Social Care (Self-directed Support) (Scotland) Act 2013: Draft Regulations and Statutory Guidance – Analysis of Consultation Responses

8 GUIDANCE - FACILITATING GENUINE CHOICE FOR INDIVIDUALS

8.1 Section 7: Facilitating genuine choice for individuals looks at the requirement in the 2013 Act for a local authority to take active steps to promote variety in the support options available to those who are eligible for care and support.

8.2 The guidance offers an approach to commissioning for self-directed support. This approach sets out four steps:

• Learn and understand what people need and want.
• Set out what you will do to meet what people need and want.
• Try out different approaches.
• Review - ask if it worked and make changes.

Question 6a: Was this section of the guidance clear and easy to understand?

8.3 Seventy-one respondents said that this section of the guidance was clear and easy to understand. Five said it was not and 68 did not reply.

Question 6b: How useful did you find this section of the guidance?

8.4 As can be seen in the table below, most of those who answered said it was quite useful (48). Twelve respondents felt it was very useful, 15 said it was not very useful and two said not at all useful. Sixty-seven did not reply.

Table 8.2 Usefulness of Section 7 of the guidance

Respondent group	Very useful	Quite useful	Not very useful	Not at all useful	No response
Individuals (21)	3	2	-	1	15
Local authority (24)	2	13	7	-	2
Community Health Partnership (4)	-	2	1	-	1
Health Board (2)	1	-	-	-	1
Voluntary sector organisation (57)	4	16	6	1	30
Private Sector organisation (2)	1	-	-	-	1
Professional or regulatory body (8)	-	4	-	-	4
Support & information/Advocacy (16)	1	6	1	-	8
Other (10)	-	5	-	-	5
Total (144)	12	48	15	2	67

Question 6c: Do you have any further comments on this section of the guidance?

8.5 Seventy-five respondents commented and, while several respondents welcomed the guidance in this section, the main theme to emerge from responses was a feeling that this section is under-developed or simplistic. One private sector organisation reported that their members were disappointed by this section. The need for more detail and more examples was stressed by many respondents. A particular omission identified by respondents was the need to show how the outlined approach would be achieved.

8.6 Respondents saw a need for more in-depth information for local authorities, professionals and providers. The following is a typical example:

"We welcome the explanation of Section 19 of the 2013 Act in this Section 7 of the guidance however we feel that as a whole it would benefit from a more in-depth description to emphasise and demonstrate the breadth and source of the variety implied here. In particular the inclusion of Disabled People's Organisations and support providers."
(voluntary organisation)

8.7 A professional/regulatory body commented: "review should not just be about the commissioning process working, but should also measure whether the provision of services to meet identified need resulted in improved outcomes for people".

8.8 Respondents felt that reference to community capacity building would strengthen the section; there were commented that local organisations are vital elements in providing support in a range or areas, including support to participate in the local community. One support & information/advocacy organisation suggested "Part 82 should be enhanced to include the local authority's role in capacity building in their local area".

8.9 Another organisation said: "there is too great a focus on formal services. We feel that there should be greater emphasis on the importance of seeing an individual within context of the family and wider community." A local authority commented that this section focuses solely on local authority provision and suggested it be expanded to encompass wider options such as third sector, health and community support. Other comments on this issue included a CHP respondent who said: "Should there be more reference to the capacity of providers for both statutory and independent providers. Links could be made to both in-house local authority support, independent support and possibly refer to SPAEN and SDS Scotland as other sources." This comment was also noted in a number of responses from local authorities and other groups.

8.10 Inclusion in the community is particularly important. One voluntary organisation gave the following example: "In order for people with PMLD to successfully access their community, lack of access to basic requirements such as fully accessible changing places facilities must be addressed". A local authority commented:

"There is a need to develop stronger links with those who live and work in our communities, with groups and organisations, which are already actively promoting the development of community capacity and with service users and carers at locality level. This requires a shift in emphasis for planning and commissioning teams, operational social work teams and other Council, health and statutory services towards a community focus."

