4 Stage 2: evaluating process and impact
4.1 In this chapter, a range of data from Stage 2 of the evaluation has been used to assess the test site local authorities' progress towards increasing SDS against their action plans. Wherever possible, we explicitly reference the impact of any changes the sites made in relation to the 3 main themes (bridging finance; reducing red tape; and leadership training). The chapter begins by examining definitions of SDS in practice, and brings together data about the people who received SDS packages during the test site period. Test site activities are examined under the 3 themes, drawing upon a range of information sources.
4.2 According to the test sites' espoused definitions of SDS, a range of options were possible under the umbrella of ' SDS' - from DPs to individually tailored local authority services. In practice, the majority of what was counted as SDS packages ( see table 4.3) involved a cash transfer or DP. An underlying confusion about what should 'count' as SDS may have meant, however, that practice other than that involving a cash transfer was not fully captured. For instance, despite the evaluation team's efforts to design data collection around a broad definition of SDS, it is possible that more subtle changes to individuals' use of local authority and other managed services did occur but were not recorded consistently by the test sites.
4.3 In Dumfries & Galloway, SDS remained broadly interpreted, and was not used as a synonym for DPs. A variety of terms emerged, with 'personalisation' and ' SDS' used interchangeably. Few of those interviewed saw the test site as merely focusing on DP targets. Instead, there was a widely shared view about the potential of SDS to improve outcomes for people using services, as this parent carer stated:
"At the first meeting we went to...it was like instead of the Social Work running the budget now it was giving (my child) more right to do what they wanted and to .. the money that they got was to help them do things that they wanted to do in life and help … it was more giving them a better outlook on life..."'
4.4 The new Personalisation Panel in Dumfries & Galloway to approve SDS plans was felt to be well received locally. Its practice was perceived as promoting the view that SDS was about achieving better outcomes for service users and carers, and was not just about financial transactions (or who receives and controls the budget).
4.5 Although different definitions were in use at the start of the Glasgow test site, a consensus view soon emerged across the local authority and partner service providers that SDS is broader than DPs. SDS was taken to cover a range of approaches to delivering outcomes based support, with individual budgets ( IB) being allocated either via a direct payment ( DP), an indirect or third party payment, or an individualised service fund ( ISF).
4.6 In contrast, Highland tended to emphasise the promotion of personalisation/ SDS for the most part through the increased uptake and use of DPs, that is, SDS always involved a cash transfer. It was only in the final stages that a broader interpretation of SDS and a range of mechanisms were embraced, including ISFs.
4.7 With this situation in mind, the evaluation explored howSDS was implemented by the test sites rather than assess their success in relation to limited and predetermined criteria ( i.e. whether there has been an increase in uptake of DPs). Because of the evolving nature of definitions and understandings of SDS across the 3 sites, this part of the evaluation is primarily descriptive: in other words, we describe what happened during the test site period on the basis of what was recorded.
Detail of SDS Packages
4.8 From April 2010 to end March 2011 information was sought on a quarterly basis from the 3 local authorities about the characteristics of the service users engaged by the SDS test site. Information included whether clients were allocated an IB, type of SDS options chosen, and the funding mix of SDS packages. Information up to 31 March 2011 was received from all 3 test sites.
4.9 It is important to note that we are only able to report on information provided in these returns. Our assessment is therefore dependent upon both the quality and accuracy of the information provided, which in turn may have been affected by different interpretations of SDS in each site.
Number of SDS packages
4.10 Each local authority verbally reported that around 100 people at each test site had been assessed and received some kind of SDS package over the course of the 2 years. These were people who had experienced new processes and systems of assessment, resource allocation and support arrangements. However, the test sites reported on fewer than half this number of individuals in the cohort forms.
4.11 Dumfries & Galloway provided information regarding SDS packages with 35 people. In an email communication it reported that another 51 people were "within the personalisation process". However, on account of not being allocated an individual budget, the local authority did not include them in the cohort returns. Additionally, 13 people were said to have withdrawn from the test site process, or had not completed the process because of a change in personal circumstances. Therefore, while the test site appeared to have engaged with nearly 100 people over the course of the 2 years, the analysis that follows only includes those 35 people recorded as receiving an SDS package.
4.12 Glasgow provided data on 57 people who had an SDS support package, and stated that slightly more people were at earlier stages in the approvals process and had not been included in the detailed statistics. An additional 50 individuals were reported to have had an estimated SDS budget awarded and were awaiting contracts. No further information was given to the evaluation team about these packages. Hence, although Glasgow reported engaging with around 100 people during the 2 years, the analysis that follows is of the 57 individuals recorded in the cohort form as receiving an SDS package.
