Self-directed Support Implementation Study 2018: report 3

2. Dumfries and Galloway

Local context

Dumfries and Galloway has a population of 149,200.

The Council’s history with self-directed support began with one of the early pilots in Wigtonshire. This gave them some early insights into the issues around roll out and helped them with wider introduction of the processes.

For all people, regardless of age, a key aspect of the approach in Dumfries and Galloway is the use of resource panels where all supported people (and parents or guardians where appropriate) and/or their carers are invited to come to the panel to discuss their personal plan. With increasing financial constraints there is an emphasis on eligibility, with a focus on those assessed as having critical or substantial needs.

Weekly budget meetings are held to review individual cases – if a person’s needs are no longer assessed as critical or substantial, their care package will be reviewed. Any new case which is not assessed as ‘critical’ is also discussed at a budget meeting. For the under 65s choosing Option 2 or Option 3, there is a budget limit linked to the equivalence^[7] of the cost of providing support under Option 3, but social workers can escalate the case to the weekly budget meetings to seek approval for exceeding this limit.

The processes for assessing people’s care needs have changed with the implementation of self-directed support. At the core is a change in practice and in how social workers perceive individuals who need support, moving away from asking supported people “What’s the problem?” and instead asking “What do you want to do?” To answer this question well, the ‘good conversation’^[8] involves getting to know the supported person, what they can self-manage by using an asset-based approach, what is available locally, what gap needs to be filled and how social work can help to fill this gap.

Implementation of social care and support in Dumfries & Galloway

Accessing their personal budget as a direct payment (self-directed support Option 1) has mostly been chosen by individuals under the age of 65 (53% and 11% of people aged under 18 and adults aged under 65 respectively in 2016/17). There is limited uptake by those over 65 (1% in 2016/17); local authority representatives suggested that social workers may find it more difficult to explain Option 1 to this group without it sounding daunting to some. Additional challenges include the rural nature of Dumfries and Galloway, which makes it more difficult to recruit personal assistants (PAs) and increases the travel times involved.  To help address these barriers, the Council is now using Facebook as a PA recruitment tool and they have established a web-based application process so that those keen to be PAs can record their details.

While there appears to be general agreement among practitioners that Option 2 would be the preferred option for many, the introduction of this option was delayed until an appropriate contract became available in September 2017. Therefore, the data for 2016/17 showed that no one had chosen Option 2 over that period but now that this is available, it is likely that more people will choose Option 2.

In many areas of Dumfries & Galloway, there is a lack of a critical mass in terms of the number of supported people, so even although Option 2 is now available it is hard to create a viable provider business model. A further challenge for providers is that the principle of equivalence means that Option 2 is the same price as Option 3 – so providers may need a business model which covers their costs for delivering services under both of these.

Option 3 was used by 96% of people aged 65 and over in 2016/17. The local authority selects a provider for a new supported person from an approved provider list. Unlike some other areas, where there can be considerable choice around Option 3 providers, individuals may only have one Option 3 provider locally and may need to accept the time slots that the provider has available.

The individual case study from Dumfries and Galloway provides an example of social care under Option 3.

Case Study 1: Jane, Dumfries and Galloway

Jane is in her 40s and has had a chronic condition since she was in her late 20s. Her story shows how the good conversation can lead to an Option 3 choice that can be outcomes focused, flexible and responsive.

Jane lives in a small community outside Dumfries and her parents live in the same community. Until 10 years ago Jane’s parents provided for all her care needs (for example going around every evening to cook a meal), but as they aged they became unable to do this and the local care provider was contracted to cook a meal for Jane every evening.

With the introduction of self-directed support, the care provider became an Option 3 provider – the only one in the area.  With Option 2 not being available at that time, Jane’s only other choice was Option 1. Jane was aware of this option but her view was that, ‘It seemed quite complicated and too much for me to think about. You need to be on the ball and know what you are doing, and there are quite a few days when I am not like that. I have had relapses when I did not even know how to deal with a letter.’

Jane’s provider has proved highly responsive and flexible under their Option 3 contract. More recently, Jane’s mother became unable to provide personal care so the provider now provides personal care for Jane (under Option 3).  In addition, because her parents can no longer take her out, Jane’s funding was increased so she has an additional seven hours a fortnight with Crossroads which allows, for example, trips to Dumfries or Ayr. With her chronic condition having a cyclical component, when Jane is not feeling up to these experiences the contractor can bank the hours and agree a longer trip when Jane is feeling better.

There is a key component of this additional support linked to the outcomes which are important to Jane: keeping her connected with her local community which maintains her local network which is important to her.  It also provides a more rounded model of support to include her family and community as well as the support provided through social care.

Figure 2: Summary infographic - Case Study 1, Dumfries & Galloway