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Self-Directed Support project update
- 1. Self-directed Support Project Team Jane Kellock, Head of Strategy Social Work Scotland Ailsa McAllister, SDS Project Manager Donna Murray, SDS Project Officer Calum Campbell, SDS Project Officer Calum Carlyle, SDS Project Assistant
- 3. How to get from here to there? the Change Map 1. People have choice and control over their social care and support 2. People are empowered to make informed decisions about their social care and support 3. Workers in all aspects of the delivery of social care and support exercise the appropriate skills, knowledge and confidence 4. Senior decision makers and systems create the conditions to enable choice and control Scottish Government, 2019
- 4. The Development of the Self- directed Support Framework • SDS Steering Group (including national partners, supported people, Care Inspectorate, Academic, SSSC, SIRD, SDS Leads) • HSCP/Local Authority Reference Groups • Work Streams on Assessment and Resource Allocation • Surveys • Wide engagement with stakeholders • Evidence based research from a wide variety of sources • Identification of key issues that are impacting on practice • Development of actions to support SDS implementation These engagements and research have led to the development of the SDS assumptions and the draft SDS standards, which were presented to the COSLA Health & Social Care Board on 16th October 2020.
- 5. Key Issues National policy vs local practice- leading to inconsistency Eligibility & Charging Community Support Models Human rights based approach Worker Autonomy Transparency Access to independent advice and support Deficit based assessments Inflexible commissioning Whole system change Risk enabling practice Reduced resources Data collection Accountability Transitions
- 6. Area of Relevance SDS Standards Access to independent support and advocacy Adults, children, young people and their carers are offered independent advice, support and advocacy to have choice and control over their social care and support and to exercise their human rights. Early help and support Early help and support is available to all people who need it. Strength and asset-based approaches Assessment, support planning and review systems and processes are personalised, recognising people’s strengths, assets and community supports, and result in agreed personal outcomes. Outcome monitoring Agreed personal outcomes are monitored through ongoing review processes. Reliable outcome data is captured routinely, is used for continuous improvement and demonstrates the extent to which SDS practice is carried out as intended. Accountability Clear and supportive processes are in place for SDS decisions to be challenged and appealed. Risk enablement Workers and supported people work together through shared decision making to plan for positive risk enablement whilst balancing the responsibility of statutory protection of children, young people, adults and carers. Consideration should be given to supported decision making in relation to capacity.
- 7. Flexible and outcome focused commissioning Commissioners shape the local markets to support people to live their lives in ways which evidence choice and control over their care and supports. Worker autonomy Workers are enabled to exercise professional autonomy in support planning and setting personal budgets within agreed delegated parameters. Transparency Processes and decisions that affect a supported person’s social care budget and options are recorded and/or explained in ways that make sense to the supported person. This includes helping the person understand what direct care and support they are eligible for, their level of contribution and how a budget can be spent. Early planning for transitions The Principles of Good Transitions are embedded within SDS policy, planning and practice across all sectors as a framework to support young people and families. Transition planning processes have the person’s wellbeing, aspirations and personal outcomes at the centre. Young people and their families are given the time, information and help they need to make choices and have control of their care and support as they move into the next phase of their lives. Consistency of care Supported people moving from one local authority to another can expect their agreed personal outcomes to be met in a comparable way.
- 8. What will it take? - assumptions 1. Assessment and the identification of resources is all part of the same process. We start by having a ‘good conversation’. 2. Community supports offer early help and support to people. 3. All social care processes are designed to meet the values and principles of Self-directed Support.
- 9. Active Implementation for SDS – Consultation base around the focus shifting: From: “What can we do with what we have?” To: “What will it take to do what needs to be done?” - Herbert Foege, the epidemiologist credited for the strategy to eradicate smallpox © 2019 Melissa Van Dyke, Karen Blase, and Dean L. Fixsen (info@activeimplementation.org)
- 10. COSLA agreed to the consultation at their H&SC Board (including an input from their C+F Board). (16th October) 1. Consultation for LAs to comment on the practicality of further implementation taking the assumptions into account, running from 10th November – 8th January 2. Rolling Call for Comment targeted at capturing good ideas for taking forward the standards. Will be hosted on the SWS website 16th November – 8th January 3. Continued work with 11 LAs developing the detail behind the standards. 4. Final Framework to be taken to COSLA for approval early 2020.
