Self-directed Support Implementation Study 2018: report 3

7. Eilean Siar (Western Isles)

Local context

The area covered by Comhairle nan Eilean Siar (the Western Isles Council) has a population of 26,950.

Although Option 1 has been established for some time, preparations for the implementation of self-directed support did not begin in earnest in the Western Isles until 2014 when the Act came into force. At this point, the Council used Scottish Government implementation funding to employ a Service Improvement Officer (SIO) for self-directed support along with an administrative member of staff.

There is no formal preferred provider framework in the Western Isles because there are only four organisations registered with the Care Inspectorate: the local authority, Crossroads, Alzheimer Scotland and Action for Children. There is a close relationship between the Council and the other providers, and developing a formal framework is not considered necessary.  Members of the Council commissioning team meet with providers regularly to ensure that outcomes are being met and to discuss contractual arrangements.

The SIO’s role now covers a wider social care remit. It is supported by two staff who: administer Option 1; assist social work staff with financial queries; support people with the administration of the payment and invoicing, and liaise with providers on behalf of Option 2 supported people.

Implementation of social care and support in Eilean Siar

The approach to social care in the Western Isles is based on a ‘good conversation’ and a strengths-based approach when planning care packages.  The authority estimates that it takes anywhere between 5 and 7 hours of a social worker’s time to undertake a social care assessment at a cost of between £215 and £301.^[14]

Although the data shows that take up of Option 2 in the Western Isles is broadly in line with Scotland as a whole (14% among supported people aged 18 to 64 and 5% among those aged 65 and over), the local authority’s self-directed support lead feels that they are unable to offer this option in its “true spirit” because of the limited number of care providers in the area’s remote and rural communities.

Option 3 is the most popular option (taken up by 47% of supported people aged 18 to 64 and 81% of those aged 65 and over) and this is viewed as especially appropriate for supported people, particularly older people, who want care at home but do not want to take on the responsibility of a direct payment via Option 1 yet want some control over their care.

The lead officer explained that, in some cases, supported people who would prefer to be on Option 3 have to choose Option 1 because of the limited capacity across the local authority social care team and the small number of other care providers. This means that taking up Option 1 to employ a personal assistant from the community can often be the only option for achieving their personal outcomes.

All budgets and care plans are agreed at a weekly resource allocation panel meeting. This involves a Strategic Commissioning Manager, Social Work Services Manager and two Service Improvement Officers. This approach helps to ensure equity in the allocation of time for each supported person, regardless of the option they choose. The panel was established partly in response to an issue identified early in the implementation of self-directed support, when social work practitioners designing Option 1 and 2 packages included inflated numbers of hours in care packages, which was unsustainable. All supported people choosing Option 1 or 2 are informed of the budget available to them.

The self-directed support lead feels that this approach to approving care plans could be improved and made more systematic, and the local authority is considering introducing an Equivalency Matrix model^[15]. It is also exploring how to make the assessment process easier for staff and more conducive to the self-directed approach, for example by reviewing the outdated single shared assessment forms.

The lead officer also recognises the importance of continuing to promote an open and dynamic procurement and commissioning system with community involvement, and now, with the funding of an independent brokerage service through the Support in the Right Direction Fund, supported people will have more information and support when making choices about their social care.

One case study was undertaken in the Western Isles where Moira uses Option 1 to design a flexible package of care for her son.

Case Study 13: James, Eilean Siar

Moira’s son, James, is in his twenties and has a condition that causes learning disabilities and other health problems. Their experience shows how Option 1 can be used to create a flexible package of care delivered by local people from within the community.

Moira said that, although James can write well, he finds it difficult to express himself verbally, and he requires support to access activities in the community. Once James left school in 2010, his care needs were re-assessed and Moira receives Option 1 to support his independence within the community and access activities. James attends college for two days per week during term time.

The local authority pays the budget directly into a bank account set up by Moira for the direct payment and Moira then makes the relevant payments to those providing support. The Council calculates a direct payment based upon an hourly rate of support of £14.35 with £7.20 per week for administration costs. This approach is consistent with the Comhairle’s plans under consideration to introduce an equivalency model of resource allocation for all options.

James spends one day per week at a local voluntary sector café and shop with staff and volunteers. Moira described this as an important social opportunity for James: “[It’s] really great that he can socialise independently of his parents.”

James and Moira use Option 1 in various ways. This includes support workers who take James to activities of his choice including the gym, swimming pool and music shows, as well as providing overnight care if his parents need to stay off the island. The support workers are students and young people who Moira and James identify via their local networks in the community, rather than from a social care provider. This approach is sometimes a necessity for families in the Western Isles, given the number of providers in the area and their limited capacity.

Moira explained that this approach allows the family to choose the individuals who they want to support James. She said that, “James can be very particular about who he likes,” so it is important that they “can select people who work well with James.” Moira likes “the flexibility of picking and choosing” from people she knows in the community, and she prefers this approach to selecting from a list of suppliers provided by the Council. This process is made easier because Moira has strong connections with the other families who live in the area and this provides reassurance that the people recruited are suitable to work with James.

Harris Voluntary Service (HVS) helps the family with their responsibilities as the support workers’ employer. HVS looks after the books and informs the family how much they have to pay HMRC in income tax, which Moira finds very helpful.

Moira described the budget as adequate and the family sends the local authority a quarterly breakdown of what the direct payment has been spent on. The budget is often underspent and the money is returned to the Council. Moira is not aware of any formal regular reviews, but she knows she could ask for a meeting if the family had any concerns or if “anything was amiss”.

Overall, the family is happy with Option 1, particularly as it allows them to flexibly access community networks to choose people who James gets on well with and who can support him to access the activities he enjoys.

James’ experience shows the benefits of supported people being able to design a package of support that meets their individual needs and addresses their personal outcomes, and it highlights the importance in remote rural locations of being able to recruit workers from the supported person’s local community.

Figure 6: Summary infographic - Case Study 13, Eilean Siar