Social Care (Self-directed Support) (Scotland) Act 2013: statutory guidance

Section 8: Assess (Part 2) The Duty to Provide Choice and the Four Options Under the 2013 Act

Introduction

8.1 After it has identified the person's needs in collaboration with the adult, child/family or carer the authority is required to offer four options in relation to the relevant support identified at the assessment stage. The four options provided under the 2013 Act are:

Option 1 The making of a direct payment by the local authority to the supported person for the provision of support.

Option 2 The selection of support by the supported person, the making of arrangements for the provision of it by the local authority on behalf of the supported person and, where it is provided by someone other than the authority, the payment by the local authority of the relevant amount in respect of the cost of that provision.

Option 3 The selection of support for the supported person by the local authority, the making of arrangements for the provision of it by the authority and, where it is provided by someone other than the authority, the payment by the authority of the relevant amount in respect of the cost of that provision.

Option 4 The selection by the supported person of Option 1, 2 or 3 for each type of support and, where it is provided by someone other than the authority, the payment by the local authority of the relevant amount in respect of the cost of the support.

8.2 All of the choices must be described to the supported person. A key challenge for the authority is how to relate the options to the supported person and how to make them "come alive" to the supported person. Information and support services and the relevant legal duties on information, support and advocacy play a vital role at this state. See section 6 for further guidance on information and support.

Option 1: Direct payment

8.3 Option 1 is a direct payment. The authority should ensure that the supported person understands what a direct payment is and how it might be used. It should take steps to provide the necessary training and awareness raising to its own social work workforce to ensure that they are aware of and trained in, the nature and effect of a direct payment, the purpose behind a direct payment and the flexibility and responsibilities that come with direct payments. It should take steps to support their workforce to engage with the philosophy behind direct payments and their potential application for a wide range of individuals and circumstances.

8.4 There are certain key points that the authority should take account of when providing the direct payment option:

• The authority should be aware of and be able to explain the key characteristics of a direct payment. For instance, under a direct payment the supported person - or an organisation or person identified by the authority (under a "third party" direct payment) - receives a sum of money into a bank account. The supported person, either on their own or with support, can then purchase the support that they wish in order to meet their personal outcomes.
• The authority should ensure that the relevant local guidance or procedures work to assist the person to use the available financial resource in a variety of ways. In other words, to use it in any way provided that it will secure the provision of support agreed with the professional and provided that it meets the outcomes contained in the support plan.
• The decision to become an employer will only be available under the direct payment option. However, the authority should make it clear that the supported person can also use their direct payment to purchase a range of services that might otherwise be available under Options 2 to 4. For example, a direct payment can be used to purchase services from a registered care provider, from the local authority itself or from another local authority. In other words the direct payment is not only a route to employing personal assistants.
• A direct payment is not a benefit and nor is it a gift. It is a means to meet eligible needs. Its ultimate purpose is to meet the eligible needs of the supported person. As such, it should relate to the person's support plan. The direct payment should be used in flexible ways which relate to the outcomes set out in the support plan.
• Of the four options available under the 2013 Act the direct payment, if constructed and developed on a sound basis, carries the greatest level of flexibility and responsibility. The authority should make this point clear to the supported person. It should be transparent but it should also be supportive, explaining the additional support and information that can "make the DP work" for the supported person.

Means testing for direct payments

8.5 The authority may assess a direct payment user's ability to contribute to the cost of securing their support. If the authority decides to carry out such a means test they must do so before the direct payment is made or as soon as possible and no later than one year after the direct payment has been made. If the authority determines the direct payment user's requirement to contribute to the direct payment and the means test has happened after the direct payment has been made, the local authority may make arrangements to recover some or part of the direct payment from the direct payment user.

Payment net or gross

8.6 The authority can arrange for the direct payment to be paid in instalments or in a lump sum payment. Where a person is eligible for a charge towards their support the direct payment can be made on a "net" or a "gross" basis, i.e. the charge can be removed prior to the provision of the monthly direct payment or following the provision of the monthly payment. The supported person may request the payment be made gross. In this circumstance, the local authority should give this request full consideration, taking into account the direct payment user's reasons and circumstances behind this request prior to a decision being made. If the authority decides to pay the direct payment gross it will pay the relevant amount to the direct payment user and the direct payment user will pay the local authority any contribution required. If the authority refuses to pay direct payments on a gross basis they should inform the supported person as to the reasons why.

