SECTION 2: ASSESSMENT, PLANNING AND COSTING SELF-DIRECTED SUPPORT
13. This section goes through the first steps of the journey to maximise a person's independence, and covers stand alone self-directed support as well as where it is part of a mixed package of care including traditional arranged services. It also looks at the planning and costing of the package to ensure that there is money available for the user to get a service that the local authority is satisfied will meet assessed need.
Single shared assessment ( SSA)
14. The first port of call for anyone seeking any care service is single shared assessment ( SSA) which should include some self-assessment work. The emphasis here is on 'single', meaning that one professional carries out the assessment with the individual, often with contributions from other professionals and carers, and that is shared with all those who have an interest to avoid the need for several professionals to undertake separate assessments. The 'shared' refers to the time and skill needed for this holistic approach so that the care manager can work in partnership with the prospective service user and those supporting them. From 2005 it is a requirement that SSA specifically discusses self-directed support as one delivery option.
15. The local authority should inform users of local support services, where available, to support individuals exploring self-directed support and preparing for their assessment. Local support services have a key role in equalising the relationship so that individuals can choose and manage their support. Local authorities should fund those local support organisations who have the capacity to do so to provide this service.
Self-assessment and preparing for being assessed
16. As part of best practice for assessments local authorities should make available information about any eligibility criteria applied in the assessment process that may affect whether support can be offered to individuals. This helps avoid raising expectations about services, which are always subject to assessment.
17. Individuals should be encouraged, as part of a self-assessment process, to consider for themselves what care and support they might need. Doing so will better assist the person in articulating their own needs and so enhance their self-care, which may help prevent escalation where more extensive service provision becomes necessary. It may also assist someone to regain their previous capability.
18. Self-assessment forms should be designed by user groups to prompt people to think through the tasks with which they need assistance before their needs are assessed by the local authority. Annex D has an example of a self-assessment checklist. In addition, some local support services are able to provide courses that can enable users to think of themselves as active citizens making decisions about how to best meet their support needs.
Brokering an individual budget
19. Care managers usually consider multiple funding streams to make up the individual budget ( IB) to meet a person's assessed support needs. Systems such as the Indicator of Relative Need ( SSA- IoRN) 10 are there to assist local authorities in achieving an equitable use of budgets according to assessed needs. Besides the local authority care budget, funding for equipment and temporary adaptations and Supporting People, there may be Free Personal Care, the Independent Living Fund, Access to Work, Disabled Students Allowance ( SAAS) 11, Disability Living Allowance ( DLA) 12, Carer's Allowance ( CA) 13 and health monies to meet continuing health needs. The funds are combined within one bank account and monitoring done as a whole.
20. The care manager is best placed to perform this brokering function as the process is integral to assessment. Their skills and creativity helps them know about an individual's aspirations and wishes, work with them through times of change and help them attain choice and control. They are professionally trained and publicly accountable, and their cost effective approach is to work in partnership with individuals, their carers and families, and local advocates and support services to facilitate good practice.
21. It is not envisaged that additional organisational arrangements are usually necessary at extra cost involving independent brokers, commissioners or navigators as this may duplicate work already done by care managers and local support organisations and require quality and competence monitoring. Commissioners usually develop new services for more than one individual (block contract) so this is less common for self-directed support. Instead local support services are usually able to work with an individual to spot purchase an individualised service or employ PAs, making independent brokers unnecessary.
22. Almost any disabled or older person should be able to get self-directed support if they choose it. Eligible people must give their consent to do so, or if they evidently lack the capacity to do so, consent can be given by an attorney or guardian. Appropriately trained advocacy workers should be made available to support people effectively through the process. Learning disability or cognitive impairment of any kind should not be a barrier to a person having more, or more effective, control of their lives. Further detail is given in section 3.
Ability to manage self-directed support
23. The person carrying out the assessment will need to form a judgement of whether the individual is capable of directing and managing a package. For example, some people with dementia or profound and multiple impairments may need help with planning and running a care package. The practitioner should consider and provide the necessary assistance to the user.
24. This could include any of the following:
- communication support
- record keeping
- pay roll service
- good employment practice
- managing self-directed support on an ongoing basis even through periods of fluctuating or deteriorating condition.
25. Where the authority decides, in exceptional circumstances, that a person is unable to manage self-directed support, the reasons for this decision must be communicated competently and sensitively in writing. This allows for any misinformation to be challenged or clarified. The authority should also make the individual aware that they can use the complaints procedure to challenge the local authority's decision not to offer self-directed support.
'… The difference that self-directed support has made to my life has been fantastic… I feel sad that there are people who may be scared of doing this. People should get the support they need and be encouraged…' (Young person in receipt of self-directed support).
26. The 2002 Act gives local authorities a duty to inform carers providing 'a substantial amount of care on a regular basis' that they may be entitled to a carer's assessment. Where the carer requests an assessment, this is to establish the level of care they are willing and able to provide and what assistance they need in their caring role. A carer's assessment may be carried out separately, or combined with the assessment of the cared-for person. Further information on this can be found in guidance circular CCD 2/2003 Community Care and Health (Scotland) Act 2002 New Statutory Rights for Carers: Guidance in March 2003 14.
27. A carer's assessment does not at present give the carer an entitlement to self-directed support in their own right. Its purpose is to clarify what they can do, what assistance they may need in order to be able to continue in their caring role, the carer's aspirations, and what assistance they may need planning for life balance beyond the caring role and to be able to keep well.
Personal care plans and self-directed support agreements
28. A personal plan describes how an individual's assessed needs will be met. A self-directed support agreement is a separate contract (see Annex E) that spells out the part of these needs which will be met through self-directed support. Both are developed with the user and they should always be given a copy.
