Self-directed support is Scotland's approach to social care support. It applies across all ages and user groups, including unpaid carers. Exceptions are few and are in relation to crisis or re-ablement support (as these can precede assessment), or the assessed support is prescriptive (such as compulsory treatment or criminal justice orders).
The Social Care (Self-directed Support) (Scotland) Act 2013 was established to ensure that social care is controlled by the person to the extent that they wish; is personalised to their own outcomes (including where they receive social care support commissioned or delivered by the public sector); and respects the person's right to participate in society. The legislation and this implementation plan form part of a 10 year strategy.
This document sets out a guide for the local planning and delivery of social care support services (see the change map on page 9). It sets out the actions that national public and voluntary sector organisations will take to support authorities to build on their progress towards more flexible and responsive social care support, co-produced with communities and supported people.
It offers both support and challenge to local systems as they remodel the way they understand, plan and deliver social care support (including carer support) within an integrated health and social care landscape.
This plan will be of interest to anyone involved in, delivering or using social care support in Scotland. It is designed to enable professionals within health and social care to change the ways in which they work, enabling greater flexibility, choice and control for people using support.
It builds on the learning from implementation 2011-2018 and the findings of the 2017 Audit Scotland progress report. It is informed by the voices of supported people and professionals, including the local authority leads for self-directed support, who responded to a range of engagement opportunities to share their challenges in making self-directed social care and support a reality.
We expect that national partners will work in a collaborative manner with local systems and each other, sharing learning and building on progress in an iterative way. They will also work closely with people who use support, frontline workers and social care support providers. Scottish Government and COSLA will convene advisory groups (which will include people who use social care support) for each of the workstreams of the adult social care reform programme and use these to support this collaborative process.
We expect that local partners will embrace these changes at local level, drawing on the national support available to them and building on their existing implementation of self-directed support and other agendas. Local adoption of the change map framework by authorities will be a key factor in the success of this plan.
How is social care support changing?
The integration of health and social care is beginning to deliver real benefits for the people of Scotland. Audit Scotland recently recognised that despite the extremely challenging environment that Integration Authorities are working in, progress is being made. The Ministerial Strategic Group for Health and Community Care's Health and Social Care integration: progress review sets out the next steps required to increase the pace and effectiveness of integration.
Self-directed support forms a key part of this integrated landscape. Free personal care now extends to people under 65; unpaid carers have rights to support under the Carers (Scotland) Act 2016; there is greater demand for support as people live longer lives with more complex needs; and there are significant workforce and labour market challenges.
East Ayrshire have created a peer mentor model and Thinking Differently Programme Board to lead and oversee transformational change in social care. This approach has encouraged staff to be innovative in the implementation of self-directed support. SDS Finance Officers play a lead role, supporting the completion of finance documentation, calculating detailed costs of support plans and maintaining personal budget records. Carer Peer Mentors with lived experience of caring for a family member are also key members of the Thinking Differently Team.
The peer mentor model provides coaching and support to frontline practitioners. This dynamic leadership approach allows the workers to 'think differently', gives individuals more choice and control and ultimately improves outcomes for supported people and their carers.
Supporting reform of adult social care
Demand for social care support is growing faster than our traditional services were designed for. Despite much good practice and high levels of service satisfaction, there remain areas for improvement in people's experience of care and support.
The Scottish Government and COSLA are developing a national programme to enhance local reform of adult social care support. This plan forms part of that programme.
The programme is being designed using the expertise and experiences of: people who use social care support, their families and unpaid carers; those who work in social work and social care; and those responsible for regulating and leading integrated health and social care systems.
During 2018, the Scottish Government and COSLA worked with a wide range of people to gather views and evidence on the key challenges in adult social care and what needs to change. From that evidence, the People-led Policy Panel and Leadership Alliance have developed a shared vision, blueprint and workstream themes. Further information can be at https://www2.gov.scot/Topics/Health/Support-Social-Care/Support/Adult-Social-Care.
The full implementation of self-directed support is integral to the programme of adult social care reform, and will be considered across all of its workstreams.
This national programme will seek to support authorities, the wider sector and communities in planning and taking forward the changes that they identify. It will advise Scottish Ministers if national changes or interventions are required and raise awareness of the role and value (both social and economic) of social care support. The co-production approach employed so far will continue to shape the design, delivery and monitoring of the programme.
Local reforms must lead to a consistent outcome: the realisation of our vision for health and social care support across Scotland, regardless of location. The way in which each local system achieves that outcome will vary according to local strengths, infrastructure, demographics and preferences.
There are particular issues around choice and control of support within remote and rural settings and for specific user groups that it will be important to understand and reflect as the programme of reform develops.