Third party direct payments

8.7 The supported person can ask for their direct payment to be paid to a third party and administered on the supported person's behalf. Under a third party payment the authority should take reasonable steps to ensure that the supported person remains in control of the payment and the supported person remains responsible for the direct payment. It is important that the role of both the supported person and the third party are made clear to the supported person and that there is evidence that all parties understand their responsibilities e.g. signed mandate or user agreement. This can help in the event of problems occurring at a later stage.

8.8 The authority should satisfy itself that the relationship between the supported person and the third party has been discussed and agreed before the package begins. The authority must also be satisfied that the supported person is aware that they can receive the payments direct if they wish.

8.9 The authority should ensure that the third party direct payment facilitates choice and control for the supported person. Third party direct payments are a flexible alternative where the supported person does not wish to take on the additional money management responsibilities. But the supported person should be firmly in control. A third party arrangement should not lead to a switch from dependence on the local authority to dependence on a third party.

Responsibilities that come with a direct payment

8.10 There are certain additional responsibilities that come with a direct payment. The local authority should explain those responsibilities to the supported person, relatives and relevant circles of support where applicable, but they should also explain the additional support and information that the person can receive in order to manage their payment. There is no specific requirement to do so, but it would represent good practice to explain the following responsibilities:

• to use the payment to meet the outcomes within the support plan;
• to report back in a proportionate and reasonable way on how the funding is being spent; and
• where the supported person chooses to employ a Personal Assistant, the responsibility to be a good employer and the responsibilities to discharge the range of additional responsibilities that come with being an employer.

8.11 The authority should make the supported person aware of further sources of information which can help them to understand their responsibilities.

Flexible use of direct payments: the choices available to a supported person under a direct payment

8.12 The authority should take steps to ensure that the supported person can use their direct payment in any way provided that the support purchased via the payment is in line with the assessment and support plan, meets the supported person's "eligible need" and is within the criminal and civil law.

8.13 Typically, direct payments have been understood as a route to employing a personal assistant. However, a direct payment can also be used to purchase a very wide range of things. For instance:

• a service from the local authority or from another local authority;
• a service from a provider organisation in either the voluntary or private sector;
• a product which can help to meet the supported person's needs;
• a short break or respite of one sort or another; and
• anything else which will help to meet the supported person's needs and the outcomes in the support plan.

8.14 This flexibility is supported by the legal meaning of the term "services" as provided in the core assessment and service duties. The 1968 Act uses the language of community care service and the 1995 Act refers to a range and level of services. This can encompass any form of support which will meet the person's needs. It need not be restricted to the provision of a service in the form of a home care service or a day care service (though those are perfectly acceptable examples of a community care service). It can and should extend to any intervention or purchase which meets the needs and outcomes of the supported person.

Direct payments: key information that should be provided to the supported person

8.15 Table 8 outlines the main steps that the authority should take in order to ensure that the person is provided with the key information in relation to the direct payment option.

