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A review of Self Directed Support ( SDS) in Scotland was commissioned by the Scottish Government's Health Directorates. The review aimed to provide qualitative evidence of the experience of clients in receipt of SDS and to explore the innovative work that is going on in areas with a good track record in delivering SDS, in order to better understand how a range of practices impact positively upon the quality of life of individuals. Of particular interest was how multiple funding streams, including health monies, could be combined within individual budgets to better meet the needs of the whole person. The research used a case study approach in Edinburgh, Fife and Scottish Borders. The work was undertaken by Tony Homer Consulting in conjunction with Paula Gilder Consulting.

Main Findings

• The overwhelming majority of SDS clients and their informal carers had very positive experiences of using SDS funding to directly purchase their support and employ Personal Assistants ( PAs). Flexibility, control, choice and independence were the main benefits reported. Clients in receipt of health funding as part of their SDS support reported a significantly more flexible response to their needs.
• An effective support service that provides clients with assistance in their role as employer was considered absolutely essential to the continued development of SDS as becoming an employer was reported to be the most challenging aspect for clients, of taking on SDS. Assistance with staff recruitment and enhanced peer support would make a positive difference, as would more access to training for PAs.
• The key enablers to facilitating growth at a strategic level were identified as effective leadership on the part of local authorities ( LAs), a dedicated resource providing knowledgeable and skilled support to SDS clients and the capability to apply consistent and appropriate lighter touch practices and procedures in the administration of funding rules.
• The working relationship between different funders was reported to have improved significantly over recent years. However, while LA administered funds were managed in a joined up way, separate rules and arrangements for these and other funds meant that, overall, arrangements for paying and administering multiple funded packages lacked transparency and did not deliver the advantages for clients that they might have. In particular, available guidance on what clients could spend their money on was insufficiently clear.
• The requirement by some local authorities to operate a separate bank account for some SDS funds imposed an additional administrative burden upon clients and made it harder for them to use their multiple funded SDS packages flexibly. By contrast, individuals using a single bank account found this both empowering and simpler to operate.

Background

SDS, (previously called direct payments), is at the centre of the Scottish Government's agenda to promote personalised services and to give people greater control over their care and support.

SDS payments relate specifically to social care services and are LA funded. However, many SDS clients have care packages involving payments from a number of other funding streams and agencies e.g. Independent Living Fund, Disabled Living Allowance and health, with which they can purchase the services and support they require.

The objectives for this review were:

• To gather evidence on the experience of clients in receipt of SDS.
• To examine the range of practices in local partnerships with a good track record in this area.
• To explore the impact that different practice has on service users, in particular the inclusion of three or more funding streams within an individual budget where a person is eligible.
• To identify barriers and enablers in relation to further developing the policy.
• To recommend best practice for furthering the uptake of SDS.

Method

The review involved 38 interviews with 2 main groups of participants:

1. Face to face interviews with 24 SDS clients and/or their informal carers: Key characteristics of SDS clients who had agreed to participate in the review were identified by local officials in order to generate a pool of participants that reflected a range of particular needs and funding streams. Other characteristics such as ethnicity, age and extent of experience of SDS were also taken into account in compiling the final sample.

2. 14 Face to face and telephone interviews with local authority officials, local support service staff and stakeholder representatives in each of the 3 review areas: A key LA contact was identified to assist in setting up the study and this person was also interviewed, in addition to others involved in administering SDS expenditure and providing support to clients.

Research Findings

Clients' and carers' experience of SDS

The overwhelming majority of clients were extremely positive about the difference that SDS had made to the quality of their care and support and the opportunities that were available to them.

Increased flexibility, control, choice and independence were the most widely reported benefits of SDS and collectively reflected a very substantial gain for SDS clients relative to their experiences of other forms of service.

The quality of care provided by PAs was reported as exceptional and this underpinned the ability of SDS to deliver some of the wider benefits commented upon by clients, such as flexibility, choice and independence.

Clients in receipt of health funding used PAs to provide care relating to their medical condition. This enabled them to avoid having to use direct NHS services on a regular basis and represented a significantly more flexible response to their needs.

SDS enabled clients to continue to live their lives largely as they wished, it enabled families to stay together and family carers to feel valued and supported. As a result the client and/or their family carers retained a sense of their own identity and place in the world that reaffirmed their self worth.

