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Changing services, changing regulation
- Increased personalisation of services through self-directed support
- Progress on integration of health and social care
- Increasing diversity of support and care
- Greater focus on outcomes, beyond rigid categories of care provision.
- Changes in inspection methods and revised standards
Having a greater say in support
Undoubtedly there are opportunities in the current situation. People can have a greater say in how their support is to be provided, and in the outcomes and goals of that support.
What works best in response to a person's needs can now be considered, beyond what was often a choice of residential care or home support. A person's chosen outcomes will increasingly be the focus, rather than where they 'fit in' to rigid service boundaries defined by regulators and commissioners.
Identifying the challenges
But there are challenges for service commissioning, for regulating, and for managing an increasingly diverse approach and range of opportunities.
A report last year by the Coalition of Care Providers in Scotland summarised a research survey into these challenges. The research was done under a Scottish Government funded program (Providers & Personalisation) which aims to facilitate the ongoing changes in how support and care is seen and provided.
Providers, managers and inspectors were consulted through focus groups and surveys. The researchers concluded that:
- Major cultural and system changes are needed by support providers, and by the Care Inspectorate, the regulatory body.
- The quality and flexibility of support is often affected by external factors, such as funding, commissioning contracts and potentially restrictive requirements.
- Personal budgets are often spent partly on private, unregulated services which can pose dilemmas for funders, as well as the regulator.
- The measurement of quality in terms of outcomes for the individual, rather than the previously fixed National Care Standards, poses problems for providers as well as inspectors.
Transforming lives for the better
I have met and spoken with people for whom self-directed support has transformed their lives for the better. Their choices and participation in society have vastly widened, from a previous support regime which was dictated by the provider rather than the user. Providers and regulators face changes to their systems and operations, and in an ongoing culture of change and economic uncertainty there are many anxieties.
Nevertheless there are exciting opportunities: the coming few years hold out great promise for improvement in the lives of people in need of care and support.