Self-directed support: A National Strategy for Scotland

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Conclusion

Next steps

The Scottish Government and Cosla will work with an implementation group to help bring about the changes in the strategy.

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.

Delivering change

Short term goals - 2010-2012

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 should provide information to inform implementation, particularly with regard to setting targets and timescales for delivering change.

RECOMMENDATION 20

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.

RECOMMENDATION 21

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 remains firmly committed to seeing an increase in direct payments and that remains a key goal of this strategy. In doing so, the Government may consider new primary legislation to address some of the gaps in eligibility. Any legislative proposals would require formal consultation and significant engagement 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.

RECOMMENDATION 22

The Scottish Government should consult on the need for, and the provisions of, a Self-directed Support Bill by Spring 2010.

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.

RECOMMENDATION 23

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. 25 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.

RECOMMENDATION 24

The Scottish Government should review current data collection on direct payments to measure the broader 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 from 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 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.

RECOMMENDATION 25

The Independent Living in Scotland group in conjunction with key academic interests, should produce a values framework which articulates how to achieve effective co-production of both individual and collective outcomes for the policy by 2012.

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.

RECOMMENDATION 26

Scrutiny bodies should devise a method to measure the incremental progress of the policy collaboration with individuals, carers and other interested parties and commence a scrutiny programme by 2012.

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.

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.

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 SDS national network of independent support organisations, which is recognised as an authoritative source of experiential expertise and proficiency in the training and support of personal assistant employers
  • 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