8.11 In particular, there is a need for local authorities and their partners to find out what services are required and to take steps to ensure these are available: "Consultation by commissioners on the types of services which people need and want should be inclusive and meaningful. It should seek to gather a broad and representative base of opinions in an accessible way" (voluntary organisation).

8.12 Another voluntary organisation "recommends that the Scottish Government strengthen provision within the guidance around facilitating choice by including the recommendation that authorities undertake a review of their service to ensure there are clear plans, and capacity to appropriately commission, for self-directed support".

8.13 Another, from the support & information/advocacy group, said it is important that "full and meaningful consultations are conducted by local authorities to help discover views on current services and what people need and want from services available. User views on current services can be sought from local collective advocacy groups. When conducting consultation with other service users consideration should be given for advocacy support to be made available for service users during this process".

8.14 The Scottish Government Strategy for Autism was highlighted as a good practice example. It requires that people with autism have access to services which understand their needs and which are able to deliver in ways specifically related to their autism.

8.15 Commenting on the table 'Commissioning for self-directed support', several respondents, mainly local authorities, made the same point "we would suggest the description here should be asset based rather than focussing on gaps or deficits".

8.16 Also, in relation to this table, a professional/regulatory body said: "review should not just be about the commissioning process working, but should also measure whether the provision of services to meet identified need resulted in improved outcomes for people".

8.17 There were comments in relation to financial matters and resource needs. Respondents wanted to see more information on:

• Bridging finance.
• Special project finance.
• The development of Public Social Partnerships.
• Support for cooperative and user controlled developments that are starting from scratch.
• How to ensure services in local areas are sustainable.

8.18 More detail was requested in relation to local authority commissioning. There were requests for guidance on commissioning bespoke packages as well as on strategic commissioning of social work services. A voluntary sector organisation said: "It would be helpful if specific guidance on commissioning for self-directed support, in particular how to deliver the step change between block funded services and direct payment funded services could be included in this section. There is also the need for a transparent pricing approach from all providers".

8.19 One voluntary organisation commented on the question of how to ensure rates attached to SDS are sufficient to buy the support that is available:

"Our experience with parents of disabled children with complex needs is that rates are currently set too low to buy support from a provider employing practitioners with the necessary level of skill. Further to this, depending on where children and their families live, they may not be offered the same choice of provision from their own council as you would in others. A strategic planning process for councils and local area co-ordinators managing resources may assist this. It would also be useful if the Government monitored the resource allocation in Local Authorities after implementation to ensure consistency and equity."

8.20 Problems in rural areas were highlighted; services in these areas may not be sustainable without core funding. Inconsistency in services for specific groups such as deaf people were also raised. A local authority commented: "As we understand it, the assertion made in paragraph 81 is incorrect: Section 19, sub-section 2 does not require local authorities to provide greater options for choice, but to promote the choice available. If there is little or no current choice (for example, in some remote and rural areas there are limited private care provision options) then authorities can only promote the choices available".

8.21 The need for consistency across local authorities was stressed; respondents worried that there could be a post-code lottery situation where people are assessed differently depending on where they live. The need to ensure assessment is accessible to all was also mentioned; a voluntary organisation commented that this is the only way to ensure genuine informed choice. Another commented that independent advocacy should be available to ensure the person seeking support has all the options and is supported to choose the one they think is best.

8.22 Voluntary organisations spoke of the need for innovation in the approach of those providing support to ensure the support is tailored to the needs of each individual; this would have to involve services users, carers and the wider community.

8.23 Respondents also commented on the need for professionals to have full knowledge of the options available . However, there was also some concern over the resources required to provide genuine choice.

8.24 Implications for health staff were also mentioned, one health respondent, while welcoming the opportunity for health staff to undertake SDS assessment, commented that there would be an impact on training and support for the health staff undertaking assessments.

8.25 A small number of respondents again commented on the lack of detail in relation to children and families in this section and suggested that much more detail should be included.