Table 8: Key information in relation to the direct payment

Key information that should be provided to the supported person	Why is it important to inform the person
Responsibilities associated with the direct payment The authority should ensure that the person is made aware of the general responsibilities that come with a direct payment arrangement. This includes the importance of using the funding provided via the direct payment to meet the supported person's assessed needs and agreed outcomes.	The 2013 Act includes a general principle on informed choice. As part of this, it is important that the supported person is aware of the responsibilities and flexible opportunities that might stem from a direct payment.
Support and information The authority should ensure that the person is made aware of all relevant support and information services. This should include services that provide additional advice about the relevant direct payment responsibilities along with specific support and advice on employing personal assistants. For further guidance on support and information services in relation to all 4 options see section 6.	It is important that people have access to sources of information and support beyond their local authority social worker, including peer support options. This is because studies have shown that direct payment arrangements are more likely to work when the person has the right support and assistance from others.
Supported person agreements Supported person or user agreements provide a proportionate and effective means by which to develop a "contract" between the two parties. The authority should set up arrangements for such agreements as part of their direct payment schemes. The formal nature of supported person agreements provides a realistic and factual contract between the two parties as to how the arrangement will be taken forward. In addition, it ensures that both parties are aware of their respective responsibilities. The Supported Person agreement should cover all of the key items referred to in this table. It should include commitments relating to both parties and not simply the supported person. Example responsibilities that can be outlined in the Supported Person agreement are: For the authority: Responsibility to direct the supported person towards information and support services available in the local area Responsibility to act in a proportionate and reasonable way if/when considering terminating a direct payment Responsibility to provide sufficient notice of any changes to general direct payment arrangements. For the supported person: Responsibility to take forward safe and effective recruitment Responsibility to provide appropriate reports on use of the direct payment Responsibility to inform the authority when things go wrong	A direct payment brings with it a range of additional responsibilities for both parties. It can help to ensure good planning, including contingency planning. It can help to improve the quality of information provided to the supported person at the outset.
Safe and effective recruitment The authority should inform the person of the importance of safe and effective recruitment. It should ensure that the person has access to the necessary additional support and information services to help them to discharge this role. The type of information that should be imparted to the supported in relation to safe and effective recruitment includes the importance of: taking up references advertising and interviewing ensuring that the relevant processes are undertaken with respect to the Protecting Vulnerable Groups (Scotland) Act 2007 safe induction and training probationary periods staff management staff appraisal disciplinary procedures obtaining employer's liability insurance obtaining employer's indemnity cover	Safe and effective recruitment is vital to ensuring that the person recruits the right person with the right mix of skills. It also helps to ensure that personal assistants are employed by well informed and effective employers.
Contingency plans Where the person's needs are likely to fluctuate the authority should discuss the appropriate contingency plans and the importance of effective arrangements to ensure the continuity of support. For further guidance see Section 9 in this guidance.	Things can go wrong across all of the four options under the 2013 Act. However, due to the nature of the direct payment option it is vital that the supported person is provided with the appropriate additional support to ensure that they do not feel "cut loose" when things do not go to plan.
Employment of close relatives Where the person wishes to consider employing a close relative, the authority should explain the considerations involved and the discretion that the local authority holds to either agree or disagree to any such arrangement. The authority should make it clear that it retains a decision-making role in relation to allowing close relatives to be employed using state funded direct payments, and that such arrangements should occur only where appropriate. Further guidance on employing relatives see paragraphs 11.18 to11.26.	While it is possible for the supported person to employ a close relative in appropriate circumstances, the local authority retains to the discretion to agree or disagree to any such arrangement as it involves an important change in the relationship between the two individuals.
Monitoring and review arrangements The authority should ensure that all monitoring arrangements are explained to the supported person. The authority should discuss with the supported person the information they will be expected to provide and the way in which monitoring will be carried out. The direct payment arrangement should not begin until the supported person has agreed to any conditions which are necessary for monitoring purposes. For further guidance on monitoring of direct payments see Section 11 "provision of support".	Monitoring arrangements should be effective but they should also be proportionate.
Terminating Direct Payments Under the Direct Payment Regulations 2014 the authority can terminate the direct payment under certain circumstances. The authority should make this clear to the supported person at the outset.	Direct payments remain public funding and are to meet assessed needs and so authorities retain powers to end direct payment arrangements. However, such powers should be used with great care and direct payments should only be terminated where there is a clear justification.

Further guidance: contingency plans

8.16 Where appropriate the authority should take steps to support the person to plan ahead and make arrangements whereby a designated person or group of people - circle of support, trustees - can be given permission by the supported person to take over during a period when the supported person is unable to manage.

8.17 A statement in advance is one method to ensure that contingency plans are put in place. For example a person could write down what a support worker should do if they have a crisis, write guidelines for how to assess risk or provide a list of useful telephone numbers that the support worker could phone for advice or information if necessary. This can ensure that if the supported person becomes ill they retain as much control and choice as possible of the arrangements and are able to regain full control if they become well again. This may help prevent the supported person reverting to local authority provision unless they wish this to happen.

8.18 The authority should ensure that it has the necessary systems and processes in place to ensure continuity of funding during times of crisis. For example where the person chooses to use their payment to employ their own staff the authority should take steps to fund Personal Assistant (PA) employer packages during short stays in hospital, where appropriate. This will enable the supported person to continue to pay employees for the initial four weeks of any hospital stay. The authority should encourage PA employers to include arrangements for hospital admission within the employment contract and terms and conditions. In all circumstances the statutory requirements governed by employment legislation must be applied.

