This summary presents key findings from an external review of independent information and support services funded by the Scottish Government. The overall objective of this study was to provide an evaluation of services supported by the Scottish Government through the Support in the Right Direction ( SIRD) Fund. It fulfils a specific commitment in the “The Implementation Plan 2016-18, for the Self-directed Support Strategy 2010-2020” ( COSLA and Scottish Government 2016) to evaluate how independent information and support help and enable people to achieve personal outcomes, to be in control of their social care and to make their own decisions about social care. The findings from this review will help to inform decisions about future funding of such projects.
The research was carried out between June and November 2017 and included interviews with SIRD projects, local authorities and key stakeholders. A total of 148 supported people or carers who had used one of the SIRD projects also contributed by responding to a survey or taking part in interviews.
The study looks at the work of the SIRD projects through the experiences of those using the projects, and from the perspective of those working in the projects and other key stakeholders, including local authorities. It offers a diversity of voices shaped by individuals’ personal or professional experiences of social care and of independent support. Detailed views of local authorities on the benefits and quality of advice given by SIRD projects were outwith the scope of this review.
It is important to acknowledge that some service users had contacted a SIRD project because of concerns about the way local social services were handling their case; this is reflected in the strength of some people’s views of the process. These views should not be taken as representative of all those who have applied for, and/or are in receipt of, a social care budget. As the focus of the study is on those who have used a SIRD project, its design did not include people who may have been through assessment or review for a budget, and may have a budget, but have not contacted any of the projects. The views of this latter group may or may not reflect those who did access independent information or support through a SIRD project.
Overview of the SIRD projects
The SIRD funding programme began in 2012. A second round of three-year funding began in April 2015 and runs to the end of March 2018. In total 36 organisations have been funded through the second round, receiving £2.96 million between them in the 2017/18 financial year. Performance monitoring of the SIRD projects is overseen by an external partner, Inspiring Scotland. They publish annual reports and provide 6-monthly overview reports of service activity.
Between them, SIRD projects are delivering direct information and support in all but one of Scotland’s local authority areas. They are working across a broad range of client groups, with the most frequent being carers, people with learning disabilities and people with physical disabilities. There are seven projects which work across all client groups.
Compared to all social care clients who made a choice about services, as set out in the 2015-16 self-directed support statistics (Scottish Government, 2017), SIRD project service users tended to be younger. SIRD projects were working with a relatively high number of those aged 17 or under and in the 18 to 64 age group and a relatively small number of those aged 65 or over.
The context for SIRD
In August 2017, Audit Scotland published its “Self-directed support: 2017 progress report” (Audit Scotland 2017). Its messages include that local authorities are experiencing pressures due to increasing demand and limited budgets for social care services. Similarly, in this review budgetary pressures were recognised across the range of participants. Projects and service users expressed concerns about the impact of local eligibility criteria on whether people are being assessed as eligible for a funded package of support.
A number of the projects had made initial assumptions, at the funding application stage, about progress in embedding self-directed support as the norm for social care in the local authorities in which they were planning to work. The reality has often been different, particularly around the number of referrals received from social work teams. Some projects have had to adapt their focus and practice accordingly.
Overall, there was a broadly positive picture in terms of the working relationships between the SIRD projects and the local authorities in which they were operating. The strength and quality of those relationships had often built very clearly on the relationship in place prior to the award of SIRD funding.
Where working relationships have been less positive, a range of factors appear to have been at play. These have included different views on who should have choice and control over their social care budget and the types of choices that should be available.
For a number of the projects, work to build good relationships between themselves and local authority staff has been ongoing throughout the SIRD funding period. Much of this work has had a practical ‘hook’ focused on offering social work staff training on self-directed support.
Strategic engagement and impact
A number of projects working in a single local authority or in a number of local authorities were involved in working groups focused specifically on the implementation of self-directed support. Strategic involvement was not always through specific groups but sometimes through regular but less formal discussions with key service planners or commissioners.
Projects had different views on the success of their attempts to influence local policy and practice. Some felt that they had had little impact, others (including some of those feeling their impact had been limited) pointed to changes in practice locally as a result of their work. A small number of projects were able to point to influence they had exercised at a national level. This included work to develop accessible information.
