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Self-directed support: A National Strategy for Scotland



The Scottish Government and COSLA are committed to driving a cultural shift around the delivery of care and support in Scotland, with self-directed support becoming the mainstream approach.

We are pleased to have worked closely with people who direct their own support and those who design and deliver support, in developing this strategy's proposals. Consultations showed strong endorsement of the 10-year agenda which we will now begin to take forward. We know how important it is to work together and we will embed co-production in our approach to the delivery of self-directed support locally and nationally.

The strategy sets out a clear message about individuals and families having real choice and control, and the key challenges that we need to work on over the next ten years to deliver that. The focus is on delivering better outcomes through focused assessment and review, improved information and advice, and a clear and transparent approach to support planning. The strategy is part of a wider reform agenda, and reflects the common goals of current health and social care policy to deliver better outcomes for individuals and communities. These include recent developments in Reshaping Care for Older People, Caring Together, and the National Dementia Strategy. Implementation will also bring a focus to the development of self-directed support for children and young people alongside GIRFEC. This will also make a significant contribution to our Shared Vision for Independent Living.

We know this strategy is being published in a difficult economic climate. Both national and local government have to deal with significant reductions in resources over the next three years. It is recognised that demographic change is driving costs across most areas of social work. But we also know more of the same will not work, and it is abundantly clear that those economic pressures have not stifled people's willingness to be innovative and solution focused.

The Scottish Government and COSLA hold that self-directed support should be available to everyone but imposed on no-one. If we are serious about enabling people to exercise choice and control over their lives, then they should be able to maximise choice and control over any formal support they require too. That is our shared ambition.

We believe this strategy represents an important step forward to delivering support that is fit for the future.

Shona Robison
Minister for Public Health and Sport

Councillor Douglas Yates
COSLA Spokesperson for Health and Wellbeing

Getting a life back

Linda is a 51 year old lady who lives with her husband, Bob. She worked in full time employment until last October when she had to stop working due to her health issues. Linda suffers from Multiple Sclerosis and requires a high level of support. She had received 22 hours of support from the traditional home care services and was also given two day place in a day service. These arrangements however did not work well for her or Bob . Bob, suffers from COPD and also has problems with his joints which sometimes restrict the help he can give to Linda.

Now, Linda manages her own budget and employs her own Personal Assistants to support her on a daily basis to meet her social care needs. Having a SDS budget not only means that Linda can receive the services to meet her needs in a more flexible way, but it also means that she can have greater control of her life. The cost of the support package Linda put in place herself was also lower than the cost of her previous services provided.

Linda remembers the day she opted to direct her own support as the day she got her life back:

On the first day I took control of my own budget, I celebrated by doing lots of thing like going out for lunch and doing some shopping. All that was possible because I had my PA with me to help with things like going to the loo. I know these are pretty ordinary things to do, but I can't convey what joy they brought me. I literally felt as though I had my life back. When I was receiving standard home care it was like being a prisoner in my own home. I can't go anywhere without a carer, and they couldn't take me outside my own four walls.

The worst part of the old system was that they treated Bob as a non-person. The carers would come in to make my lunch but they weren't allowed to cook for Bob. Then they would only wash any dishes they had dirtied themselves. So even if Bob scrambled up something so we could eat together, it was like apartheid for dishes and his had to be kept separate from mine.

I also had to be ready for bed at 8.00 pm because that was the latest the carers would call. That was really awful. Sometimes it made me want to cry. They would come in through the back door and shout out cheerily: 'Time to be in your jim-jams' It didn't matter if I was in the middle of a meal or entertaining friends. I had to drop what I was doing because I can't get ready for bed on my own.

I have only been on self-directed support for a couple of months, and already those days are like a distant memory. I am sure this will be a generational thing in that children growing up now will find it hard to believe that care regimes were so rigid and impersonal, in the same way as my daughter who is only 21 finds it difficult to comprehend that in the past we locked mildly disabled people away in mental hospitals.

The difference is absolutely amazing. And of course it was great for Bob because he was free to do whatever he wanted without worrying about me. Thanks to self-directed support I've got people I know and like coming into help me, and they do it on my terms because their payments come through me as I now control my own budget. I don't go to bed till 10.30 pm and they will even help me take Mandy our Labrador for a walk, or they will take her out if we can't for any reason. It's just such a delight. I wish I could have done it years ago.

I am definitely living a much fuller life thanks to the independence and confidence that having my own budget has given me. I still love swimming, but I have also taken up tai chi, going to the athletics track, and boccia.