- 11. What next? • Social Care (Self-directed Support) (Scotland) Act 2013 -supports, promotes and protects human rights. • Self-directed Support is effective when implemented as intended. • Social Care in Scotland is being reviewed • A focus on improvement • Support for our framework approach, which consists of: • SDS Standards • Core assumptions • Key elements for implementation • A repository of key tools and resources
Editor's Notes
- Thank you so much for the opportunity to come along and speak to you on behalf of the SDS Project. What I plan to outline today is around where the team have been where they are now and what work they have planned for the future. So I am Ailsa McAllister the project Manager we are a team of five consisting Calum Campbell Donna Murray Calum Carlyle and last and by no means least we have our overall guide and mentor Jane Kellock she is the Head of Strategy in Social Work Scotland who keeps us all aligned to the Social Work dimension of this project. The team is sponsored by Scottish Government and we are hosted by Social Work Scotland and this has actually been proven to be a very good fit, given the values and principles that underpin the Self directed support Act. The skill in making these values and principles a reality requires workers to engage with people using good traditional social work relational practice. I’m seconded from Dundee Health and Social Care Partnership and I remember lots of workers who were employed before community care and care management was introduced. Saying they were really pretty excited by the SDS legislation when it went live in 2014. SDS offered them a welcome return of a more relational way of working as opposed to an impersonal transactional way, taking a more holistic approach to carrying out their professional assessments.
- The SDS Project so far! Reflecting back over the last 10 years since the publication of Scottish Governments 10 year strategy for implementing self directed support We have learned that this implementation has been variable across Scotland. How do we know this? Well there are many pieces of evidence that tell us this. Including; Care Inspectorate Inspections, Audits from Audit Scotland, National Research universities and IRISS and consultations. All of which have informed the SDS project teams work this year. ….not forgetting the most recent piece of research that you have just learned about from Lucy carried out by the out by the Alliance and SDSS Scotland. We plan acknowledge all 66 recommendations in our work going forward. We feel that this is an invaluable piece of work that has been done and paints the current picture around and is and what is not working for people in the world of SDS. Just to say at this stage thinking about the future we want to ensure that anything we produce is aligned with the Independent Review of Adult Social Care and the Promise (developed following the Independent Review of Care Children and Families settings) as we know SDS is not just for Adults. We feel that this is timely for this project and a great opportunity to feed into the Independent Review of Adult Social Care. If you don’t mind us doing so Derek?
- So as we know we have our change map published in 2019 by Scottish Government built on the views of supported people, local authorities, national partner organisations The Change Map outlines what is considered to be the critical key elements for further implementation of SDS. Were hoping to take the detail of the change map to the next level. But what have we done
- .So what have we done so far? We initially set up a the SDS Consistency Steering Group. This steering group is chaired by Johanna McDonald the Chief Officer of Argyle and Bute We also have set up work streams to take forward the project brief around reducing the inconsistencies in relation to assessment, resource release and worker autonomy. But we quickly acknowledged that these elements were just the spokes and wheels of the bike but not the whole functioning bike. So we knew we needed to take a whole systems approach to this project. We also undertook questionnaires on an ongoing basis with our stakeholders This process has led to the development of a set of SDS standards for Local Authorities. In terms of spelling out what local authorities need to meet as a minimum to deliver SDS well. They also link to the Health and Social Care standards and also the Children's Charter and take a human rights approach. These standards form one part of a wider framework including action statements that outline what local authorities need to do to meet the standards and also links to helpful tools and resources to help them along the way. These action statements will be built around what we know is ‘good SDS’. These will be informed by the captured effective evidence based practice and some of them will need to be developed with national experts, people and LAs. We also set up a Short life reference group which brought together 11 local authorities to ask them how they felt about the introduction of a set of standards and the practicalities around implementing them. The feedback from them was surprising. They were welcoming of the standards, they felt they were timely and that they were simply a bit stuck with their ongoing implementation of SDS. They felt that it didn’t help that Integration came along very quickly after the SDS legislation and that that then became the local priority for change. We are also looking to develop action statements that demonstrate poor SDS as we also have an evidence bank around this too. Were also looking as part of the framework to have a national central repository thank brings together all of the helpful tools and resources that are out there developed by national partners in order to help LAs achieve the standards. We know that there are many tools and resources out there but we know that uptake of them has been very low. Either because they are not widely known about or they are difficult to find. We would like to develop an online resource where the standards are the main interface and when each standard is clicked into this will being up all the actions that LAs need to do to meet the standards, where we will embed all links to all of available tools and resources to help them implement the standards.