4.13 Highland provided information on 40 individuals who had engaged with new SDS processes, and were receiving an SDS package. Other information from this site suggested an additional 101 people had at some stage either sought information about SDS, or had been advised to consider SDS. These were mostly young adults in transition (the main target group) who, for various reasons, had not opted into the test site process. Nearly half were enquiries in relation to disabled school leavers, the core group targeted by the test site, but there is no further information to tell us why these individuals decided not to be part of the test site SDS process. Seven of those who did not pursue the SDS process are known to have accessed a DP through the traditional route in the local authority. The analysis that follows includes only the 40 individuals for whom we have information from the cohort form.
Service user type
4.14 Taken overall, people with learning disabilities were the main client group to utilise SDS across all sites, which is not surprising given the test sites' target groups. Both Glasgow and Highland, for instance, started with a focus on adults and/or young people with learning disabilities, resulting in 75% of Glasgow's total and 62% of Highland's total being people with learning disabilities. This compares with Dumfries & Galloway where just 46% of the cohort came from this client group.
4.15 Having started with people with learning disabilities as its primary focus in the East of the City, the Glasgow test site had begun by December 2010 to widen the range of needs addressed. In Highland, 2 main groups were targeted by the SDS test site: young people in transition to adult services and situations where people's discharge from hospital could be facilitated and accelerated through SDS. However, only 3 older people had an SDS package, while a quarter of the total was people with physical disabilities.
4.16 In contrast, Dumfries & Galloway seemed to adopt more open criteria for inclusion and subsequently the spread of people across different client groups was greater (possibly because of its geographical focus). Having said that, the largest group receiving SDS in Dumfries & Galloway were people with learning disabilities. It is likely that the work of the Association for Real Change ( ARC) with self advocates in Wigtonshire in promoting personalisation and SDS with people with learning disabilities, may partly account for this.
4.17 Client groups who were less likely to feature in test site activities were people with mental health problems, parents of disabled children, and people defined as having 'multiple and complex needs'. However, the individual case studies in each site, discussed in the next chapter, suggest that there were more people with more complex needs engaging with SDS than were actually recorded in the cohort forms. Again, there may have been under-recording of complex or multiple needs as a result of categorising people according to local authorities' existing systems, which are often based upon a notion of primary or main presenting need.
Table 4.1: Comparison of service user type in each test site
|Client Group||Local Authority|
|Dumfries & Galloway||Glasgow ||Highland ||Total |
|Number ||Percent |
|Learning disabilities||16 ||43 ||26 ||84 ||64% |
|Physical disabilities||13 ||7 ||10 ||30 ||23% |
|Older people ||2 ||5 ||3 ||10 ||7% |
|Parent (disabled child)||2 ||- ||- ||2 ||1% |
|Mental health problems||2 ||1 ||1 ||4 ||3% |
|Complex needs ||- ||- ||1 ||1 ||1% |
|Not known ||- ||1 ||- ||1 ||1% |
|Total ||35 ||57 ||40 ||132 ||100 |
4.18 Drawing on the wider potential cohort it appears that the majority of people who did not finally engage with SDS in Dumfries & Galloway were people with learning disabilities (9 out of 13 people). In Glasgow those who were at an early stage of the process, but had not received an individual budget allocation, included a mix of people with learning disabilities (20); physical disabilities (10); children with disabilities (9); older adults (6); parents with disabled child (4); and mental health problems (2). In Highland, 44 of the 101 people who were offered the chance to take up SDS and did not, were disabled school leavers - the core group of young adults in transition targeted by this test site.
Gender of service users
4.19 Across the 3 test sites, almost the same numbers of women and men accessed SDS (see table 4.2 below). However, the proportions differed between test sites: while there were nearly twice as many men as women who accessed SDS through Dumfries & Galloway test site, the ratio was reversed in Glasgow. See table 4.2 below.
Table 4.2: Gender of people accessing SDS packages in the test sites
|Sex||Dumfries & Galloway||Glasgow*||Highland||Total|
*The gender of 5 people in Glasgow test site was not recorded
4.20 Given that national statistics show the breakdown of DP recipients as 45% male: 55% female overall (Scottish Government, 2010), it might reasonably have been expected that more women than men would access SDS but this was not the case. Involvement of women in SDS packages however was clearly greater than these figures would imply: many were managed in partnership with family members and carers, the majority of whom were women.
Age of service users
4.21 The age profile of those accessing SDS through the test sites varied considerably between sites. In Dumfries & Galloway, where a broader range of needs were addressed, the age range was greater. Nearly half (47%) were aged between 26 and 60 years. Another 32% were under 25 years, and the youngest person was recorded as 8 years old (presumably the team were working with the parent of a disabled child). The oldest person receiving SDS was 96 years old.
4.22 This contrasts with Glasgow where 42% of SDS service users were aged 16-25 years, 35% were 26-54 years, and 23% were aged 55 or over. The oldest client in the Glasgow cohort was 71 years and the youngest, 17 years. The proportion of younger people receiving SDS was most pronounced in Highland, with 73% being under 25 years, and most of these were 18 years or under. This clearly reflects the primary cohort of young disabled people in transition targeted by this test site.
