Interim National Care Service Advisory Board: Advice to Scottish Ministers and Council Leaders - Self-Directed Support

Introduction

1. The Social Care (Self-directed support) (Scotland) Act 2013 (SDS Act) introduced Self-directed Support (SDS) in Scotland. SDS was grounded in the belief that:

• the majority of people know what will make their own lives better
• empowering people to make decisions about their own care will drive improvement in services.

2. Constraining decision-making power to professionals and excluding people from decisions about their own care, does not live up to that founding belief.

3. SDS means people in receipt of social care support in Scotland have the right to make informed choices about what their support looks like and how it is delivered to meet their personal outcomes. SDS is central to providing choice and control for people who require social care. However, current implementation of direct payments – option one – often limits flexibility, undermining outcomes and creating unnecessary stress for the supported person and families. This advice from the interim Board focuses on the implementation of option one – direct payments – and ways in which to increase flexibility in how those payments can be used.

4. Social care delivery is currently undermining choice and control. It is also undermining the very spirit of the SDS legislation which is about independent living, as defined by Article 19 of the United Nations Convention on the Rights of Disabled People. In his Independent Review of Adult Social Care, Derek Feeley highlights the definition of independent living adopted over many years by the Scottish Government, COSLA, the NHS and defined by the Disabled People’s Independent Living Movement as follows:

Independent living means people of all ages having the same freedom, choice, dignity and control as other citizens at home, at work and in the community. It does not mean living by yourself or fending for yourself. It means having rights to practical assistance and support to participate in society and live a full life.

5. The IRASC continues:

Social care support is the means to an end, not an end in itself. The end is human rights, wellbeing, independent living and equity, as well as people in communities and society who care for each other. However, more recently the default narrative about social care is too often one of crisis, unsustainability, . . . and occasionally even harm.^[1]

6. The interim Board has gathered significant and compelling evidence that cuts to option 1 – direct payments – have created harm. In some cases this has resulted in people:

• not being able to continue to or take up work
• being forced to take medical interventions they might otherwise not need
• ending up in residential care
• being forced to withdraw from social and community connections

7. On top of concerns about disabled people and supported people, the interim Board is concerned that cuts to social care and how these are being carried out are:

• undermining professional judgement
• compromising the professional standards and practice of social workers and social care staff

8. It is therefore essential that the interim Board advises swift action to improve this situation and change direction, so that social care can once more support people to live a life of meaning, purpose and choices, as intended by the SDS Act.

9. SDS is one of five areas the interim NCS Advisory Board has identified as a priority in need of improvements. This priority was discussed at the November 2025 meeting of the interim Board when substantial evidence was shared with members. The evidence, pulled together by Social Work Scotland, had been provided by

• Disabled People-led Organisations
• independent support organisations
• brokerage
• integrated care systems
• housing organisations
• carers
• supported people

10. This evidence made clear that cuts are creating situations which fundamentally undermine some of the Board’s other priority areas:

• Getting it right for everyone (GIRFE)

GIRFE focuses on a person-led approach and prioritising what matters most to individuals. The interim Board is separately advising Ministers and local areas on the importance of embedding the GIRFE approach at both national and local level. GIRFE can reduce duplication, improve efficiency and ensure timely, holistic support and improved outcomes for people by focusing on collaboration of those delivering support, no matter what kind of help is needed.

• Rights to breaks for carers

By reducing the support provided to individuals, there is a greater burden placed on unpaid carers, with the assumption that they will step in to fill the gap. This in turn will significantly increase unpaid carers’ need for respite.

The interim Board believes that the cuts made to social care support in recent times mean that the costs of implementing the new legal rights to breaks for carers cited in the Care Reform (Scotland) Act 2025 Financial Memorandum will already have been significantly overtaken. The interim Board will provide separate advice on the factors which must be in place in order to support the effective implementation of the new rights to breaks for carers.

The interim Board notes that providing appropriately funded support packages for individuals is the most effective way of ensuring that unpaid carers do not require crisis intervention. By way of example, this would be particularly helpful to a carer, Moyra, who supports her daughter Linda and has told us that because of cuts, she has to act as “the second person for the 2 to 1 support which my daughter needs.”

11. The interim Board also notes the strong links between the effective delivery of self-directed support and the Coming Home initiative, in terms of a shared focus on human rights and citizenship.

12. As the evidence shared at the November interim Board meeting highlighted, reductions in care packages are causing harm to those using each of the self-directed support options. Cuts are also impacting more widely across the health and social care system. The interim Board recognises the considerable financial constraints within which the health and social care system is currently operating. The interim Board firmly believes, however, that action must be taken to avoid further harm and deliver fairness, opportunities and freedom for those needing and using social care alongside other citizens.

13. Within that context and with a wish to be pragmatic in bringing about immediate and meaningful change for those people who most need it; interim Board members have agreed to focus this initial advice around improving practice that can be made for those in receipt of direct payments – self-directed support Option 1. This is because the interim Board believes it is in relation to this group that relatively straightforward changes can be made most quickly – i.e. without the need for legislative change or significant additional funding – and which could have a significant positive impact to people in receipt of these direct payments.

14. The interim Board will recommend to the final, recruited Board that it continues to consider a wider range of advice to effect further improvements in relation to the implementation of self-directed support.