Local Authority approaches to SDS

Measures to promote and support SDS within the 3 study areas varied but in each case the LA had dedicated staff to support and facilitate SDS. In addition each LA funded social worker SDS training and a local support service.

Local support services focused upon supporting SDS clients in their role as an employer of PAs and were highly valued by SDS clients. They were however under considerable pressure due to increased demand.

Local financial pressures dictated eligibility criteria for SDS and other services. This tended to limit access for people hoping to remain in work as the application of criteria required clients to be in critical need and did not prioritise preventative or anticipatory needs.

The impact of measures to promote and support SDS

The support provided by social workers and/or support service workers during the set up of SDS packages was widely praised as being invaluable in enabling prospective clients to proceed with SDS. Not all social workers were however sufficiently aware of, or trained in, SDS.

Most SDS clients employed PAs rather than commissioning services from an agency.

Being an employer was the biggest challenge facing all SDS clients and, whilst clients were happy with the support they received from their local service, employing PAs remained a demanding task even after many years.

The working relationship between different funders was reported to have improved significantly over recent years and this had resulted in a generally more joined up and flexible approach to funding for individual clients.

However there were continuing differences and contradictions between the rules and operating procedures that governed the different funds and a lack of guidance on these matters left clients feeling unsure about what they could spend their money on.

A requirement by some LAs to operate a separate bank account for some funds imposed an additional administrative burden upon clients and made it harder for them to use their funds flexibly. By contrast, individuals using a single bank account found this both empowering and much simpler to operate. Where a lighter touch approach to auditing was applied it also allowed greater focus on delivery of flexible support outcomes.

LA arrangements to support SDS varied but all 3 areas had seen significant growth in the number of SDS users in recent years. Edinburgh had a greater proportion of multiple funded packages, possibly due to its greater focus upon a wide spectrum of funding sources.

There is potential to begin a greater shift of resources to SDS to meet demand, and emerging approaches include block contracting core tasks only and spot purchasing additional hours. In the case of building based services, by separating out the true capital (building-related) costs from the marginal operating costs, the funds associated with individual clients can be identified and released.

Conclusions

The great majority of SDS clients had very positive experiences of using PAs, and the gains to them in terms of flexibility, control, choice and independence far outweighed the challenge of being an employer. Clients in receipt of health funding as part of their SDS support reported a significantly more flexible response to their needs.

The existence of an effective support service providing support to clients in their employer role was key to the success of SDS. Ensuring the sustainability of support services is fundamental to further development of SDS.

Effective LA leadership to deliver flexible personalised care, a dedicated SDS team providing knowledgeable and skilled oversight and support to SDS clients, and light touch systems promoting consistent practices and procedures in the administration of funding rules are central to delivering SDS growth .

Limited social work training in SDS was widely acknowledged to be a factor in restricting take-up of SDS. The creation of new and innovative information materials to assist social workers may improve progress.

LA administered funds are managed in a joined up way but separate rules and arrangements for these and other funds mean that, overall, arrangements for paying and administering multiple funded packages are not yet streamlined and do not therefore deliver the advantages for clients, regarding accessibility and ease of management, that they might be expected to do.

Becoming an employer was a major challenge for all SDS clients and whilst the available support was greatly valued, more needs to be done to improve access to PA employer training and provide more personalised client support.

Ongoing difficulties and concerns regarding the recruitment of PAs suggest that new ways should be explored to provide PA training and to better enable clients to source new long or short term staff more quickly and with fewer of the risks that they currently face.

The development of better peer support networks, possibly using a web- based approach, could enable SDS clients to learn more effectively about how SDS funds can be used.

This review demonstrates that SDS can and does provide benefits for clients. If the issues outlined above are addressed access to SDS could be further improved and so benefit a greater number of people.

If you wish further copies of this Research Findings or have any enquiries about social research, please contact us at:

Scottish Government Social Research

Tel: 0131 244 7560
Fax: 0131 244 5393
Email: socialresearch@scotland.gsi.gov.uk
Website: www.scotland.gov.uk/socialresearch

If you wish a copy of "A Review of Self Directed Support in Scotland" the research report which is summarised in this research findings, please send a cheque for £5.00 made payable to:

Tel: 0131 622 8283 / 0131 622 8258
Fax: 0131 622 8258
Email: business.edinburgh@blackwell.co.uk

This document (and other Research Findings and Reports) and information about social research in the Scottish Government may be viewed on the Internet at: http://www.scotland.gov.uk/socialresearc

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