local support services are listed in Annex C.