- Through our consultation and our research we were together able to identify the key issues impacting SDS implementation. Our standards were developed with the aim to address all of these key issues. Now is the tipping point where we draw a line in the sand acknowledge these are the issues and focus on the future implementation of SDS Disconnect between national policy and what's actually being implemented on the ground Eligibility criteria policies prevent people accessing supports below levels of critical need Charging Policies People still not being able to meet some of their human rights Workers not being trusted to work autonomously or the system prevents this Lack of Transparency in terms of the recording decisions Inconsistent access to independent advice and support Deficit based assessments still being undertaken Care Management Structures still in place for option 3s everything else regarded as an ad on or is SDS. Inflexible commissioning still focused on commissioning services before conversations are had with people Risk Aversion Reduced resources Poor outcome monitoring Poor accountability around the delivery of SDS
- We then translated these issues into standards focusing on 11 areas of relevance. Area of Relevance Access to independent support and advocacy Early help and support (we’ve heard many stories of people being refused help and support as they don’t meet local eligibility criteria) and we've also seen how good well defined community models help to avoid this and assist people in getting that early help and support they need. Strength and asset based approaches people need to be empowered to do as much as they can themselves involving their own natural supports.. lets empower people. Outcome monitoring Accountability well there’s not much of that in the system apart from the 6 inspections and the SG return on how LAs spend their SDS transformation monies. Of which 10 out of the 32 responded with no recourse to not responding. There are complaints procedures and the Ombadsman but people need supported to challenge the system. And challenging the legislation through a judicial review requires great expense which most supported people cannot afford. Risk enablement (there needs to be a weighing up of Risks versus rights ) Great examples demonstrated where an SDS budget has benefited a family where there was CP issues. Not either or scenario in that its either CP, ASP or its SDS. It can actually be both.
- Flexible and outcome focused commissioning Worker autonomy Las need to trust and empower workers to assess, identify with people their outcome's and give them access to budgets easier. Transparency the recording of the care plan needs to explicit and understood by the person and demonstrate the decisions that have been made in relation to the SDS budget. Early planning for transitions when children are moving from CS into adults. This should be done timely and well Consistency of care between LAs ensureing that if agreed outcomes are funded in one area and the person moves LA then these outcomes are also funded in another. You know these standards are not saying anything that is not already outlined in the legislation and also the National Practitioner Guidance so why standards? Simply rolling out legislation and guidance and expecting LAs to roll it out has proven to be a challenge and ineffective. Some areas have managed very well in their implementation, achieving significant transformational change to make SDS a reality. Others have struggled and have simply viewed SDS as an add on to their traditional systems which has resulted in this approach being challenging and financially unsustainable. A whole systems approach and properly resourced local implementation teams are what is required to help make this a reality. The workforce also needs to be supported through coaching and peer mentoring on a daily basis.
- Underpinning the standards are a set of assumptions. When we set up the work streams it became apparent throughout the discussions that assessment and costing up an SDS budget is all part of the same process. It was stated that the process should not begin with the budget but a good conversation between the person and their worker. The question raised was around… How do you determine a budget without undertaking some form of assessment? Assumption 1 states that Assessment and the identification of resources is all part of the same process. We start by having a ‘good conversation’. These good conversations really should identify all of the things that matter to a person in their life and should result in the identification of their personal outcomes. Current evidence and literature tells us that this conversation should take a strengths- and asset-based approach to assessment, and should support the person’s right to choice and control. It should not undermine peoples own natural supports (friends, family and carers), by replacing them with services. It should also involve exploring suitable technological supports and all available grants and benefits available to a person and how the community and other universal services could help. Budgets should only be costed once this exploration has been undertaken, identifying available assets and strengths, the personal outcomes have been agreed and how the person wants to achieve them. All outstanding outcomes should be considered for funding, as long as they are legal and cannot be met by other supports or funding streams. If a budget is required to purchase registered social care services, a personal assistant or bespoke support, then this should be costed up and agreed with the person in a timely and accessible manner. How the person chooses to manage their budget, care and supports should then be explored and the four options offered to manage the budget to meet each of their outcomes. I really should also say that in this assumption two people presenting with the same needs do not necessarily require the same budget; given their natural support systems and they have different interests in their life. Personal outcomes should be reviewed regularly and when changes occur in the persons' life. Assumption 2: states that Community supports offer early help and support to people. Locality based, community models really have demonstrated their value in supporting people who do not meet high levels of eligibility for social-care. Community support models offer a universal approach where everyone is welcome to have a ‘good conversation’. Early help and advice can be offered to anyone who needs it, This approach serves as a gateway into more formal assessment and access to services including social work, social care, housing, health, welfare advice and third sector. A community support approach should not be regarded as a replacement for registered statutory services, and does require investment. Assumption 3 suggests that All social care systems and processes need to be designed to meet the values and principles of SDS. This has been raised as an issue and highlighted as an area that will also require significant resourcing.