In addition to their own influencing work, a number of projects had been supporting their service users to have their voice heard and influence how self-directed support is being implemented in their own local authority area or more widely.
Direct client support
Service user feedback suggests that people tended to have made contact with a SIRD project relatively quickly and easily. Those who said they had struggled to find independent information or support tended to be living in rural areas or be in the older age group. Unless already in contact with the project, people had most frequently been given information about it by: a social worker; another support or care worker; or family or friends.
According to the service user survey, people were most likely to be looking for advice on which self-directed support option they wanted to use or for practical support and assistance in relation to Options 1 or 4. A number of projects have been carrying out awareness-raising and community capacity-building work. This has included outreach work designed to increase general awareness of and understanding of self-directed support amongst the wider public. There has also been awareness-raising work targeting specific groups, such as carers. Overall, projects feel their community-focused awareness-raising work has been useful.
SIRD projects have also been involved in the delivery of training or personal development sessions or courses for supported people or carers covering self-directed support in greater depth. Other projects have been involved in the delivery of personal development courses, over a series of weeks or months. Their focus is on supporting people to gain the knowledge, skills and confidence to take control of their own lives and make their own choices.
Many of the SIRD projects place considerable value and importance on the work they have been doing to support people through the assessment for, or review of, a social care budget. For projects delivering what might be described as ‘end-to-end’ support, throughout the whole self-directed support process, there was a clear preference for engagement with clients at an early stage.
Projects were seeking to achieve a number of outcomes when working with people to prepare for a social work assessment or review. In particular, they tended to refer to trying to reduce clients’ anxieties and make sure that assessments or reviews are well-handled from their clients’ perspective.
A smaller range of projects were involved in supporting people at assessments or other meetings with social work. The approach taken tended to be led by the client. At one end of the spectrum, clients sometimes simply wanted a SIRD project representative there to act as a reassuring presence. At the other end of the spectrum, and although relatively unusual, a small number of clients reported that they were looking for project staff to play an active role.
Brokerage should be understood as providing service users with the support and assistance they need to put in place and manage the arrangements which will enable them to live according to their choices. There was a very broad consensus around the value of this type of work; this consensus spanned the projects, service users, local authorities and key stakeholder interviewees.
A majority of the projects were providing some form of brokerage support. All of those were working with people with a social care budget in relation to that budget. Most were also offering a community brokerage service for both those with and without a budget.
For some projects, brokerage was the predominant focus of their work and was concentrated on working with Option 1 or 4 clients referred to them by social work once an assessment had been carried out. For others, brokerage was the latter phase of a broader package of ‘end-to-end’ support for people with a budget which had begun at the information provision or assessment stages.
Option 1-focused support ranged from providing further information and advice around how it works on a day-to-day basis through to support with recruiting and managing a Personal Assistant. There were also examples of projects equipping people with skills or tools which would help them manage their own, sometimes quite complex, support packages.
Although much of the SIRD projects’ work has been with people who are applying for or who have a social care budget, many have also been working with other members of the community with a social care need but who are not eligible for a budget who might benefit from information, advice or support. For most of those interviewees who did not have a budget, making links into other services and groups, and community-based groups in particular, was often a key reason for being in touch with the project.
For a small number of the projects, the peer support approach has been central to their SIRD work. This has been a particular focus for user-controlled organisations, reflecting their overall philosophy and approach. The type of work that has been carried out includes assisting with setting up and running a peer support group or network.
Reflections on direct client support work
A small number of projects reported meeting their original targets for working with people looking for direct client support. However, a number of projects have fallen significantly short of their target in terms of the numbers of people to whom they had provided direct client support.
A small number of the projects have concluded that the focus of their work - and in particular their client group focus - may simply have been premature given national progress on self-directed support implementation. Very much reflecting the national experience, this was most likely to be the case for projects working with people experiencing homelessness or with community justice service clients.
When faced with lower than anticipated numbers looking for social care budget-related support, many projects have looked for ways of using the SIRD funding available constructively and as part of a wider package of work around supporting the rollout of a choice and control-based approach.