Ethnicity of service users
4.23 All those who accessed SDS through the Dumfries & Galloway and Highland test sites were recorded as being either white British or white Scottish. Unfortunately Glasgow did not record ethnicity where it might have been expected to capture a more diverse range of ethnicities. However, as none of the 10 case studies in Glasgow (reported in the next chapter) included any clients from black or minority ethnic ( BME) backgrounds it is possible that no-one from a BME community accessed SDS through the test site.
Range of options in SDS packages
4.24 The range of SDS options included both DPs and Individual Service Funds ( ISFs), as well as individually tailored local authority services, which is in keeping with the broad definition of SDS favoured by the test site local authorities. While ISFs were arranged with providers external to the local authority in 2 local authorities during the test site period, it was only in Dumfries & Galloway that an ISF with a local authority service was arranged or an individually tailored local authority service. Only a small number however appeared to have an SDS package that involved a mix of different options. The following table (4.3) summarises the SDS options across the test site cohorts.
Table 4.3: Type of SDS options in each test site
|Local Authority||Type of SDS Option|
|DP Self||DP 3rd Party||ISFLA||ISF Provider||Tailored LA||Mixed Package||Missing|
4.25 DPs were clearly the most common SDS option across all 3 test sites with 107 DPs set up during the test sites: that is, 71 DPs managed directly by the individual and 36 payments managed by a 3 rd party, usually family members. Highland stands out as having a greater proportion of DPs managed in this way. Further, the majority of its 40 DPs were one-off payments (25 out of 40 DPs). Whether or not this happened in the other 2 sites was unknown, as such information was not supplied to the evaluation team. Highland targeted its DPs involving regular or on-going payments at young disabled people, in particular those less than 21 years.
4.26 The second most common SDS option was ISFs arranged with external providers such as Enable (24 ISFs across 2 test sites). It was notable in both Glasgow and Highland that the numbers of ISFs increased towards the end of the test site period. In Highland, ISFs were in the process of being arranged for 4 existing service users of Leonard Cheshire Disability Services.
4.27 Few SDS packages involved more than one option other than in Dumfries & Galloway where 2 people had a DP and either one or 2 ISFs, and another had a DP and individual tailored local authority services.
Funding mix of SDS packages
Table 4.4: Funding mix of SDS packages in each test site
|Local Authority||Type of Funding Stream|
|Dumfries & Galloway||34||-||2||-||19||1 charitable body|
4.28 Social Work and client contributions (means tested payments) funded the majority of SDS packages across all the sites. There were some differences in the funding mix of SDS packages between sites: Glasgow had higher numbers of people making client contributions despite the test site covering an area of severe deprivation, while Highland had fewest client contributions to packages of support. This may largely be accounted for by the young age group of this cohort. It is also perhaps indicative of a proactive income maximisation policy operating in the Glasgow local authority. It might also be speculated that some of those accessing support via SDS were doing so outwith the local authority's normal eligibility criteria in this early period.
4.29 As might be expected, given the restrictions on the national Independent Living Fund ( ILF), this did not feature prominently, and was in fact only part of 5 people's packages across all 3 sites. Only in Highland did the Housing funding stream feature (presumably Supporting People Funding) and then only for 2 people. For one of these young people, the SDS package was funded solely from Housing monies. Health ( NHS) funding was not recorded in any SDS packages and only 2 cases had involved accessing 'other' funding from charitable trusts .
4.30 Quarterly monitoring forms designed around each test site's action plan gave information about the activities implemented under the 3 themes. This information is now analysed below to provide an assessment of test site implementation. Again, it is important to note that we are only able to report on the information provided, which varied considerably in detail. Our assessment is therefore dependent upon the quality and detail of information provided by each test site. Interviews and learning sets with a range of key local stakeholders at Stage 2 provided confirmatory qualitative data about implementation and, to some extent, impact.
Leadership and Training
4.31 The test sites adopted slightly different approaches to how they addressed the leadership theme, although there were many similarities. Different strategies were used, and infrastructures created, to provide leadership within and across stakeholder organisations. Commitment to a joint approach with providers was evident, particularly in Glasgow where active links were made with the Glasgow Social Care Providers Forum ( GSCPF). In other areas, partnerships with providers had grown more slowly.
4.32 Overall the work of the test sites could be seen as developing different relationships between those who require support and those who commission and those who provide it - the evidence for this is presented in Chapter 5. However, in terms of the collective engagement of service user organisations in developing policy and planning, test site activity was less evident, although in Glasgow there was investment in Glasgow Centre for Inclusive Living ( GCIL), an independent user-led support organisation. This is not to deny what was achieved in developing individualised SDS packages, or the value of test sites enrolling individual service users and carers, as 'champions' to spread the word about SDS, or the importance of setting up local service user and carer networks to provide an opportunity for people with SDS packages to meet and share experiences. Such initiatives were clearly invaluable.
