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Self-directed support – getting there?
Self-directed support is a national strategic framework in Scotland, to maximise the personalisation of care and support services, extending person-centred choice to all who are assessed as needing support. It was introduced as a ten-year policy framework in 2010, backed up by legislation in 2013. The government acknowledged it was the start of a change process which would take time to implement fully. However, third sector organisations have commented on the slow pace of implementation to date.
What is it?
A government information site states that it is a policy which:
‘… allows people, their carers and their families to make informed choices on what their support looks like and how it is delivered, making it possible to meet agreed personal outcomes; Self-directed Support includes a range of options to ensure everyone can exercise choice and control:
- a Direct Payment (a cash payment);
- funding allocated to a provider of your choice but the person is in charge of how it is spent);
- the council can arrange a service for you; or
- you can choose a mix of these options for different types of support.’
Clearly this is an innovative, not to say revolutionary policy. Fully implemented, the role of local authorities in care services would be often reduced to an assessment of an individual's needs, and then, when appropriate, funding their choice of service, often by direct payment to the person themselves. It is fully compatible with the new rights-based and person- centred health and social care standards which are being rolled out over the next year.
So far, so good. But three public organisations have been reported in the Herald newspaper as being critical of the rate of progress in implementing this policy.
The Chief Executive of Scottish Care, a support organisation for third sector service providers, has said that very few people in care homes have been provided with self-directed support. “The rights of vulnerable people are being breached”, he stated, issuing a report jointly with In Control, and Alzheimer's Scotland, two other charity groups.
The Chief Executive of Alzheimer's Scotland was critical of care funding policies, and inadequate funding contracts. This led to neglect of the workforce, and made it difficult to implement the rights-based aspect of the law when care workers have had to be on minimum zero hours contracts.
The report calls for the Government to look into how human rights may have been breached, and councils should ensure that everyone receiving care should be provided with the opportunity for self-directed support. A report for the Centre for Welfare Reform stated that local authorities are restricting the choices for people who need care and support, and in some cases are denying them self-directed support.
The Government seems to acknowledge that progress has been slow. A spokesperson stated that the Government has laid out plans and actions to accelerate the process of change, and to ensure that self-directed support is working on the ground as intended.
I believe we have to retain optimism: such a major transformation in how care is provided involves a shifting of decisions, funding and power to the Consumer, and the existing procedures and resources will take some time to adapt to this. In introducing the policy in 2010, the government stated that the balance of power had to change, and that
'Risk aversive practice can also significantly inhibit the choices and empowerment of individuals and families... It is important to identify and manage risk in a way that is shared among the person, family and friends, the Council and the provider(s).'
Let us hope that calling attention to the delays will stimulate a speed up, to ensure that everyone who could benefit from this radical policy will have their right to do so upheld.
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