Scottish Government

3 Stage 1: Baseline

Introduction

3.1 In this chapter, we use data collected from Stage 1 of the evaluation to provide baseline information, first about perception of the national picture, and second, to examine views about SDS in each of the selected local authority areas pre-test site. Interviews with a range of national stakeholders at Stage 1 (see appendices for detail) investigated the rationale for the selection of the test site key themes - leadership and training; cutting red tape; and bridging finance. Views about the themes are explored as well as stakeholders' opinions about the importance of these particular themes. The views of national stakeholders about SDS policy and practice in Scotland are then discussed, followed by a summary assessment of SDS experience in the test site local authorities as gleaned from interviews with various local stakeholders and local documentation.

Leadership & Training

3.2 The national SDS Strategy which emerged during the lifetime of the test sites accentuates the importance of leadership at all levels, including citizen leadership (Scottish Government, 2010, p15). According to this Strategy, management leadership is essential, but so too is commitment across all levels and functions, including from elected members, finance directors, commissioners and social work managers, otherwise SDS will not be implemented effectively. The Strategy suggests that leadership can be achieved "through champions who spread the vision, dedicated teams in each local authority and a national forum to share best practice", (ibid: p18). It includes a commitment to joint approaches and partnership involving all stakeholders, including those at policy and planning levels and with organisations that are led by and represent people who use services.

3.3 At the baseline, those interviewed from national organisations highlighted wide variations in the effectiveness of existing leadership in promoting SDS within Scottish local authorities. In principle, most identified leadership as a vital component of successful promotion of SDS, but they were usually less clear about what form this should take.

3.4 One element of leadership included promoting a change in culture and practice through training. In relation to training, the national SDS Strategy underlines the importance of training being delivered by people with experience of directing their own support. It also emphasises the importance of individuals and families who provide support being able to access information and training, especially on becoming employers. Furthermore, it highlights the need for training for staff at all levels in the values and principles of SDS, including senior and middle managers, finance and commissioning staff and front line staff. Stakeholders interviewed at the baseline stage concurred with the national Strategy, adding that staff/professionals at all levels should act as pioneers in their particular field, whether finance, commissioning, front line staff or managers.

Cutting Red Tape

3.5 This theme sought to enable a local authority to cut non-essential 'red tape' surrounding SDS arrangements. Scottish Government envisaged this would enable front line staff to better concentrate on their core job and therefore improve service users' experience. This was expected to help increase demand for SDS as previous research has shown that the level of bureaucracy surrounding DPs has been off-putting for service users and carers (Manthorpe et al, 2011). At baseline, several national stakeholders suggested that current arrangements within local authorities for the assessment, monitoring and review of SDS (usually referring to DPs) tended to be overly time-consuming and complex:

" SDS is a nightmare for social workers delivering care, due to the volume of paperwork and lack of clarity."
(Representative of Specialist SDS/ DP Organisation)

3.6 Most national stakeholders felt the key issue here was local authorities' 'heavy handed' monitoring of individual arrangements typified by DPs. Monitoring arrangements varied across Scottish local authorities - with some thought to be more 'bureaucratic' than others. Only a small number of national interviewees pre-test site worried that monitoring was too 'light touch' ( i.e. in relation to local authorities' legal responsibilities). Most agreed that local authorities' monitoring requirements were overly prescriptive and laborious. Such requirements were believed to be putting additional strain on service users, carers and front line staff, who often found the complexity of the process daunting and off-putting - to the point that some might disengage:

"Every penny has to be accounted for; there is a high level of scrutiny. Sometimes there is a lack of consistency of required accountability - it can change without warning, leaving people without the required accounts / receipts."
(Representative of Special Interest Group)

3.7 Interviewees agreed on the need to simplify monitoring requirements "so long as desired outcomes are met" (Provider Organisation), and to re-focus attention onto demonstrating that desired outcomes were being met:

"What we're trying to do with the new CIPFA guidance is back off with the monitoring. I mean in my local authority we monitor people every month. We're in the process of developing a policy so that, for people who have established DPs and are managing it well, we'll do a spot check once a year, rather than doing what we're doing now."
(Representative of Local Government Organisation)