4.33 The test sites had translated the need for effective leadership into specific lead or management roles funded by the Scottish Government grant. Additionally, test site project managers or leads were variously linked into, and reported to, service change or modernisation infrastructures set up by the local authorities. Such programme boards and/or committees had not been set up as part of the test sites but were created to manage broader service development.
4.34 All test sites had sought to further promote SDS though 'growing' local champions who would spread the vision: both those receiving SDS packages (particularly in Glasgow) and the staff working with them (particularly in Highland) were considered to be potential champions. In reality, this was slow to develop as originally envisaged but was a key feature of the Dumfries and Galloway site. The test sites suggested that activity in this area demonstrated the power of individual stories in conveying the benefits of SDS, although we have no way of measuring this impact.
4.35 The most notable way that all the test sites attempted to grow expertise and provide leadership was through the development of SDS teams. Therefore, we describe this in a specific sub-section below.
Specialist SDS Teams
4.36 The test sites created specialist SDS teams to take developments forward and work with other staff. However, these teams were formed at different points, and comprised different roles. Glasgow was different initially in that it did not immediately set up an SDS team, but instead expected the SDS Manager to involve and develop the practice of area team social workers in one part of the City, and also to provide training on SDS to social workers in other area teams.
4.37 All the sites invested in a lead officer post to project manage the test site. They were variously termed the Project Lead or SDS Manager. Whilst these posts were appointed at various stages during the test site period, they all ended up heading up the SDS team. Only in Glasgow was this post in place from the start (January 2009). This was because the post was filled by 2 existing staff working as job sharers seconded from their post of Principal Officer (Learning Disabilities) who had previously led the Glasgow IB pilot. Project managers in the other 2 test sites had to be recruited and neither was in post until late 2009.
4.38 The 3 test sites experienced some problems appointing to temporary contracts and also with finding suitably qualified and knowledgeable people to take on the designated roles. For example, Highland Council's recruitment processes required approval from 4 bodies - Project Board, Vacancy Monitoring Committee, Resource Committee, and the Job Evaluation Committee - before any position could be advertised, and this inevitably caused delays in appointing to the SDS Team. All except the Project Manager post had to be re-filled at least once, and several posts were filled by agency or temporary staff.
4.39 Project or Programme Boards that involved senior personnel from the local authority and other organisations were also set up as part of the test site. The efficacy of these in terms of promoting the wider development of SDS came in for some criticism. While the Project Board in Glasgow was generally seen as helpful in engaging key stakeholders in directing and supporting SDS managers and team, several stakeholders from Highland commented on a lack of shared vision among its members.
4.40 The following diagrams depict the composition of the SDS team set up in each site.
Figure 4.1: Dumfries & Galloway Personalisation Team
4.41 The full team complement in Dumfries & Galloway was not achieved until near the end of 2010, which obviously had an impact on what the team could collectively achieve within the timeframe of the test site. A barrier to recruiting to several posts within the team was identified by local interviewees as resulting from the short term nature of test site funding. Fundamentally, the local authority adopted a 3-pronged approach to leading SDS in that it set up a Personalisation Team (as above), a Personalisation Programme Board and a Personalisation Panel (senior social work managers who considered and approved personal plans). The team reported to the Head of Social Work as well as the Board.
Figure 4.2: Glasgow SDS team
4.42 A dedicated SDS Team was established later in Glasgow (August 2010) when the local authority decided that to progress its agenda, there needed to be further dedicated SDS posts created. Its remit was to develop systems and engage and support care managers and other staff within East Glasgow as well as other areas as required. The team worked closely with finance section, and forged a close partnership with GSCPF and its work to promote SDS among providers.
4.43 Glasgow's stated plan post test site was to appoint 3 dedicated social work staff in each of 3 new geographical areas to link with the centralised SDS team, with the aim of helping roll out SDS practice.
4.44 Despite originally planning to bring DP and SDS staff together in one central team in Highland, in practice, the SDS and DP teams were separate. There were plans for a unified team post test site. Again as elsewhere, the Highland SDS team did not start until late 2009 with the appointment of the SDS Project Manager in September, and consisted of the following staff.
Figure 4.3: Highland SDS Team
4.45 The test sites' approach of setting up dedicated teams appeared to work well in relation to the specific service users they supported through new systems. However, at the stakeholder evaluation event held in early 2011, participants from all areas felt that the intention to bring about major cultural shift in provision towards more personalised services had not happened despite the efforts of dedicated SDS teams.
4.46 The setting up of dedicated teams may have inadvertently resulted in limited engagement and change in the local authorities as a whole. An interview with a senior manager in another local authority (not one of the test sites) provided an opportunity to compare this with an exemplar of an alternative strategy to a project-based way of transforming social work services. The local authority in question had chosen to invest in " a whole rich spectrum of support arrangements" some of which could be described as SDS or DPs, while others were individual or personalised services. The authority had invested in supported employment, peer support and approaches that were best described as "community capacity building" but would not necessarily fit the model of SDS involving an IB. This approach was not in evidence in any of the test sites.