8.19 The authority should discuss what arrangements the supported person wishes to make for emergencies. If the authority becomes aware that the person is unable to secure support to meet their needs the authority's responsibility to arrange emergency support for that person is the same as if the supported person chooses Option 2 or 3 under the 2013 Act. The authority may decide to step in, albeit temporarily, and arrange the necessary services but it should first consider providing assistance to enable the person to continue to manage their own support. Examples might include making arrangements with independent agencies for emergency cover or recruiting personal assistants who are prepared to work additional shifts at short notice when necessary. Where difficulties arise that were not anticipated it is helpful if the supported person knows they can contact a named individual in the local authority or a local support service whom they can ask for help. Such contingencies should form part of the user/supported person agreement.

Further guidance and hyperlinks:

For further guidance on direct payments and the Protecting Vulnerable Groups scheme, consult the Scottish Government's "Guidance on the interaction between Self-Directed Support and Protecting Vulnerable Groups Scheme": http://www.scotland.gov.uk/Publications/2011/08/04111811/0

National Chartered Institute of Public Finance and Accountancy (CIPFA) good practice guidance http://www.cipfa.org/policy-and-guidance

Scottish Personal Assistant Employers Network http://www.spaen.co.uk

Self-directed Support Scotland http://www.sdsscotland.org.uk/

Option 2: "Directing the available support"

8.20 Option 2 is an important addition to the options available to supported people. It describes an arrangement where the supported person selects the support that they wish and the authority, or subsequently a provider acting under the person's direction, makes the relevant administrative arrangements on the supported person's behalf.

8.21 The purpose of Option 2 is to facilitate greater choice and control, making it easier for people to choose the provider of their choice, with the authority (or subsequently the provider) the servant of the support person, making arrangements on their behalf. The authority should use Option 2 to widen the flexibility offered to supported persons to the maximum possible extent. It should make use of Option 2 to provide a route to greater choice and control for those who want to take greater control over their day-to-day support but are not willing or do not feel ready or able, to choose the direct payment option. The authority should take as flexible an approach as possible to Option 2, ensuring that it is delivered in line with the policy aims which underpin Section 1 and 4 within the 2013 Act.

8.22 The authority should develop a flexible range of options under Option 2 in line with the policy intentions described in Section 4 in the 2013 Act, the accompanying Policy Memorandum and this guidance. As with the direct payment option, the provision of support under Option 2 should be flexible, as supported by the provisions in the legislation. Again, a "service" should be interpreted as meaning any intervention which helps to make a positive difference to the person's assessed needs, delivered under the broad concept of social welfare.

8.23 The authority should not seek to limit flexibility beyond what is allowed under procurement law. The key limitation is that a person cannot use Option 2 in order to employ their own staff. Unlike the direct payment there is no requirement for the funding to be provided directly to the supported person as a cash payment. The budget provided to the person should be operated as a virtual budget. The resource can remain with the local authority or it can be delegated to a provider to hold and distribute under the supported person's direction.

Case study example: Individual Service Fund

Option 2 may be provided as an "Individual Service Fund". An Individual Service Fund is a sum of money managed by a service provider on behalf of an individual. As with a direct payment, the funding should be used to meet the needs identified at assessment and the personal outcomes outlined in the support plan. It can include services purchased from other providers.

8.24 The authority's arrangements may be operated as a formal framework agreement or other similar arrangements, though there is no requirement to do so within the 2013 Act, nor detailed restrictions imposed on the local authority as to how flexible and creative it wishes to be in relation to Option 2. The arrangements should be flexible and inclusive. Flexible - in that they should not seek to create or re-impose barriers to choice and control. Inclusive - in that they should not seek to exclude particular types of service provision or particular providers from the full range of supports available to the person. For example, the arrangements should allow for flexibility in budgeting, allowing sufficient over-and under-spends within the individual's package of support. The authority - and providers acting as custodians of the person's budget under the person's direction - should not seek to impose restrictions or limitations over and above any that are reasonably defined in the person's assessment or support plan.

8.25 For further guidance on the subsequent provision of support under Option 2 arrangements please see section 11 of this guidance.

Option 3: the local authority arranges support for the supported person

8.26 Under Option 3 the authority in collaboration with the supported person selects the appropriate support and then makes arrangements on the supported person's behalf. In contrast to Option 2, the supported person steps back somewhat. The person actively chooses to leave many of the detailed decisions to the authority. This may be described as "arranged service provision" or "direct services". It differs from Option 2 in that the local authority provides or arranges services on the supported person's behalf. The supported person does not have direct, on-going or day-to-day responsibility for planning and controlling how the available resource is used.

