Self-directed support: a change for the better?

Dementia Care
August 25, 2017

Self-directed support (SDS) is a flagship policy of Scottish Government, first implemented as a 10-year program seven years ago. It promised greater personalisation of social care through devolving power, finance and decisions on individual support to the people themselves who need the support. I wrote earlier this year about concerns that the policy may not be yet fully implemented. There are now further criticisms being raised.

Continued concern

Fresh concerns are now arising from various sources in the public, independent and voluntary sectors.

The Government financial and effectiveness watchdog, Audit Scotland has raised concerns in a recent report. While examples of improvements as a result of SDS are noted, the watchdog could see little evidence of its widespread implementation. People over 85, people with few social supports, and people with poor mental health were among those who did not appear to get the advice and support they needed to take over control of the personal care. This is despite legislation and specific funding to enable SDS to be available to all who need it.

The Chief Executive of Age Scotland has said that it is imperative that people are fully informed of their options when they need support and care. He said that, in some cases, inaccurate information is being given, with the result that many people are allowing local authorities to make decisions on their behalf.

Scottish Care is the umbrella body for independent sector agencies and services. Its Chief Executive has said that people are denied real choice through a combination of bureaucracy, financial constraints, a control culture in local authorities and the establishment of new integrated Heath and Social Care Boards. Scottish Care feels that people are being effectively denied their basic rights for more say in their care, as laid down in legislation and backed by public finance to the tune of £70m.

No easy task?

Of course, the policy was introduced in difficult times: reduced public funding and the introduction of integrated Health and Social care may be delaying factors.

COSLA, the local authority representative body was a partner in the original formulation and introduction of SDS. A spokesperson has written in the Herald newspaper that social care is undervalued and underfunded, yet its effectiveness has a huge influence on mainstream NHS performance. The spokesperson gave three reasons for continued underperformance: inadequate ring fencing of resources by central government; continued cuts in local authority funding, and knock on financial effects reducing the capability of the third sector to meet expectations. He claimed that reduced funding led to reduced promotion of active lifestyles, eating well, community involvement, informal caring, employment, continued education, and mental health.

The way forward

I think it is regrettable that such an empowering and innovative policy has had an unpromising introduction. New Scottish Health and social care standards introduced this year emphasise personalisation, good outcomes and respect for people’s rights. In many situations, by these standards, agencies and services are failing to provide proper care.

It is perhaps unfeasible to think that local councils who hold the funds and exercise controlling decisions on service provision will easily give these up. I also think it unrealistic of COSLA to think that more money is the solution, and also unrealistic to think that community wellbeing must rest solely on the work of local authorities.

The preventive measures mentioned by the spokesperson, active and healthy lifestyles, more informal caring, and improved mental health will only come from a change in how our communities are structured and how we relate to each other. SDS has the promise to support and leverage this, by giving ring-fenced resources and legislative support to enable people to creatively determine their own care. A public information program may help to stimulate the required take up and creative approaches in our community, but it may also need a firmer monitoring and guiding hand from central government to ensure full implementation.

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Tony Clarke

Scottish Care Inspectorate Specialist

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