4.47 Test sites activities recorded as training included 6 key strands of related activity as follows:
- Information sharing events about SDS - 'numerous' road shows and information events were organised around Dumfries & Galloway including at an agricultural show (number attending not recorded); 11 one-day sessions to 50 staff working for providers and 80 social work staff in Glasgow; transition road shows in Highland (100 staff and families), and 5 awareness raising events in March run by GCIL involving 170 people (service users, carers, social workers and providers) in Highland;
- Briefings on the procedures and processes of SDS - briefing sessions with elected members in Dumfries & Galloway; 4 SDS briefing and awareness workshops for 70 social work staff in Glasgow; in Highland 57 social workers working with young people attended small group briefing sessions about SDS and its processes, and 34 social workers case managing young people in transition from children's to adults' services were briefed on the 'nuts and bolts' of new SDS systems;
- Training programmes in specific skills - 25 participants in total in Dumfries & Galloway trained (across 8 sessions) in the In Control approach and person centred planning; in Glasgow 2-day training on outcomes-based support planning to 10 care managers; and in Highland 29 service users, social work staff and providers were trained in the In Control approach over 3 sessions;
- Mentoring and consultancy - SDS team in Glasgow received mentoring and support from OLM Professional Services (consultancy, support and delivery focused on improving care sector) and In Control, and became mentors for social work staff;
- Online training modules - Glasgow developed 3 online modules based on the In Control 7 steps which can be accessed by staff across the local authority;
- Participation in national training days - Dumfries & Galloway funded 17 service users and staff to attend an In Control conference in Liverpool;
- Strategic events - the SDS team in Glasgow provided inputs at management meetings and development days held by provider organisations; in Highland, 31 senior social work managers attended a whole day event organised by the SDS team.
4.48 In addition to organising its own activities, Glasgow worked in partnership with GSCPF to deliver and participate in SDS workshops for providers. The importance of this strategy can be seen in contrast to the experience of Dumfries & Galloway where, at the end of the test site, it was remarked that several providers were neither engaged in, nor knowledgeable about, SDS.
4.49 From the information provided, relatively small numbers of existing staff were recorded as having participated in any in-depth formal training programmes through the test sites. Experiential learning or learning by doing, alongside support from staff in the SDS teams, was the main way that most care managers learnt about SDS, rather than through formal or informal training events. Obviously some staff would have received training and had opportunities to learn by doing.
4.50 However, whilst beneficial for some, this approach had its drawbacks. Knowledge of SDS and new processes was clearly uneven among care managers and others involved in assessment across the test sites. In Glasgow, this was particularly the case as the process widened out geographically and to more client groups. Some indicated that they had been "fumbling through", and would have appreciated training early in the process. Key informants in Dumfries & Galloway commented that it would have been helpful to have had the formal training on the In Control approach before 'going live' with personalisation. Several care managers in Dumfries & Galloway felt that there had been insufficient information filtered down to front line social work staff to enable them to work confidently with the new system. One manager eloquently summed up the situation as:
"Personalisation is like trying to put together a piece of flat pack furniture without any instructions. It's a nightmare doing it but great when you have finished."
4.51 This may be another limitation of this 'new project' approach to implementation whereby expertise appeared to be primarily developed within specialist SDS teams. For example, although a large-scale training programme was originally planned in Highland, this soon became more tightly focused on staff involved with the test site's target population for SDS. At the end of the test site, one Highland manager commented on the remaining challenge to move SDS from a centrally managed project to mainstream activity. Information sharing events in the other 2 sites had been more widespread.
4.52 The training activities that were provided across all the sites did not appear to reach large numbers and generated various levels of awareness and skill regarding SDS. According to the information from the sites, at times staff, service users and carers had sometimes been offered information or training together, and it was unclear how well their different information and training needs were catered for through such activities.
4.53 In Highland, briefing and training events combined with a supportive SDS team, had meant that care managers on the whole felt able to complete processes adequately, though not without some glitches. Not surprisingly, in the early stages of the test site, views about training were less favourable than later:
"...was quite rushed, a lot of new info. Documents were in draft which created some concerns to the clients..."
(Care manager, Highland)
Information about SDS for users and carers
4.54 By the end of the test sites, the needs of service users and carers for information about and support with SDS were beginning to be addressed through information sharing events; the development of specific website pages and promotional materials; and through specific support about becoming an employer. Highland, for example, had commissioned the national user-led Scottish Personal Assistants Employment Network ( SPAEN) to deliver training on employment law to 49 social work staff, and was funding future sessions with service users on becoming an employer.
4.55 Glasgow published detailed guidance on SDS on its website outlining what service users might expect from the SDS process and how the money could be spent, and produced a user-friendly information leaflet. Similarly, Highland developed an SDS website that went live in February 2011, featuring illustrative examples of experiences and the benefits of SDS. The Highland SDS team was also in the process of further developing a subset of the High Societies online database of providers, and had produced new local SDS guidance and promotional materials including posters. In Dumfries and Galloway and Glasgow DVDs had been produced.