8.27 Nevertheless under Option 3 the principles of choice and control, collaboration and involvement should continue to apply. The authority, through its approach to commissioning and procurement of services, should seek to ensure that the services provided are as flexible as possible, are sufficiently personalised and are ready to adapt to the desires of the individuals who use them. This should involve the necessary workforce education and development, ensuring that those who provide care and support do so in line with the general principles in the 2013 Act.

Option 4: "mix and match"

8.28 Option 4 - a combination of two or more of the options - recognises that some people will be content to take on some but not all of the control associated with one or other of the self-directed options. This is a "mix and match" approach to ensure maximum flexibility in the options available. This option may be attractive to people who would like to experiment with the direct payment or individual service fund for a small aspect of their support or for a small portion of their outcomes.

The application of the 2013 Act & local authority discretion in relation to the 4 Options

The form of support and its relevance to the 4 Options in the 2013 Act

8.29 The form of support is important in considering whether or not the 2013 Act's duties apply. The 2013 Act applies to support which a local authority decides to provide following an assessment under section 12A or 12AA of the 1968 Act and Section 22 of the 1995 Act. However there are certain instances where the form of support may be relevant to deciding whether the 2013 Act duties apply. This section provides additional guidance to authorities in order to help them to decide which forms of support are relevant to the 2013 Act and which are not.

Social welfare services provided to adults in connection with criminal justice orders

8.30 In relation to adults the 2013 Act duties apply to community care services which a local authority decides are called for as a result of an assessment completed under Section 12A of the 1968 Act. Community care services means all services which a local authority provides under Part 2 of the 1968 Act (promotion of social welfare) or sections 25 to 27 of the 2003 Act. This covers the majority of forms of support provided by social work departments however the definition specifically excludes services or forms of support which local authorities provide in connection with criminal justice orders, services connected with visiting people who are receiving assistance and services connected with burials and funerals. An example is a drug treatment and resting order (DTTO). Under a DTTO, the offender is required to submit to treatment by or under the direction or a suitably qualified person with a view to the reduction or elimination of the offender's dependency or propensity to misuse drugs. The order also requires the local authority in whose area the offender must reside to appoint a supervising officer to supervise the offender and report back to the court.

8.31 The authority in such cases is acting as a result of a requirement in the drug treatment and testing order, but is also exercising functions under section 27 of the 1968 Act (supervision and care of persons put on probation or released from prisons etc.). However, the definition of 'community care services' in section 24(1) of the 2013 Act excludes services provided under sections 27-27B, 28 and 29 of the 1968 Act. That means that criminal justice-related social services provided under section 27 of the 1968 Act are not 'community care services' within the meaning of section 5 of the 2013 Act to which the duty to offer the four options apply.

8.32 This means that the authority is not placed under an obligation to offer the four SDS options where the form of service is tied to a specific criminal justice order. This reflects the fact that the form of service will be by its very nature prescriptive and controlled. This is not to say that individuals in such situation cannot be provided with the four options in relation to wider community care needs that they may have.

Instances where the form of support cannot be delivered via any of the four options in the 2013 Act

8.33 A further consideration for the authority is whether the particular form of support which has been decided is necessary is incapable of being delivered through the 2013 Act's four options. For example, instances where the nature of the support means that it cannot be delivered through an alternative self-directed option such as a direct payment or individual service fund. In relation to support to children and families, if removal of a child to foster care is capable of being 'support' under section 22, then clearly the foster care itself is something which cannot be purchased by means of a direct payment or converted into a single budget. Similarly, if the authority's support to a family in crisis is the social worker's intervention with the child/family to deal with complex safeguarding situation then clearly that is a form of support which cannot be converted into a direct payment or individual service fund and so those options are simply not available.

8.34 The authority should be aware that all other forms of support are relevant to the SDS Act 2013. The 2013 Act and Direct Payment Regulations 2014 have been developed so as not to exclude entire groups of individuals. This is to ensure that the authority retains maximum positive discretion to offer the choices and to take advantage of the flexibility offered by self-directed support. For example the authority may encounter situations where one particular aspect of the person's support may not be relevant to the four options but other aspects may be relevant. If so, the authority should discuss the alternative SDS options in relation to the forms of support which are relevant to the provision of choice.