29. By exploring creative options, it may be possible to identify needs-led alternatives rather than service-led solutions. The individual chooses whether to purchase services or become an employer. Users can meet their needs by:
- contracting directly with a service provider e.g. an agency, private provider or voluntary organisation
- employing staff (personal assistants, PAs) to provide the services
- purchasing services from any local authority
- other forms of support, for example, those used on a recovery journey after a period of mental ill health, or
- a combination of some or all of the above.
30. The 2003 Regulations prevent people from using direct payments to secure services from some family members. However, this is shortly to be modified by the Adult Support and Protection (Scotland) Act 2007.
Costing a package: an individual's budget
31. The 1968 Act requires local authorities to ensure that the available budget is sufficient to enable the recipient to secure support of a standard that will satisfy the local authority that the person's needs are being met. It should meet the cost of providing a service which is of an equivalent standard to that which the local authority would provide. This means that a self-directed support package using service providers needs to take into account the range of hourly rates for day, night, weekend, bank and local holiday and emergency cover. Some local authorities have set maximum rates for standard agency care for particular client groups, and if service users choose a more expensive rate they will be asked to pay the difference.
32. Whilst some individuals using self-directed support prefer to purchase support from service providers, the majority of people take responsibility for employing their own workers directly and costing is done differently.
Costing a personal assistant ( PA) employer's package
33. Self-directed support is not about promoting a two-tier workforce of social care with a regulated professional workforce sitting alongside a personal assistant ( PA) network. Local authorities will wish to ensure that rates of pay and conditions allow the smooth running of the arrangements for self-directed support. A critical element will be ensuring that PAs are sufficiently remunerated to wish to continue in that role. Pay rates, other benefits and conditions on offer at local authorities should provide a bench mark for setting equivalent rates of pay for PAs. The importance of being a good and responsible employer cannot be over-stated 15. Good working relationships are essential for recruiting and retaining PAs, and will avoid the financial and emotional costs of high staff turnover.
34. The local authority should take the following items into account when constructing the individual budget:
- start up costs such as advertising and recruitment expenses
- pay rates and maximum working hours legislation for staff
- employers National Insurance
- the minimum statutory holiday and bank holiday pay
- statutory sick pay and cover
- statutory maternity, paternity, adoption or dependents' pay and cover
- employer's liability insurance
- training costs
- emergency cover for staff absence
- any required protective clothing for PAs
- any payroll and book-keeping fees.
35. In order to encourage good employment practice the following discretionary elements should also be included where possible. Discretionary elements might include:
- employer's contribution to a pension scheme to match local authority pension contributions
- employer's indemnity insurance to insure the employer for claims made against them arising out of their employment of a PA.
36. The local authority should give individuals as much notice as possible of the individual budget, and any contribution the person needs to make towards their support, before the payment begins or the level is changed. It should be clear to the person from the outset that self-directed support packages may involve their making a contribution, as they would for receiving arranged services.
Assessing a service user contribution
37. Section 87 of the 1968 Act enables the local authority to require the individual to make a financial contribution to the cost of any services they need to meet their assessed needs. In considering if an individual should make a financial contribution, local authorities should treat people on self-directed support as they would treat them if the person was being charged for using the authorities' equivalent services. The individual budget can therefore consist of a combination of an individual's own contribution, a contribution from the local authority, and money from funding streams such as the ILF16 which are not means tested.
38. Local authorities should refer to the Executive's 2003 circular 17 and CoSLA's guidance to local authorities on charging for non-residential care 18.
39. From June 2003 local authorities have been required to make direct payments either on a gross or a net basis of any contribution required. This guidance changes this position. Local authorities are now required to make direct payments on a gross basis and to recover the individual's contribution later. This ensures that people on self-directed support are on an equal footing with people receiving other local authority services. It also enables there to be clear distinction between the individual budget and the service user's own funds.
40. Local authorities are reminded that since 1 July 2002, people aged 65 and over, have been able to receive personal care services at home free of charge. Local authorities should refer to Executive circular CCD 4/2002: Free Personal and Nursing Care 19, particularly Section 5: Payment Mechanisms. Where a person aged 65 or over chooses their individual budget to purchase this element of personal care at home the individual should not be asked for a contribution.
41. Local authorities must ensure that when applying their charging policies to people on self-directed support they do so fairly and equitably with people who receive arranged services 20. People in receipt of housing benefit and those receiving housing support services 21 on a short-term basis (up to 2 years), will not be asked for a contribution, for that element of their self-directed support package relating to housing support, nor will people who receive housing support services previously funded from the Special Needs Allowance package. Details can be found in the Supporting People Charging and Financial Assessment guidance 22.
42. Under section 22(4) of the 1995 Act, local authorities have discretionary powers to charge contributions for children's services where the means of the family are sufficient.
Complaints about funding of individual budgets
43. There may be cases where an individual thinks that the total value of the individual budget should be greater than the local authority proposes, or that their contribution should be less than the local authority proposes. In such cases, the local authority is under no obligation to increase the amount offered. Nevertheless the local authority may decide to increase the amount enabling the person to secure the preferred service if it is satisfied that the benefits of doing so outweigh the costs. A consultative approach is encouraged towards reaching a decision about the level of the individual budget. However, where a case cannot be resolved through discussion, the local authority should advise the individual that they might pursue the matter through the local authority's complaints procedure. If this still does not resolve the matter, the complaint can be passed to the Scottish Public Services Ombudsman (see Annex C).
44. While any complaint is being considered, the individual may choose to manage on the individual budget being offered, without prejudice to the complaint that it is inadequate. Alternatively the person may choose to refuse to accept the individual budget, in which case the local authority must arrange the relevant services instead.