Training on adult protection
4.56 Matters of capacity to make decisions were said to be clear in the context of DPs and the Adults with Incapacity (2000) Act. However, the main issue identified by AP leads was that SDS workers needed to understand that SDS interventions would be subject to AP investigations as are other aspects of adult care. Therefore, adult protection was frequently viewed by the AP leads as a specific training need in relation to implementing SDS. In this respect, in all the sites, joint training initiatives were all very much in their infancy. Amongst the themes emerging from the interviews with AP leads was the lack of integration of procedures:
" SDS is still standing as a separate issue- we're still talking about outcomes and needs separately…we mustn't have parallel processes- but a single approach, to DP/ SDSAP. We need to know there's a fit."
4.57 Such integration was to be achieved by what was referred to as holistic training so that personalisation/ SDS workers would have the confidence to take this on. A priority in the training agenda was identified as the need to make the link between relevant guidelines, policy and procedures. It is not clear how far this was addressed in the training provided in the test sites.
Cutting Red Tape
4.58 Developing and implementing new systems to support SDS as well as attempting to reduce red tape were, to some extent, contradictory pursuits. All test sites did not so much set about analysing how bureaucracy or red tape could be reduced, as invest their teams' effort and time into designing or re-designing new systems. For example, drafting associated paperwork or computer systems related to the processes of assessment, resource allocation and monitoring were the necessary building blocks of SDS. New systems were, therefore, developed in addition to those that already existed under care management and DPs. As the following personalisation board member from Dumfries & Galloway observed:
"To be honest I have never heard of it [the priority to cut red tape]...I've got no reason to doubt what you're saying...it may have been there but by the time I had caught up in the thinking, this was much more about us promoting a model of working about how we actually engage with people to provide and create better outcomes..."
4.59 In some areas of work this approach appeared to result in an apparent increase in red tape and bureaucracy rather than a decrease, at least in the short term, as there were dual new systems to navigate. Except, that is, in Dumfries & Galloway where initially there was no paperwork or written procedures and guidance beyond the In Control self-assessment and normal documentation. However, this was felt to be more disconcerting rather than liberating by some staff, especially administrative staff who reported problems with knowing what to record and file. In addition, the local authority's IT system had not been adapted to accommodate personalisation.
4.60 That the test sites had increased rather than decreased paperwork was the consensus of opinion at the evaluation stakeholder event in 2011. Some did not feel this was necessarily a negative development - that it might be a necessary stage in getting new systems in place. However, too much paperwork was still being raised as a challenge to staff at the end of the test site period. Staff in the SDS teams and others indicated that they had struggled with managing the drive for 'light touch' monitoring with accountability demands on the local authority, and the fact that some 'red tape' is perceived necessary as a protection against financial abuse.
4.61 Staff in all 3 sites still bemoaned the amount of paperwork involved with assessment and the problems with managing this within busy caseloads. One service user in Dumfries & Galloway described how "a lot of people wanted to know about my problems", suggesting that people were being asked to tell their story more than once and may experience this as excessive bureaucracy.
4.62 Some family carers felt that the only people able to give precise and accurate advice were those working on DPs. This may be because the DP systems were better established. While others (as we shall see in the following chapter), felt that SDS was a much easier process than DPs, though this may be related to the high level of support:
"X from Direct Payments has been the backbone to us. It's that person that actually got it up and running now the personal assistant is part of it. It wasn't [member of the personalisation team] it was [ DP worker] that really got everything up. I'd praise her to the highest because she knows her job."
(Carer, Dumfries & Galloway)
4.63 Addressing this theme was generally perceived to have been the least successful of the test sites. This was partly because - as the following quotation illustrates - local authorities continued to run (unnecessarily in some people's view) parallel systems for assessment throughout the test site, as well as parallel systems for SDS and DPs, thus potentially duplicating the amount of paperwork required to access support:
"...nobody's confident about giving up on the old systems...it feels a wee bit like we've increased bureaucracy...because not everybody is involved in SDS at the moment you need 2 sets of systems running..."
(Professional, Glasgow test site)
4.64 The following sub-sections will look at specific procedures which are necessary for enabling SDS but can be considered overly bureaucratic and time-consuming.
4.65 All test sites adapted some form of 'self-assessment' that had originated from In Control. Two test sites set up new decision-making panels to decide the allocation of resources and approve packages, while Highland referred SDS cases to its existing Resource Allocation Panel that dealt with DPs. All incorporated outcomes monitoring, even though review processes sometimes remained unchanged as in Highland. The latter process - monitoring and review - is largely outwith the timeframe of this evaluation given that most SDS packages had been in place for only a short time by the end of the test sites.