Additional legal restrictions/discretion in relation to direct payments

Restrictions on the authority's ability to offer the direct payment: long-term residential care

8.35 Under the Direct Payment Regulations 2014 the only circumstance where the authority is not permitted to offer a direct payment is in relation to the provision of long-term residential or nursing care to persons of any age. This means that the authority cannot provide a direct payment to any person of any age where the support required by the person is long-term residential care.

Circumstances where the authority has the discretion to refuse a direct payment

8.36 The direct payment option (Option 1 in the 2013 Act) involves some important responsibilities for the supported person. The persons takes on direct control of the social care resource. The person assumes day-to-day responsibility for arranging and overseeing their care and support.

8.37 Social care assessments will be completed in a wide variety of circumstances. This means that there may be specific circumstances where in the authority's considered judgement it is simply impossible for the direct payment option to meet the needs of the supported person and, at the same time, be assured that the person's safety is not being further jeopardised by the direct payment. The Direct Payment Regulations 2014 specify that a local authority is not required to offer the option of a direct payment where it is likely that the making of a direct payment will put the safety of the supported person at risk. Appropriate examples whereby the authority can use this "duty of care" discretion are provided below:

• where the child's safety will be put at risk by having a direct payment because it is clear that the money will not be used to purchase the support the child needs;
• where the assessment is conducted at an acute point of "crisis" to the extent that the person's safety would be further jeopardised by the provision of a direct payment, and;
• where the adult is defined as an adult at risk under the Adult Support and Protection (Scotland) Act 2007 there is a protection order in place and there are specific circumstances that give rise to concerns about the person's safety.

8.38 The test in relation to duty of care considerations and circumstances where it is appropriate to refuse the option due to these considerations, is a significant one. The authority should not depart from the policy intention and spirit of the 2013 Act without good reason. For example:

• it would not be appropriate for the authority to refuse a direct payment simply because the person's disability means that it is a challenge (even a significant challenge) for them to manage the direct payment option;
• it would not be appropriate for the authority to refuse to provide a direct payment simply because the person has dementia or learning disability or any other disability which may require them to need extra support to make the direct payment option work, and;
• it would not be appropriate for the authority to develop internal policy guidance documents which define access to direct payments on the basis of general client group or disability alone.

8.39 In all instances where the authority concludes that it cannot provide a direct payment it should explain to the supported person why it is not appropriate at that point in time. It should explain that the person can request a review at a later date in order to return to the options. Where the circumstances that gave rise to the initial decision subsequently change the authority should return to consider the direct payment option alongside the other Options provided under the 2013 Act. Section 13 of the 2013 Act specifically requires a local authority to offer the person another opportunity to choose one of the SDS options whenever it becomes aware of a material change in that person's circumstances.

Further guidance: children and families

Transition from children's to adult's support

8.40 For any young person the process of growing up involves the gradual taking on of responsibility for themselves. Parents can face challenges in supporting and preparing young people for an independent adult life. The transition to greater independence is rarely a single event, nor does it happen quickly. Families with disabled children often face additional challenges that may delay or limit the young person's transition towards independence. The flexibility offered by self-directed options may offer advantages to the young person and their family. A direct payment or the opportunity to take control of their support may help the child/young person to take on greater responsibility right across their life, to be more independent and to have greater control over their future. Alternatively, the "mix and match" approach (where the young supported person takes direct control over a portion of their package or to meet a small collection of outcomes) may offer an opportunity to build the young supported person's confidence in managing their own support. It may make sense to facilitate transitional arrangements whereby initially the young person manages only a small proportion of their support but takes on greater responsibility over time.

8.41 Throughout the assessment and support planning process the young person should receive the practical support that they need in order to help them to make the relevant decisions and manage their support. This may include assistance from parents and carers, independent advice and support or, in some cases, advocacy services. The young person's ability to manage may change as they gain experience. Where the young person or family decides to take greater control - for instance, to take a direct payment and employ their own staff, then additional local support services - the authority should ensure that they direct the young person and their family to agencies that assist with employment advice and payroll support.

Case Study example: John's story

Support for transition from child support into adult support

John is 20 and from birth was diagnosed with a complex learning disability and epilepsy. From the age of nine John received a short break and outreach service from Action for Children which was financed by Social Services.

This package of support was successful for several years. The three day a month short break service gave John the opportunity to have time away from home and continue to have his communication, development and wellbeing supported. This also gave John's family a break.

