Section Six: Conclusion
6.1. Next steps
The Scottish Government and Cosla will work with the National SDS Implementation Group to help bring about the changes in the strategy.
The remit of the Group is to:
- help make all the recommendations of this strategy happen
- advise on and plan the way forward
- agree priorities and when they will happen in an action plan
- find out how the strategy is making a difference
This will be done in co-production with all members, who will also gather and disseminate information amongst their representative organisations.
The first step for the group will be to agree an action plan with targets and milestones for delivery of the high level objectives. There may be a need to update or develop guidance on specific issues. Some of the milestones are already set out in recommendations. Others will need to be agreed, and will depend on related policy and legislative opportunities.
Implementation of the strategy should adopt the co-production approach at the heart of self-directed support theory and practice, and milestones will therefore be collectively agreed.
6.2. Delivering change
Short term goals - 2010-2011
Given the organisational and infrastructural changes that will be necessary for individual councils to more fully develop SDS, we would expect public finances to affect the pace of implementation as well as the level of individual budgets offered. As such, the development of SDS may be evolutionary rather than revolutionary.
The shift to self-directed support as a mainstream approach relies on an early shift to outcomes focused assessment and review. Some of the barriers to self-directed support are already known as the same barriers that have prevented growth of direct payments. National evaluation of the test sites will provide useful information for implementation of this strategy, particularly with regard to timescales for delivering change.
The Test Sites (Glasgow, Dumfries &Galloway, Highland) running across 2009/2011 have evidenced the level of challenge in shifting into SDS from traditional services. The 3 themes: bridging /invest to save; reducing red tape, and leadership have each in turn tested current practice.
Leadership has proved to be a positive theme as knowledge of SDS, and buy in, has clearly grown in each site. The effect has been evident in making SDS a central part of overall Council strategy, at political and officer level, and through the necessary engagement with individuals, carers and providers. The dedicated project teams with support from senior management are likely to be a key factor in providing the necessary impetus for this change agenda.
Bridging funds, with their sense of meeting temporary double running costs, are more often used as change funds allowing an investment in new delivery. This process can however lead to a positive shift in Council resources, although this is likely to be over longer timescales than the Test duration itself. The importance of aligning this process with the commissioning (and decommissioning) strategies, service delivery models, training and staff development, and workforce planning requires careful long term commitment. Links to other policy are also important if an outcomes agenda is to be pursued. These are described earlier in the strategy.
Red Tape has proved particularly resistant to streamlining at this stage, especially as newer supported self- assessment, resource allocation, and support planning approaches have been developed alongside existing assessment and direct payment systems. The challenge of producing simple systems to align resource allocation against needs, while eligibility criteria and resource demands impact, have proved challenging to commissioning and provider organisations. It is also clear that the development of support organisations is required to enable individuals to have real choice and control.
Again however, reduced business processes are likely to be identified over timescales that may be beyond the funding period for the test sites.
Whilst the evaluation report will not be available until summer 2011, the progress in each area gives a sense of the range of activity needed to take SDS forward.
Highland Council Test Site
The Highland test site is now operating well and results are encouraging.
This can be demonstrated through the following achievements in the pilot's funding period from 1 April 2009 to 30 Sept 2010.
- The number of Direct Payment recipients has increased from 165 to 200 (including the 16 described below). This represents a 17% growth rate in the Highland DP program during this period, and a change from the previous years' picture which was showing a slight decline in the number of people taking a DP.
- There are now 16 people who have received SDS packages in Highland and a further two people whose packages are very close to finalisation bringing the total to 18. Of this group 15 are young people in transition to adult services who are the primary target group in the Highland pilot project. Work is currently underway to develop SDS packages with a further 6 young people in transition and these are expected to be in place by Christmas 2010.
- Planning is presently underway for phase two of the pilot project which will target people facing delays in discharge from hospital. This phase of the project will operate in two community hospitals in Highland: Invergordon and RNI hospitals. The second phase is expected to commence at Invergordon Hospital on 1 October and at RNI on 1 November 2010.
In addition to the above the Highland SDS project team have also completed the following to date:
- Development of Highlands SDS communications strategy which is currently being implemented.
- Training of 30 practitioners working with younger adults in the development of SDS packages.
- Awareness raising workshops delivered across Highland for over 200 people from a variety of professions working with young people.
- Jointly conducted training with SPEAN to promote awareness of employment issues with over 70 practitioners.
- Planning and construction is well underway for the SDS Highland Website which will include video content from local people using SDS.
- Two workshops on SDS conducted for over 100 providers from across Highland with speakers from across Scotland.
- SDS service user network established which has now met 3 times and work is being done with the group to ensure that it is self sustaining beyond the life of the project.