4.66 All test sites were running SDS and single shared assessment ( SSA) processes in parallel: SDS teams had put into place new person-centred, outcomes-focused assessments but these were in addition to, rather than instead of, the SSA. In the case of assessment for one-off payments only, an SDS assessment was undertaken in Highland. Reflecting on Highland's SDS assessment, one care manager commented:
"The self-assessment tool was ideal if the time was available and you would aspire to use this method...But because clients were in transition, this complicated and extended the process...due to current work pressures the paperwork was excessive."
(Care manager, Highland)
4.67 Towards the end of Highland's test site, a root and branch review of existing paperwork and processes was undertaken by a member of the SDS team with expertise in systems analysis, which resulted in the production of enhanced materials and guidance. However, this was implemented too late for the purposes of this evaluation to be able to assess any impact.
Resource allocation processes
4.68 Systems that were set up to discuss and approve SDS plans had delayed the starting of SDS packages according to some service users and carers in Glasgow and also in Dumfries & Galloway. There was some duplication in Highland of approval processes because SDS plans for on-going cases had often been considered both by the SDS team and separately by a resource allocation panel, adding what some felt to be an unnecessary stage in the process.
4.69 Resource allocation systems ( RAS) (based on In Control models) were trialled in both Dumfries & Galloway and Glasgow. Highland had been asked by Scottish Government to consider an alternative such as adapting the Indicator of Relative Need ( IORN) so that learning could be enhanced. In the event, Highland used its current system of allocation used for DPs known as an 'equivalency method'. In Glasgow's experience, the development of a suitable RAS was a highly complex process that involved the SDS team care managers, finance, commissioning staff and providers, and took them 2 years to complete.
4.70 Several criticisms were aimed at the equivalency model tested in Highland from those closely involved in its implementation. The system highlighted the local authority's poor information about service costs, and demonstrated a lack of sensitivity when applied in a rural setting. It was reported that in some cases this had resulted in higher individual budgets than would have been achieved through an alternative. For example, if in the past an individual had travelled long distances by taxi to a day centre, for example, the equivalency model for their SDS package would have awarded an inflated amount when alternatives might not require such extensive travel.
4.71 The difficulty of reducing red tape was not entirely the fault of local systems but arose from central government requirements for local authorities in terms of financial accountability, good governance and probity ( CIPFA, 2009). Ironically, CIPFA guidance on 'light touch' monitoring was viewed as overly bureaucratic by some of the financial officers interviewed.
4.72 Project managers and financial officers in all test sites concluded that implementation of CIPFA guidance on 'light touch' monitoring was not compatible with simplifying and integrating systems. For example, service users would still be required to have 2 separate bank accounts for ILF and DP transfers. Staff in Highland described the guidelines as " useless" and " heavy handed". However, having offered service users a 6-month reporting cycle (once trust was established), service users had requested a shorter 3-monthly cycle meaning that not all financial requirements are necessarily perceived as burdensome red tape.
4.73 Staff from Dumfries & Galloway had expressed similar views. One finance manager in Dumfries & Galloway reflected that they still had not worked out how to manage both the 'light touch' exhortation from Scottish Government and the CIPFA guidance, adding "we're talking 'light touch' but then going on to micro manage the audit trail". Further, the shift from "detailing every penny and time sheets", to less detailed requirements was described as "quite a challenge to (the) mind-set". This participant predicted that pressure for financial accountability would intensify as SDS rolled out with "serious amounts of money".
4.74 By way of making monitoring apparently less cumbersome for service users and carers, 2 test sites (Dumfries & Galloway and Glasgow) had considered use of an electronic purchase card, but not until the end of the test site. Glasgow Council decided to introduce a pre-loaded card system for future DPs as part of its post test site roll out. Interviews with staff involved with the development of the innovative Edinburgh Card in the Council's Funding Independence Team, suggested that such schemes have much potential in being able to considerably reduce the burden of paperwork for service users and carers. Major gains were also reported by staff from introducing the Edinburgh Card for individualised short breaks.
4.75 How the test sites had addressed the theme of bridging finance, indeed whether test site activities can meaningfully be assessed as fitting within the theme, was another challenge for the evaluation. Sites had not been asked by Scottish Government to implement specific models, and it was not always clear how the sites had interpreted this theme. On the whole, test site action plans were short on specifying particular actions under this theme, except Glasgow, and it was not clear what was actually implemented. Different stakeholders had conflicting views: some said that bridging finance had not been used while others were positive that this had been beneficial. Managers in Glasgow, for example, remarked on the benefits as being " invaluable" and claimed "it's made a huge difference". Some of the test sites stated that they intended to promote and increase the number of people accessing SDS packages by double funding services (such as day care and short break services), by increasing employability and routes to work (providing alternatives to traditional day services), and through providing a wide range of flexible individualised options that would effectively offer alternatives to existing services. However, we were not provided with evidence to confirm that this occurred.
4.76 Of the 3 test sites, Glasgow was the most explicit about its use of test site monies for bridging finance. This test site did identify a number of explicit priorities for bridging finance in its action plan, including the re-provisioning of some day services, provision of palliative care at home, allocating resources to school leavers, increasing choice and range of short breaks options, remodelling supported living, early intervention and prevention support using neighbourhood networks and community support, and shortening the DP waiting list.