The outreach service was delivered as a four hour period one day a week. This outreach service increased John's opportunities to participate in community activities and supported John and his other family members participating in events within their own community.

As the transition stage to adult services approached, John's mother was faced with many challenges, so often faced by families with disabled children, which caused delay in securing an appropriate Adult Service tailored to John's specific needs.

During this period of transition John no longer accessed the services of Action for Children through Children's Services. Instead, John's mother took the opportunity to agree a Direct Payment arrangement with Social Services and with this purchased the same outreach support from Action for Children.

This provision of support provided John with much needed continuity with the opportunity to continue participating in activities within his local community. It also allowed Action for Children to assist in John's transition plan. The Direct Payment option allowed John's mother the opportunity to have time to continue sourcing an appropriate adult resource as her improved parental wellbeing, knowing John's needs were continuing to be met, led to better involvement and co-operation with adult services.

The Direct Payment option employed by John's mother allowed her maximum flexibility in purchasing services that still met the outcomes set for John while the main outcome in securing a suitable Adult Service for John were explored.

Further guidance: carers

8.42 The 2013 Act imposes a duty on the authority to consider the conclusions from the carer's assessment. In considering this aspect the authority must consider whether the carer would benefit from some form of support to enable them to continue in their caring role. Section 3 of the 2013 Act then provides the legal basis for the authority to work with an adult carer in order to arrange some support for the carer. For young carers the basis is section 22 of the Children (Scotland) Act 1995, which will be replaced by the GIRFEC regulations outlined in the forthcoming Children and Young People (Scotland) Act 2014.

8.43 Support to a carer can mean a wide variety of things. It can mean access to universal services available in the community, referral to a known source of information and advice (for example, to a condition-specific organisation or to a carers centre) or the provision of further information in the form of booklets, websites, advice and guidance on coping with their caring role. Support in the form of information, advice, signposting, and other universal services is available to all carers whether or not a carer's assessment has taken place and is available to all carers regardless of whether their caring role is regular or substantial.

Support to carers out with the formal carer's assessment

8.44 Early preventative support helps to lessen any negative impact of a caring role. Working together, the carer and the professional can ensure better emotional and physical wellbeing for the carer by putting preventative support in place. The aim is to support the carer in circumstances such as the early stages of a caring role knowing that the caring will become more intensive in due course (for example, caring for a supported person just diagnosed with dementia) or whilst caring for someone whose condition is known to remain stable and low-level, but where the impact of the caring role on the carer means they require some support.

8.45 Preventative support can also mean arranging some form of funded services or support. Funded support to the carer can be of significant benefit to the carer and to the supported person, as when a carer is adequately supported in their caring role they may find it easier to continue to care. It can also lead to significant benefits to the statutory agencies responsible for care and support.

8.46 In deciding whether to provide funded services or support, the authority should consider carefully the impact of their decision. Without the contribution of the carer the authority or other statutory agencies would have to step in with higher levels of support, which would be considerably more costly. Senior managers should encourage professionals to exercise their own judgment when considering the outcomes carers wish to achieve and a preventative approach to supporting carers.

Statutory support: the choices that must be made available to the carer

8.47 If as a result of the assessment the authority decides to provide funded support it must offer the carer choices as to how the carer wishes to receive that support. The authority must provide the carer with the various options within the 2013 Act and it must give effect to the carer's choice. As with support to the disabled or older person, the authority must inform the carer of the amount of support available under each of the options. If the carer does not wish to make their own decision about how they will receive any support (and assuming that they still wish to receive support) then the authority should continue to arrange support on their behalf.

Information and additional advice and support to carers

8.48 The authority must collaborate with the carer in relation to their assessment. They must take steps to ensure the carer can exercise informed choice, involve the carer in the assessment and in the decisions around any support to them in their own right and take steps to ensure that the carer makes an informed choice. This means that they must provide the following:

• an explanation of the nature and effect of the various options under which they may arrange their carer support;
• information about how to manage that support;
• information about people or organisations, including independent organisations, who can provide assistance or information to the carer to help them to make decisions about the options (this might include general advice and information support services or it might mean more specialist advice from a carer's organisation);
• information about how to manage their carer's support; and
• in any case where the authority considers it appropriate to do so, information about independent advocacy services to help the carer to take part in their assessment, to navigate their choices and to arrange their carer support.