Investing to Save/Bridging Finance

3.8 In short, this theme was meant by the Scottish Government to refer to double funding or concurrent expenditure on buildings-based care within a local authority to enable remodelling of the service, while encouraging those who use the facilities to use other forms of social care support in the community. The availability of bridging finance was identified by national stakeholders to be the key to initial success. Lack of bridging finance was perceived as one of the main reasons why local authorities across Scotland did not appear to prioritise DPs and/or SDS. Its value lay in being able to continue to provide existing services whilst bringing about a change in service delivery:

"Bridging finance is needed while new models of care are being created. Moving to the SDS model will take time and money."
(Representative of Provider Organisation)

"People cannot move on e.g. from day centres to IBs. Local authorities need to fund both; obviously they need finance for this."
(Representative of Specialist SDS/ DP Organisation)

3.9 Concern was expressed about the wholesale closure of day centres and the transfer of money from block contracts by some local authorities, which one representative argued might leave individuals with no services at all. Paradoxically, such policies, they argued, could undermine choice:

"For some people, what they're saying to us is that our choice is to keep what we've got, and so you have to strike a balance."
(Representative of Local Government Organisation)

3.10 While the availability of bridging finance was often reported as the top priority for local authorities, there was concern that the current economic climate would mean investment in test sites was a very temporary (and inadequate) solution to the wider issue of the under-resourcing of social care:

"Irrespective of what comes out…is [Bridging Finance] actually a deliverable concept? At a time when resources are diminishing at the level that they are now…is there going to be any scope whatsoever for bridging finance? - I have serious doubts about that I've got to say, even if the outcome [of the test sites] is extremely positive." (Representative of Local Government Organisation)

3.11 This echoes recent research by the user-led Standards We Expect consortium (Joseph Rowntree Foundation, 2011). Similar concerns were also expressed by those interviewed in the local test sites. Another national stakeholder even suggested that there was a risk that bridging finance could be "a cushion that causes major problems at the end of the test sites". This quotation implies that the process of service reconfiguration, which bridging finance aimed to facilitate, would be incomplete at the end of the test sites, and might have negative rather than positive consequences. Those interviewed tended to suggest that the further development of SDS would take many years and was certainly beyond the timeframe of the SDS test sites.

SDS Policy in Scotland

3.12 Most national stakeholders were in agreement that SDS policy had to be flexible in order that local authorities could interpret guidance according to local requirements, and so as to respond to the diverse needs of service users. As one local government organisation representative argued, it was necessary to "develop a general policy that can then be individualised on a case-by-case basis". However, whilst such a loose definition of SDS in policy terms had facilitated creative interpretations, it had also acted as a hindrance to implementation. Several national stakeholders perceived wide variation in practice and it was suggested by some that this had provided an excuse to local authorities to implement the guidance selectively, or at worst, to opt out:

" SDS is a mess. It has allowed a postcode lottery situation to develop. Local authorities have been able to pick and choose bits of the guidance." (Anonymous)

"Policies are as prescribed by the local authorities in their interpretation of the legislation. There is no Scotland-wide policy. The local authorities (and within each local authority, each area Social Work team) all have their own take on it."
(Representative of Specialist SDS/ DP Organisation)

3.13 One national stakeholder felt the 'loose' guidance had enabled a cynical interpretation of SDS:

"It has worked in complete separation from the new ways of tendering. SDS is used as a new way for service users to "buy" the service they are getting and in the process to reduce the hourly rate. This makes SDS look like a rationing tool. It has not been maximised as a tool for independence." (Anonymous)

3.14 The national SDS Strategy for Scotland, which was out for consultation at the time of baseline interviews, was considered timely by many of those interviewed. The Strategy was expected to address the current confusion around the "boundaries between SDS and DP in policy terms" (Provider Organisation). This was compounded by the complex relationship between SDS and key legislation such as the Adults with Incapacity Act (Scotland) 2000, the Mental Health (Care & Treatment) (Scotland) Act 2003, and more recently, the Adult Support and Protection (Scotland) Act 2007. Some felt that SDS policy appeared to have been developed in isolation from key legislation, such as that concerning adult protection and developments in commissioning:

"Current policy is confusing and the language involved in it is confused. The current policy is too narrow, but the trend is moving in the direction we want to see… Policy is not 'joined up', [it's] not holistic and is not based on a rights-based approach"
(Representative of Specialist SDS/ DP Organisation)

3.15 Another national stakeholder felt that the original SDS policy had been developed with insufficient input from service user and carer organisations and was therefore ultimately professional-led, not user-led:

"The whole thing is being confused by different models being developed without the involvement of disabled people."
(Anonymous)

SDS Practice in Scotland

3.16 There were difficulties in defining a distinct pre-test site baseline regarding SDS in Scotland because local authorities (including the 3 test sites local authorities) had all, to different degrees, embarked upon change programmes to transform and modernise social care services in line with national agendas. Legislation had introduced DPs from the mid-1990s onwards, and there was general acknowledgement of the need for person centred services and individualised support. Interviewees from national organisations cited positive stories of people benefiting from SDS (referring usually to DPs), and of social workers who were committed to ensuring choice and control and who worked to overcome any obstacles. Even so, more weaknesses than strengths with practice were identified across Scotland.

3.17 A number of themes emerged from interviews with national stakeholders' about their opinions and experiences of practice in Scotland. These are now summarised.

Inflexible DP systems

3.18 A significant weakness of existing arrangements was identified as current DP systems. Ironically, given the underlying philosophy of DPs, national stakeholders perceived existing DP arrangements as restricting choice, control and flexibility. In contrast, SDS was perceived as offering greater flexibility and opportunity for personally directing support for a wider range of client groups. Their aspiration was that the test sites would promote wider and more equitable application of SDS, and that this would be broader than DPs.

Pressures on frontline staff

3.19 Increased workloads, problems with accessing social care resources, combined with new expectations to work differently were also hampering the capacity of frontline staff to promote SDS. At times, there was a discrepancy between the aspirations of senior management and the realities of frontline work:

"What we've got is Directors of Social Work and senior managers who completely buy into it, who are really committed to it...and you've got people who are working really hard, burnt out, struggling to get enough resources to deal with what they've got…not able to…really think about how you take this forward."
(Representative of Provider Organisation)

Professionally driven agenda

3.20 There was a perception among some interest groups that SDS was a professionally driven agenda. Indeed, as Beresford (2009) comments, while the rhetoric of personalisation is about involving service users and increasing choice and control, service users and their organisations generally have had little say in its shaping or development. One user organisation cautioned that its members were concerned about SDS meaning they had to become employers:

"How do you get rid of staff you don't like that have maybe been with you 2 or 3 weeks, how do you get rid of that person? Seems a lot of responsibility... (Representative of User Organisation)

3.21 A manager working for a national provider of social care argued that there was, for instance, "not a huge groundswell [for DPs] in the mental health movement", and that pressure to increase uptake of DPs was coming from professionals not the service user movement.

Poor awareness leading to misconceptions

3.22 Many national stakeholders referred to a general lack of awareness and knowledge about SDS among staff, service users and carers. Also, there was often confusion about the different 'models' of SDS, or what options were possible under SDS. Clear and accurate information about SDS and how to administer schemes were said to be sorely lacking in many parts of Scotland. This had unhelpfully led to several misconceptions about what payments could be used for and how it should be administered:

"…the negative perception is created within the local authorities in a sense about all the complexities around payments and how it's all about being an employer and how…it's a lot of hassle and there's a lot of bureaucracy and it's no' worth it, and what you get off it at the end of the day is like £10 that you can't do anything with anyway"
(Representative of Provider Organisation)

Problems with commissioning practice

3.23 Those interviewed identified block purchasing of social care services as a significant barrier to implementing SDS in Scotland, especially in the larger urban areas with well-developed service infrastructures. Block purchasing from large providers was perceived to be hampering development of more individualised options:

"…effectively the voluntary sector's been wiped out in this area. For mental health, learning disability, physical disability, hearing impairment - private companies (have been) brought in on really big block contracts for like 1,000 hours each. The individuals concerned have had absolutely no say in any of that."
(Representative of Provider Organisation)

3.24 Such contracts were commented upon by members of the voluntary sector (who may or may not have had a conflict of interest) as restricting the type and quality of support available to purchase under SDS. Related to the issue of block commissioning was a different perception that Scottish local government culture had been more 'protectionist' of staff and practices than their southern counterparts. New arrangements were not only more threatening, but also potentially more expensive than either block contracts or in-house services and required fundamental shifts in organisational structure and culture. Scotland was perceived by some, though not all, to be more heavily committed to local authority provision and block purchasing than other parts of the UK.

Inadequacy of support infrastructure

3.25 Setting up and running SDS were seen as matters which could potentially put pressure on both service users and their support networks. A common weakness with current implementation highlighted by several national stakeholders lay in the inadequacy of existing support infrastructure. In the whole of Scotland for instance, there are only 2 Centres for Independent or Inclusive Living (1 each in Glasgow and Edinburgh). Yet these Centres are usually viewed by disabled people's organisations as central to the success of Independent living initiatives (Barnes and Mercer, 2006). It was generally thought that there was insufficient independent support for those who might want to take up a DP, despite the presence of the Scottish Personal Assistant Employers Network ( SPAEN).

3.26 The presence (and capacity of) such support organisations across Scotland was described as "patchy" by one representative of a specialist SDS/ DP organisation. Some areas had small, and often "fragile", independent support agencies. Smaller user-led organisations were seen as disadvantaged in the current commissioning and financial environment and suffered from a lack of central funding. There was also a perception that the few Independent Living Centres that did exist had limited capacity or expertise to support a diverse client group with more complex needs, including those with mental health problems or learning disabilities.

Problems with care management

3.27 One view expressed was that the system of care management introduced under Community Care legislation was now outmoded and unfit for purpose. Significantly, this was identified as constraining social workers' ability to take the SDS agenda forward:

"Our current system has failed… what the care management system has done is made people task orientated, it's made providers volume dependent and risk averse and it's stopped us actually working alongside people to find out what it is that they would hope to achieve in their life and then think about how we can use the state's resources to help that person keep their life together and improve it…"
(Representative of Provider Organisation)

Legal interpretations of capacity

3.28 Past flexibility in SDS guidance had resulted in local authorities using different legal interpretations of a person's capacity to consent to having a DP. One representative of a local government body observed that some local authorities were more willing to work with the notion of 'implied consent', while others were known to adopt far stricter criteria for consent, thus narrowing eligibility. This situation had reportedly contributed to differences in uptake of DPs and practice across Scotland. It was suggested by an interviewee from a local government body that where implied consent was not acceptable, the service users' carer or family members would have to apply for financial guardianship in order to receive (or continue to receive) a DP. This was said to be particularly off-putting for families of service users who had just turned 18 years old - an age at which consent becomes a legal requirement.

SDS in the Test Site Local Authorities

3.29 Local stakeholders from the test site areas were asked what they thought about the strengths and weaknesses of the test site local authorities' implementation of SDS before the test site. In short, few positive aspects about local implementation were identified by those interviewed from any of the 3 areas, and many comments were in relation to how DPs had operated locally rather than about SDS.

3.30 On the positive side, stakeholders in Dumfries & Galloway suggested that the authority had good procedures for quality assurance, and Glasgow based stakeholders had evidence of DP recipients in the area who had experienced positive benefits from directing their own support. The strengths of SDS tended to be expressed as potential rather than actual or demonstrable strengths. SDS had the potential for increasing choice and flexibility, as well as increasing user control over support arrangements. Some alluded to its potential to deliver positive outcomes for those with more complex needs, and others to the possibilities of combining funding streams with the NHS.