Almost without exception, service users were very positive about the quality of support that they received from projects. When asked how they felt about the information and support they had received, more than 8 out of 10 survey respondents said it had made an enormous or big difference. Service users highlighted the impact that the support from projects has had on their health and wellbeing. A central theme of many of the stories shared with the study team was that the support a SIRD project gave has had a profound and life-enhancing impact.
The service user feedback also explored the extent to which people felt that support from a SIRD project had helped them to access or make the most of self-directed support. Helping unlock the potential of making choices and having control had an enormous impact for some people. Service users who had accessed a social care budget whilst working with a SIRD project felt that this positive outcome might not or would not have been achieved without the support they had received.
The findings of this review suggest that for those engaged in the self-directed support process, support at any stage can make a difference; for some people, having someone to walk alongside them for the entirety of their journey, end-to-end, has been critical.
For many, there were certain aspects of the self-directed support-related process where third sector providers could offer very real additional value. This was primarily in relation to supporting people who had chosen Option 1 or 4 and helping people access community-based opportunities and support. However, there was a range of opinion around who was best placed to provide information and advice in relation to choices about, and control of, a social care budget.
Single local authority-focused projects were often those involved in the delivery of the type of whole journey support that was much valued by clients. Where this approach looks to have been working well, projects were usually a well-established member of a network of statutory and third sector agencies with a history of working together. Projects working across a small number of local authorities across Scotland tended to face practical challenges associated with varied practice and eligibility criteria and the need to build and maintain working relationships across local authorities.
Client-group focused services sought to ensure that their specialist knowledge and skills meant clients received the right type of information and were supported in a way which met their particular needs. Projects taking this approach have experienced similar challenges to more generalist services working regionally. Overall, however, they have tended to report that the approach has worked well; the feedback from their clients certainly suggests this to be the case.
The current SIRD funding stream has a focus on building self-directed support-related capacity in the independent information and support sector. The relationship between project independence and the source of their funding was highlighted by a number of projects and some had concerns about receiving funding from an organisation which they might need to challenge. However, other projects had no such concerns.
Development of self-directed support-related information
Based on their reviewing of available information, a number of projects have sought to produce a range of materials informing people about self-directed support. For some projects this work has been their main, or a significant focus of their, work.
Information has been produced in a range of formats. Much use has been made of case studies, including in video format. There has also been some innovative work developing games and e-learning packages as tools for understanding and supporting client progression through the process.
Running of the funding programme
The support commissioned by the Scottish Government from Inspiring Scotland has been very much appreciated, in terms of its quality, the commitment of Inspiring Scotland staff, and the practical networking and advice provided.
The findings of this study very much echo those of the Audit Scotland “Self-directed support: 2017 progress report”. The changing environment 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 had expected when making their funding applications.
For the full potential of self-directed support to be achieved, members of the public need access to a straightforward but comprehensive package of information and support. The review found strong evidence that without the independent information and support received from SIRD projects, some clients would either have given up on applying for a social care budget or would have chosen a different option.
Although people’s needs will be different, information and support may be required at any or all stages of the self-directed support process. 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. This does not necessarily need to be provided by a single organisation but, given service users’ feedback on the value of continuity and strong working relationships built on understanding and empathy, this is likely to be the preference for many.
Often, 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 includes being aware of, and able to connect people into a range of informal social and support opportunities. However, there also appears to be a case for people with very particular support needs, such as families with children with multiple and complex needs, being able to access a highly specialised package of information and support from national or regional providers.
Irrespective of the type of organisation providing information and support, a positive working relationship, including a referral relationship, between them and the local authority is important. To work in the best interests of clients, this working relationship needs to be strong and mature enough to allow for challenge.
As well as building capacity within the information and support sector, there is also powerful evidence around the potential of various approaches used by SIRD projects to support individuals to develop skills, confidence and capacity. There was a broad consensus that some of the work done around peer support and involvement has been very valuable and that many other people might benefit from having access to this type of support.
Moving forward, the SIRD funding programme has delivered some 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.
Local authorities have a legal 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 legislative duty, there was a common view that local authorities need to play a central role in assessing the package of services, including independent information and support, which is required in their area. This was sometimes connected to a view that the Scottish Government should involve local authorities in discussions about any future SIRD funding plans, including the type and range of services required in their area.
Finally, the review findings point towards independent information and support as 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 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.