People, Policy and Legislation
“We are people first. The outcomes we want include having power and control, being able to take risks & contribute to society. This means that there needs to be a shift in power away from people who commission & provide services to users and carers…”
(Users & Carers Panel, Report of the 21st Century Social Work Review, 2006)
The Social Care (Self-Directed Support)(Scotland) Act 2013, due to be implemented on 1st April 2014, is a key building block of public service reform. It’s an approach that has its origins in the Independent Living Movement – sharing the core values of inclusion, contribution and empowerment through real choice and respect. The Act creates a statutory framework around the activities already underway across Scotland to change the way services are organised and delivered – so that they are shaped more around the individual, better meeting the outcomes they identify as important. So individuals are seen as ‘people first’ – not service users.
This simple but powerful statement from the Users & Carers Panel should sit in the hearts and minds of staff from across the sectors as the justification for change. Legislation, policy and guidance will assist with understanding what is expected. However, it is an understanding of individuals and their ambitions that will lead to an appreciation of what is needed.
Achieving better outcomes for individuals is complex. It requires a whole system change within and across organisations that supports the best intentions and abilities of individual workers and the people receiving support.
Practitioners across social care will have a pivotal role in delivering this reform in partnership with health colleagues. In Scotland, for example, during 2011/12, 684,000 hours of home care were provided in a week and 211,000 weeks of respite were supported in the year. The challenges will be many and come at a time of reduced resources and growing demands. There is a general acceptance that ‘more of the same (type of service delivery) won’t work’ – but this reform goes deeper than economic issues. It’s about making people’s lives better.
The Christie Commission Report emphasised the importance of:
“Working closely with individuals and communities to understand their needs, maximise talents and resources, support self-reliance, and build resilience.”
To drive forward this work, the Scottish Government has developed a 10-year Self Directed Support strategy with partners, stating the intention as:
“..delivering better outcomes through focused assessment and review, improved information and advice, and a clear and transparent approach to support planning. The strategy is part of a wider reform agenda, and reflects the common goals of current health and social care policy to deliver better outcomes for individuals and communities. These include recent developments in Reshaping Care for Older People, Caring Together, and the National Dementia Strategy. Implementation will also bring a focus to the development of self-directed support for children and young people alongside GIRFEC.”
The wider policy context, including the Public Bodies (Joint Working) (Scotland) Bill, evidences a move towards the integration of health and social care and provides a context for working in partnership to meet outcomes. Self Directed Support places people who use services right at the heart of this partnership.
Many staff experienced in this approach say that it reaffirms their core purpose – namely improving outcomes for people through utilising their strengths and assets. “It’s why they came into the job.”
Purpose and Scope of Guidance
- to provide a guide for all practitioners who have responsibilities under the new legislation on how to effectively deliver on the new duties and responsibilities with people who need, or may need support.
- this is one of several pieces of guidance provided or commissioned by the Scottish Government – namely – statutory guidance and regulations; guidance for people who require support; guidance for carers.
- to offer practical examples of how the new Act will translate into practice, including explanation of where new duties apply; a broad ‘how to guide’ in relation to complex assessment and support planning.
- the new duties of the Act sit with local authorities. This guidance, therefore, is primarily aimed at local authority practitioners. However duties also apply to those to whom the authority has delegated responsibility for providing information, assessment and support planning activities for example in multi-professional teams where practitioners, especially in the NHS, who undertake assessment and support planning activity.
- when a person has health and social care needs, there is a clear expectation that partner agencies will work collaboratively to meet these needs. The guidance will support this practice.
- to assist with identifying some of the key considerations for local authorities in their implementation of self-directed support.
- this guide cannot offer detailed explanation as to the mechanics of delivering the four options under Self Directed Support – as local implementation arrangements will differ and are at varying stages of development. Practitioners, therefore, have a responsibility to be knowledgeable of any local policies and systems in place designed to help support the process.
- the guide highlights relevant, existing legislation that will continue to direct practice alongside the new duties. New challenges around risk versus self-determination are considered.
- a guide for providers will be produced in late 2014/early 2015.
- where the term ‘person’ is used, it applies to all adult groups, carers, children, and young people unless otherwise specified.
- where ‘practitioner’ is referred to, this applies to all professionals undertaking activity described in guide.
Principles & Values
Self-directed support is a policy driven by the recognition that when people have more control over how they live their lives and any support they may require, they are likely to achieve better outcomes.
Sections 1 and 2 of the Act specify four general principles that guide practice.
This requires that the supported person must have as much involvement as they wish in both the assessment and in the provision of any support agreed on completion of the assessment.
Practitioners must collaborate with the supported person through assessment and in the provision of any support identified and agreed on completion of the assessment.
The supported person must be provided with any assistance that is reasonable to assist them to express their own view about the options available to them and to make an informed choice about their preferred choice.
Participation & Dignity
This applies to both the initial assessment stages and to the provision of choice as part of wider planning.
The Act is underpinned by the following values that reinforce good social work practice:
Having due regard for the feelings, wishes, or rights of others.
A reference to the individual, not the group or society at large; providing unbiased information about the choices available/ treating people in a manner which befits and benefits their individual circumstances.
People are supported to maximise their aspirations and potential.
Support focuses on the prevention of increasing dependence and enablement, or re-ablement.
Have a choice.
Individual is supported to feel safe and secure in all aspects of life, including health and wellbeing; to enjoy safety but not be over-protected; and to be free from exploitation and abuse.
The Act introduces four options that require the identification of allocated financial resources. This aspect of the legislation has attracted considerable attention as our organisational systems often do not readily support a shift in resource allocation in the manner and scale required to make this aspiration a reality. This attention has led some to believe that Self Directed Support ‘is all about money’.
Self-directed support is, in fact, about people, their strengths and assets, their right to live fulfilling lives, their right to be included as active citizens, their right to be full participants in assessing their own needs and also their right to exercise choice and control over any support provided.
Email: Heather Palmer