3.31 The catalogue of negative issues with SDS (usually DPs) pre-test site included:

• A lack of a strategic, holistic approach to implementation by local authorities;
• Poor, or even no, information about DPs and therefore low awareness among service users, carers, and staff in local authorities resulting in low numbers of DP recipients;
• Negative organisational cultures, lack of commitment or active promotion of DPs and SDS by frontline staff. Furthermore, some people had reportedly been dissuaded from considering DPs as social workers often emphasised negative aspects;
• Bureaucratic and burdensome administration of DPs that was off-putting for both service users and carers, and for social workers/care managers arranging their support. This included heavy handed monitoring systems that did not always appear proportionate to levels of cash payment awarded;
• DPs had not delivered the cultural change expected, and could potentially impact negatively on the sustainability of in-house services;
• Rather than delivering innovation, DPs had resulted in restricted models of support being set up and limited funding options;
• Limited reach of DP. The majority of DP recipients, except in Highland, tended to be people with physical disabilities with far fewer people with learning disabilities, mental health problems or older people accessing them. In Highland almost similar numbers of people with learning disabilities as people with physical disabilities were reported to be in receipt of DPs;
• Related to the above there was a sense of inequity and lack of transparency in DP support packages;
• Many service users and carers were not keen on the prospect of becoming an employer, and this seemed to be the only option open under DPs if they wanted to direct their own care;
• There were very real practical difficulties with implementing DPs in rural areas such as the small pool of potential Personal Assistants from which to recruit and concerns about privacy.

Interface with Adult Protection

3.32 Lead officers with responsibility for adult protection ( AP) in the 3 local authorities interviewed at Stage 1 showed limited knowledge of the SDS test site and none had been actively involved in test site action plans. At the first stage interviews there had been no formal exchange between the lead persons in adult protection and the SDS test sites, though one interviewee commented they were both accountable to the same line manager, which was potentially a bridging mechanism. The raising of this question by the evaluators prompted interviewees to note that SDS was implicit rather than explicit in their AP procedures and training, and vice versa.

3.33 The national organisations consulted commented on the importance of cross-referencing these 2 policies but also acknowledged the delay in doing so, suggesting that SDS and adult protection policies were on " parallel tracks", and further, that there is an inevitable tension between increasing choice and control and concerns for the safety of, and risks to, vulnerable people.

3.34 Joint training between SDS and AP teams was identified as a way of bridging the gap but plans to do so in any of the 3 areas were still aspirational. Various ambitions for training initiatives were described by the 3 AP leads; one intention was to plan a 4 day module covering all the legislation around SDS and AP; the development of a 3 day module on investigative training across the board of public protection and SDS; and an input on assessment of risk and on how SDS sits alongside protection plans.

Summary - Key Issues at Baseline

• The existing DP system was seen as failing to deliver greater choice, control and flexibility as it was seen as overly prescriptive, bureaucratic, utilising 'old style' care management processes.
• Implementation of DPs was seen as highly inconsistent, with some local authorities adopting more enthusiastic policy and practice than others. SDS was seen as having the potential to address some of these problems in the current DP system by adopting a broader and more flexible definition.
• Yet, despite SDS being defined as a spectrum of options that includesDPs, there was a prevailing view that what the test sites were doing was entirely different from established DPs. At this point, the lack of resources in the form of bridging monies was felt to be one of the main obstacles to more active promotion of SDS across Scotland.
• Inadequate or non-existent support infrastructures for service users and carers were seen as a further obstacle.
• Particularly at local level, SDS policy had not enlisted sufficient input from service user and carer organisations and was in danger of seeming to be a professional-led concept.
• There were concerns that SDS was being promoted as a cost-cutting exercise in the face of diminishing resources as opposed to a positive policy to promote independent living.
• Up until this point, leadership to promote SDS via DPs across Scotland was seen as varying greatly and local authorities were not considered to have taken a particularly strategic or holistic approach to developing SDS, despite some notable exceptions.
• A lack of consensus around what constituted good or effective leadership meant that the 3 test sites started their work without a clear steer or template on how to effectively lead the development of SDS, which was thus completely open to local interpretation and style.