4.77 In practice, Glasgow found short break or respite services to be the least complicated to remodel. This supports the City of Edinburgh's experience in expanding use of the Edinburgh Card for people choosing flexible short breaks. The greater ease in re-commissioning this type of support was attributed by the test site to the spot purchasing nature of short break services, and the relative ease with which service users and families could identify alternatives. Close working with the care provider Enable had resulted in remodelled supported living arrangements as ISFs. There had also been some success with investing in developing community support via Neighbourhood Networks, although there had been some delays.
4.78 However, progress in developing alternatives to learning disability day services in Glasgow had been slow - just a quarter of its original target had been reached - which was attributed to the complexity of the process of identifying individuals who wanted alternatives; the work involved with assessment; and the challenge of finding community-based alternatives. Some opposition from carers to changing day services was reported. Plans to introduce palliative care at home for 6 people with dementia had not materialised, which was said to be due to the lack of a procedural framework, as well as of issues around decision making capacity for this group. This test site has highlighted some of the barriers, risks and uncertainties within local authorities and the NHS of extending SDS to people with advanced cognitive impairment.
4.79 Less activity in relation to bridging finance was discerned in the other 2 sites. Interviews with financial staff in Dumfries & Galloway confirmed that, as in Glasgow, funding from the test site had been used primarily to build the staffing, training, and IT infrastructure to implement SDS, and not specifically to double fund Council services. Early on, the development of personalisation in this local authority had become associated with day centre closure plans and this had been unhelpful in the development of SDS according to managers. However, in a more general sense, the focus on individualised packages had enabled a small number of people to access opportunities in the community rather than attend traditional day services. The use of test site monies to fund bridging finance in this site has therefore to be seen as part of the evolutionary approach adopted. Developing personalised approaches was a stated Social Work priority and it was considering, in partnership with the NHS Board, using resource transfer in the future alongside other budgets, to ensure the delivery and sustainability of personalised approaches.
4.80 It is difficult to assess the impact of bridging finance spending in Highland because a clear strategy with targets and anticipated outcomes for the use of bridging finance was lacking. Whilst many of the young people in transition accessed SDS packages that enabled individualised choices in how they spent their days rather than attending day centres, these were 'pepper-potted' across Highland, and cannot therefore be equated with implementing change to specific services. That is not to say that the local authority was not considering service change, but that under the test site, bridging finance was not coherently brought to bear on advancing specific elements of a change programme. As one stakeholder involved with the change agenda in Highland commented:
"The issue of double running costs has not been addressed and is now becoming very delicate...Only now is SDS being brought forward as a an alternative option for users of services under threat..."
4.81 By not singling out services in this way, this local authority may have sought to avoid SDS becoming associated with controversial service closure, although such a move may only have side stepped the issue for the time being. Arguably, a longer term growth in SDS packages will necessitate a review of service provision, and will therefore affect a shift in spending as anticipated under bridging finance. Mainstreaming the SDS team costs that were met out of the test site monies was argued by interviewees to represent a shift in the Council's resources that will be later achieved by making savings elsewhere.
4.82 In light of their test site experience, local authority managers in Glasgow proposed that rather than designated 'bridging funds', what local authorities need is a 'change fund' to facilitate start up for new support arrangements as well as for infra-structure. Certainly across the test sites, the learning on this theme would seem to be around the timing of such funds so to ensure they are the most helpful and to provide flexibility in their deployment to fit with local circumstances.
Summary - Test Site Implementation
- While test sites' operational definitions of SDS were broader than DPs and encompassed a range of options from DPs through to individually tailored local authority services, the majority of SDS packages involved a cash transfer, either as a DP to an individual or a 3rd party, usually family members.
- There was little evidence of support packages being funded from a range of sources other than Social Work and client contributions.
- Taken overall, people with learning disabilities were the main group to access SDS, although there were notable differences between the test sites. Those groups who were less likely to feature in test site activities included people with mental health problems, older people and parents of disabled children.
- All 3 sites created a project lead/manager role; set up a dedicated SDS team; created a Project or Programme Board; and all sought to develop local champions.
- While this strategy might have worked well in relation to supporting the small numbers of service users and staff involved with new systems, it seemed to have limited the extent of system change achieved across the whole local authority in all 3 sites.
- Although significant activity was described as training in all 3 areas, it appeared that relatively small numbers of existing staff participated in any in-depth training.
- In relation to cutting red tape, the SDS teams' efforts went into designing or re-designing new systems that were more 'fit for purpose'. Whilst some felt this was necessary in the short term, those participating in the evaluation felt test sites had tended to add to, not reduce, paperwork.
- On the whole, action plans and therefore activities were short on specifics regarding addressing the theme of bridging finance and therefore the impact of this theme was difficult to ascertain.