- The team has learned that by simply enacting legislation and carrying out regulation, rolling out stand alone training or moving people’s roles without amending structures is insufficient. There has been a major piece of this jigsaw missing. These approaches have had a low return on investment and haven’t resulted in the high quality practice that is required. Without a national focus on implementation and ongoing improvement around SDS, each local will continue to struggle and inconsistency will still be an issue. There have been many excellent examples of pockets of SDS practice across Scotland, but consistently high quality practice has not been achieved. So the question we are focusing on gathering evidence around now is not: “What can we do with what we have?” But: “What will it take to do what needs to be done?” A consultation asking this question went live yesterday and was sent out to all CEs, COs and CSWOs to get them to nail to the mast what they need to meet these standards.
- COSLA has agreed for us to go ahead and undertake further consultation on the standards We are asking LAS how easy of difficult it will be to implement the standards. What will it take in terms of workforce, resources, national support? We feel that this would be central evidence that we can feed into the Independent Review of Adult Social Care, given that it has been muted already that SDS should be the way all social care is delivered across Scotland. We are also looking for individuals to comment on the standards and provide us with good constructive ideas for taking SDS forward. A call for comment is due to go live on the 16th of November and will be hosted on the SWS Website 16th November. Both engagements will draw to a close on 8th January. We will be looking to report our final analysis and final Framework to COSLA early February. Setting up 9 works streams to develop the action statements that will sit beneath the standards with an open invitation to people our national partners, LA including SDS Lead Officers, Commissioners, Finance Professionals, Social Workers and people from the people led policy panel. Setting up work streams to develop the action statements sitting behind the standards. Exploring what do LAs need to do to achieve the standards. We are also looking to develop a portal to bring into one place all of the tools and resources that are already out there to support the further implementation of SDS.
- So what next indeed..? Social Care is likely to change What that looks like needs to have SDS at its core The framework will hopefully be helpful to LAs providing them with inspiration and helpful resources to further implement SDS. sds.team@socialworkscotland.org Thank you for listening and happy to take any questions. Questions How will LAs be measured against the standards and who will be responsible for their regulation and reporting? Its been suggested by several sources that the stanrads could become a framework for measuring future success of implementation also CI have een involved and have agreed to use the standards in their inspection process. FG Do you see the Care Inspectorate having any role in external scrutiny of Local Authorities implementation of these Standards? DM How do you envisage the implementation of these standards being resourced? E.g., training of workforce FG. That is what we are consulting on we know that LAs are struggling resource wise so asking the questions around what will it take will give us a sense of what is required and we hope to feed that into the wider IRASC. At a local level, how do individuals, carers, support organisations make use of these standards? DM The can use the standards as a point of referce as to what to expect from services. As Ive already highlighted they fit with the H&SC Standards which highlights people’s rights and spell out what they can expect from services. How will the standards enable consistent application of the legislation around the country? FG They have been developed as a helpful resource focused on future implementation and ongoing imporvememt. Sharing effective EBP and ensuring that Culture, Systems, Workforce are all aligned which is currently not the case in many Local Authorities. How will these standards interplay with existing frameworks? DM H&SC standards, Childrens Charter, QI Quality Illustrations will inform the action statements ging forwards. Alignment with the Advanced Practice Statement for Social Workers.