10. Concluding Reflections
In this final chapter we reflect on the key messages and learning to emerge from this independent review.
Our initial observation would be that the findings very much support those of the recent Audit Scotland (2017) progress report. The context in which SIRD projects have been looking to build capacity within their own organisations and the wider community has usually been different to that which they expected when making their funding applications. The embedding of self-directed support in social care has not been as far advanced as some projects expected, albeit the picture varies across the country. The budgetary pressures on local authorities have had an impact, particularly with regard to eligibility criteria for social care budgets, and there may be some challenges, or even resistance, to working in a way that affords people greater choice and control. A number of projects and their clients have voiced concerns about some social work practice, including whether it is in line with either the spirit of the policy or the legislation on self-directed support.
While there have been some very real challenges, which have sometimes led to strained relationships between SIRD projects and local authorities, the transformative power and considerable further potential of the choice and control-based approach has been emphasised by many. From a service user perspective, flexibility in the use of a budget and particularly continuity of care emerged as key benefits from using Option 1 or 4. Client interviewees have spoken of the transformative power of having choice and control.
For effective implementation, members of the public need access to a straightforward but comprehensive package of information and support. The review has found strong evidence that without the independent information and support they received from their SIRD project, some service users would either have given up on applying for a social care budget or would have made a different decision about which self-directed support option they wished to take. This was not because of any lack of persistence or commitment but was because of the very considerable and, on occasions, longstanding challenges that people were dealing with. People are most likely to be looking for social care support at a difficult and stressful time in their lives. This means that they are likely to be at their least able to cope alone with a potentially complex application and assessment process or with making decisions about how they would like to use any budget they receive.
People’s needs vary, and information and support may be required at any stage. This encompasses: basic information about social care; help in identifying the outcomes someone would like to achieve; support in applying for a social care budget and through the assessment or review process; support to challenge decisions if need be; help in deciding which self-directed support option to take; and shaping a package of support for those who wish to take this on. Some people may want to dip in and out of these services, but others are likely to be looking for, and would greatly benefit from, end-to-end support, throughout the whole self-directed support journey. This does not necessarily all need to be provided by a single organisation but, given clients’ feedback on the value of continuity and being able to develop strong working relationships built on understanding and empathy, this is likely to be their preference. This also suggests that, while local authorities clearly have a role to play in providing information about social care, people need at least the opportunity to access this information elsewhere if that is their preference.
Often, this end-to-end support may be most effectively provided by an organisation with a strong local presence, which has a clear understanding of, and strong links into, the local community. This will include being aware of, and able to connect people into, a range of informal social and support opportunities. There is also a clear case for some people being able to access a package of information and support that is focused on their very particular needs as opposed to where they live. For example, parents of children with multiple and complex needs were clear that their preference was to work with an organisation that fully understood the reality of their lives.
Irrespective of the type of organisation providing information and support, a positive working relationship, including a referral relationship, between the local authority and organisations providing independent information and support in their area can only be a positive. To work in the best interests of clients, this working relationship needs to be strong and mature enough to allow for challenge, on both sides. Where SIRD projects have this type of very constructive relationship with their local authorities, they have often been able to use the SIRD funding to further develop capacity within their own organisation, and sometimes within the wider system, and they are optimistic about the role they can play in the future. This may include being optimistic that their Health and Social Care Partnership will wish to support and fund their services.
As well as building capacity within the information and support sector, there is also a powerful body of evidence around the potential of various approaches used by SIRD projects to support individuals to develop their skills, confidence and capacity. There was a broad consensus that some of the work done around peer support and involvement also has considerable potential, although projects were clear that this should not be seen as a low-cost way forward. They highlighted that peer support work needs to be properly resourced to maximise its potential to transform people’s lives.
Moving forward, the SIRD Funding programme has delivered useful learning about what works well or less well. In particular, it has highlighted that independent information and advice services are at their best when firmly embedded within their local context and when supported and valued by key local partners, and by social work services in particular. Where this has not happened, SIRD projects have sometimes struggled to make a real difference; this is not to say that they have not often gone to considerable efforts but sometimes those efforts, particularly around awareness-raising amongst the general public may have had little impact.
There will be various reasons why working relationships have not always been as might have been hoped. In some cases, for example, local authorities have felt that SIRD projects were simply replicating work that was already being done, sometimes in-house but also services already commissioned by the authority from other third sector organisations. Local authorities do have a duty to assist people to make an informed choice about their support and must provide details about independent information, support and appropriate advocacy organisations. Given this duty, there was a common view that they need to play a central role in deciding on the range of services required in their area. This was sometimes connected to a view that the Scottish Government should involve local authorities in discussions about any future funding plans, including the type and range of services required in their area.
Finally, the review findings all point towards independent information and support being an essential part of a well-functioning, choice and control-based social care system. This will require ongoing investment and, given their statutory responsibilities, Health and Social Care Partnerships would appear the most obvious source of that funding - in the longer-term at least – and, indeed, many are already investing in independent support. There may be a case for exceptions, for example around specialist organisations delivering a service across many local authority areas. In most cases, however, the evidence suggests that it is possible for third sector organisations to have good working relationships with their local partners, including those which may fund them, whilst also providing high quality, much needed and highly valued independent information and support services.