- Financial modelling work is close to finalisation in the use of bridging funds to secure the long term future of the SDS program in Highland.
The Scottish Government in conjunction with the test sites, should publish and disseminate the findings from all its local authority pilots so that this learning can be offered across Scotland by 2012.
The Scottish Government and COSLA should use the learning from the research undertaken in the test sites in both local authorities and health settings to begin to identify how best existing resources can be used to support the delivery of self directed support, and the timescales for development.
As the forerunner to broader self directed support, direct payments have demonstrated the financial constraints that limit uptake, despite the duty on local authorities to offer these. There is a view that one way to shift power to the consumer and to remove the structural bias in favour of service provision, is to adopt a default position of opt out rather than opt in.
The Government has consulted on proposals for new primary legislation to address some of the gaps in current eligibility for direct payments, and to bring self-directed support into statute. In taking forward these proposals, the Government is gathering evidence on their impact and deliverability. Legislation is sometimes perceived as a negative route to enforcing change. However, it can also provide an opportunity to bring statute up to date with the significant developments in social care over recent years, and to meet the demands for clarity about rights and responsibilities. A draft Bill will be issued for a further round of consultation by the end of 2010. The progress of the Bill through the Scottish Parliament and the evidence gathered in doing so, will be key to the Action Plan
The Community Care Outcomes Framework allows partnerships (local authorities and their NHS partners) to understand their performance locally, at a strategic level, in improving outcomes for people who use community care services or support, and their carers. It also allows partnerships to share this information with other partnerships in Scotland and mutually compare performance directly on the basis of consistent, clear information. The Community Care Outcomes Framework underpins the national performance framework.
The Scottish Government and COSLA should ensure that these policy changes are reflected in the National Performance Framework in addition to developing clear national targets for years 2011 onwards.
The Scottish Government and key stakeholders should work together to review and update the Community Care Outcomes Framework by summer 2011 in order to ensure that all client groups and forms of community care support are adequately represented in data collected for Local Outcome Agreements.
At national level, progress with direct payments is currently measured through an annual survey. 30 The shift to measuring outcomes as opposed to outputs should be reflected in the framework above. Data collection should also be updated however, to provide quantitative information on progress with the agenda.
The Scottish Government should review current data collection on direct payments to measure the approach to self-directed support
Medium term goals: 2012-2015
The next phase of change should include evidence of a shift in resources and analysis of the implications of the information gathered in line with the above recommendations.
Learning from and evaluation of test sites will inform practice across Scotland, and there should be evidence of a clear increase of health resources to support appropriate packages.
The emphasis on co-production in self-directed support will require the development of a framework that gives all relevant parties a clear understanding of what this means and how it can be delivered.
Among the outcomes identified as important to individuals and families is keeping safe. Self-directed support needs to be developed within the broader duty of care, and does not override legislation that safeguards people from harm. Some restrictive practice is attributed to scrutiny and regulation. Scrutiny bodies too are focusing more on outcomes, and on co-production in their own activities.
Scrutiny bodies should devise a method to measure the incremental progress of the policy in collaboration with individuals, carers and other interested parties.
The early goals seek to grow self-directed support in social care. Individual budgets are being trialled in other sectors too. The Scottish Government should consider key findings of the evaluation of both the personal health budget trials and Right to Control trailblazers in England, to apply that learning to developments in Scotland.
The Scottish Government should discuss with Education leads whether and how Disabled Students Allowance and other relevant funds in Further and special, and Higher education can be included in self-directed support packages.
Long term goals: 2015 onwards
By 2015, there should be significant progress in addressing the current barriers to self-directed support. Implementation should be reviewed at this stage to reflect on progress in:
- the provision of independent support
- the development of universal services
- the role of self-directed support in taking forward the Independent Living agenda beyond health and social care.
6.3. Measuring success
Progress should be recognised in the following ways:
- A better quality of life for individuals, where they can live in a way that they choose, being in control of their own life, free to do so how they wish and do this with dignity.
- A radical increase in the uptake of self-directed support ( SDS), utilising the funding of individual budgets and the consequent increase in take up of DPs; and resulting in a shift in the balance of care from more traditional service provision to SDS;
- A sustainable network of advocacy and peer support organisations that support individuals to exercise choice and control
- A sustainable SDS national network of independent support organisations, which is recognised as an authoritative source of expertise and proficiency in the training and support of personal assistant employers, by both local and central governments
- A proficient body of trained and experienced personal assistant employers; such training given by the SDS national network of independent support organisations
- A workforce of appropriately trained personal assistants, with regulated employment conditions; such training also given by the SDS national network of independent support organisations
- Working in partnership to achieve this shift