8.49 The authority will want to make the options meaningful and relevant to the carer. Table 9 provides some examples of what the various choices may mean in practice in terms of carer's support:

Table 9: Examples of carer's support under the 2013 Act

2013 Act option	Example
Direct payment	· A carer who lives in a remote rural area is feeling increasingly isolated and depressed. She has no friends or family living nearby and her nearest carers' centre is miles away. The carer uses a direct payment to pay for the installation of broadband and for a tablet computer. This means she can keep in touch with her family and friends through Skype and email, particularly her grandchildren who live overseas. She has also made friends with other carers on an online forum and now feels more connected and supported. · A young carer who cares for his mother expresses that he has not been able to have the same opportunities as his peers. Whilst all his friends are learning to drive, he cannot because his mother cannot afford the cost and because of his caring role he cannot take on a part time job in order to earn extra money. He thinks that having a driving licence would be useful as the family could get a Motability car, which would help with a lot of the tasks around his caring role such as shopping and taking his mum to places. He also thinks that being able to drive would open up more job opportunities. The young carer uses his direct payment to pay for several driving lessons and the cost of the driving tests.
Directing the available support	· A carer has never had a break from caring. He would like to have a break of an afternoon each week to have a rest where he doesn't have to worry about the safety of the person he cares for. The carer receives a carer's short break voucher as a form of "virtual budget" and he uses this to purchase a short break. The authority arranges for an individual service fund to be set up to support the carer. This carer has always been very house-proud, but her husband has had a stroke and the level of care that she has to provide means that she is falling behind with housework and laundry, which is making her feel increasingly tired and depressed. The carer uses the individual service fund to purchase domestic help from an agency so that someone can come in and help with cleaning, ironing and other domestic tasks. The carer also uses the ISF to pay for a fortnightly visit from a care worker so that she can meet her daughter for lunch and have a break from caring
Arranged services	· After the death of his father, a carer is finding caring for his mother, who has dementia, emotionally draining and he is becoming very depressed. He is on a waiting list for NHS counselling services but has been told it may take a long time and his local carers centre does not offer this service. The authority arranges for the carer to attend a private counsellor to help him manage issues of bereavement and caring. · A carer talks about missing out on making new friends as she never has time because of her caring role. She expresses an interest in attending an art class in a local authority community centre. The authority arranges for the carer to attend the class and arranges replacement care for the person she cares for once a week.

Case Study example: Isobel and John's story

Isobel cares for her husband who needs a lot of help with personal care. John does not want anyone other than his wife to help but she is exhausted trying to care for her husband and run the house. It is difficult to get time to do laundry, shopping etc. Following a carer's assessment the local authority provides Isobel with a budget of £40 per week to help with tasks that will enable her to concentrate on providing support to John, which is what she wants to do. The couple also receive support to have short breaks together of up to two weeks per year in accessible accommodation.^[2] This has helped relieve the stress felt by Isobel and has improved their relationship.

Case Study example: Mr D's Story

Mr D described the positive impact for him as a carer and for his wife when they accessed SDS in relation to her support needs, articulating that SDS had "given him back his life" and "saved his life". He utilised SDS to employ a PA with the administration of employer responsibilities undertaken by an agency. The PA was an individual who was known and trusted by the family and with the right knowledge and skills to support his wife. Mr D described the first evening he left his wife in the company of the PA. He was able to pursue his own social interests for five hours, which had been an impossibility for a number of years. He returned home to find his wife relaxed and content with her PA. His wife was generally very agitated but with the right support from the right person she became very relaxed. This had been achieved through the use of SDS. Mr D identified the flexibility of SDS as the reason it was such a positive measure in his family's circumstances. He had no interest in becoming an employer but could still utilise a direct payment to employ as PA as the paperwork responsibility was undertaken by a company. With time the direct payment increased to reflect his wife's increased support needs.

Additional guidance and hyperlinks

Care Inspectorate Practice Guide: Involving Children and Young People in Improving Services
http://www.scswis.com/index.php?option=com_docman&task=cat_view&gid=533&Itemid=378#

Institute for Research and Innovation in Social Services, Leading for Outcomes: Children and Young People
http://www.iriss.org.uk/resources/leading-outcomes-children-and-young-people

Self-directed Support in Scotland website - Professionals http://www.selfdirectedsupportscotland.org.uk/professionals/

Scottish Government (2010) Self-directed support: A National Strategy for Scotlandhttp://www.scotland.gov.uk/Publications/2010/11/05120810/0