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6 September 2017

Systemic inertia

What the difference between lemmings and those in charge of delivering the long awaited changes to social care? Not much, if the recent report from Audit Scotland is to be believed. Despite all the evidence that the social care system is heading towards the financial abyss and in need of radical overhaul, institutional inertia appears to be everywhere. Despite everyone talking the talk of self-directed support, very few seem to be walking the walk. And time is running out. 


 

By Susan Smith, TFN

Just over a quarter of Scots entitled to Self Directed Support (SDS) are getting it seven years into a 10 year strategy to transform social care.


And despite the Scottish Government spending £60 million on promoting personalisation since 2010, only 5% of people are choosing direct payments.


An Audit Scotland report out on Thursday says health and social care boards have a lot of work to do to ensure that the 208,000 adults and 17,000 children needing social care services get more choice and control. Currently an estimated 53,000 are choosing an SDS option.


The report highlighted at catalogue of challenges including budget cuts, poorly informed social workers, lack of support for service users, lengthy procedures for applying for SDS (in some cases up to two years), problems with staff recruitment and retention, poor data management and inconsistent approaches across local authorities.


The report also gives examples of where SDS is working, showing it does achieve its objective to improve the quality of people’s lives.


Since 2014, councils have had a legal responsibility to offer SDS to people receiving care at home. This involves choosing one of four options: a direct payment to manage their own support, choosing their own support but getting the council to manage and pay for it, choosing to continue with council services, or a mixture of the previous three options.


However, the report states: “The Scottish Government and partners underestimated that scale of challenges needed and the challenges in implementation”.


Ronnie Hinds, acting chair of the Accounts Commission, said: "There is a growing body of evidence that SDS is helping many people with support needs to live more fulfilling lives. However, there is no evidence of the transformation required to fully implement the policy.


"Radical change of this kind is never easy but we are in the seventh year of the 10 year SDS strategy, and it's been three years since the legislation was introduced. Authorities must respond more fully to provide services that make choice and control a reality for everyone who needs social care."


Social care services are provided across Scotland by local authorities, third sector bodies and private sector bodies.


The report also highlights concerns that the move to integrate health and social care, which came into effect in April 2016, has distracted local authorities and health boards from implementing SDS.


It contains a series of recommendations to improve access to SDS, however Florence Garabedian, chair of support body Self Directed Support Scotland, said it is difficult to see how these could be achieved.


"Nationally and locally many committed people (supported people, carers, volunteers and professionals) invest daily energy, resources and expertise to make SDS work for themselves, or the people they serve," she said. "Ultimately, however, the lack of accountability and leadership in a sector that over all is disinvesting, prevent the systemic change at the heart of the strategy.


“If this is not addressed it is difficult to see how the recommendations of the report can be implemented. For disabled people and their organisations, who believe that SDS can make a difference to the life of people, the major lesson of this report is that SDS should be at the heart of the health and social care transformation, rooted in human rights of all people, and lead towards a genuine review of what social care support means in 21st century Scotland."


Dee Fraser, deputy director of the Coalition of Care and Support Providers in Scotland (CCPS), which represents third sector social care providers, also called for more sustainable funding.


“We welcome the findings of the Audit Scotland report on SDS. It reinforces the experiences of CCPS members and other voluntary sector care and support providers that despite significant effort and investment we’re not seeing the pace and scale of change needed," she said.


“Providers can and do provide flexible, personalised services. However good quality, effective support can only happen where funding is sustainable; commissioning is collaborative and we move away from our current environment of price based competitive tendering."


Responding to the report the Scottish Government announced it would be extending funding for SDS advocacy and support projects for an additional six months until September 2018. Minister for public health and sport, Aileen Campbell, also said she has asked the Care Inspectorate to lead a thematic review of SDS as part of its future inspection programme.


However, she stressed the government's expectations that councils will ensure greater take up of SDS in future: "We expect local authorities, who are responsible for implementing Self Directed Support, to make progress on implementing these recommendations. People must be able to make decisions about what is important to them within their social care support. They must be actively assisted to understand the choices open to them and supported to recognise the assets they already have in their lives – friends, family and community interests."


Older people and people with mental health issues were the two groups least likely to be using SDS, according to Audit Scotland.


Keith Robson, chief executive of Age Scotland, said older people need more help to access SDS: “We’re disappointed that few people are taking advantage of the options available, particularly in the over-85 age group. While some older people find it works very well, too many are not informed enough about their choices. There is a perception that it is more for younger people or too much hassle to put in place.


“In many cases, the bureaucracy can be overly complicated and time-consuming, and councils can be reluctant to give appropriate advice, especially proactively.  This can be a major issue for older people who need care immediately, for example if they are just coming out of hospital."


The voice of service users


“My disabled daughter’s life has changed completely due to SDS. She now has a healthy lifestyle which includes a timetable of fitness classes, gym and swim activities that she attends along with her carers. She attends clubs to socialise with friends, goes to the cinema and bowling etc. She now leads the life of other 30-year-old girls. Prior to SDS she stayed home and watched videos. The transformation in her life has improved her health and wellbeing massively.” Parent


“The council were horrendous to deal with and at every point tried to talk us out of SDS”. Daughter of an older person


“I manage an SDS budget for my son who has severe physical and learning disabilities. I found the process of getting a social worker and an assessment for my son to be laborious and the procedures involved to be opaque. The whole process between initial calls to social work and payment of a small budget of £1,500 took almost two years”. Parent


“You have to be knowledgeable about it and stand your ground about what you and your young person want from it as councils will be budget led rather than needs led. It was not easy getting the support for our daughter as we were aware it is a significant package, however it has changed her life.” Parent


“The process by the council is long, unwieldy and bound in secrecy, for example, we are not told how the budget was calculated and how the budget decision was reached.” Parent

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