3. The Context for SIRD
This chapter looks at the local context for the delivery of information and support and its impact on the SIRD projects.
Pressures from rising demand and limited budgets were recognised across the range of research participants. Nevertheless, projects and service users had concerns about the impact of local eligibility criteria on whether people are being assessed as eligible for a budget.
A number of the projects had made initial assumptions, at the funding application stage, about progress in embedding choice and control in the local authorities in which they were planning to work. The reality has often been different, particularly around the number of referrals from social work teams. Some projects have adapted their focus and practice accordingly.
Local context for the delivery of information and support
In August 2017, Audit Scotland published its “Self-directed Support: 2017 progress report” (Audit Scotland 2017). The report noted that self-directed support is one of a number of national policies designed to empower people and communities to become more involved in designing and delivering services that affect them. The report also highlighted the range of other legislation, including the Community Empowerment (Scotland) Act 2014 and the Public Bodies (Joint Working) (Scotland) Act 2014, that was introduced in response to the report by the Christie Commission in 2011 (Commission on the Future Delivery of Public Services 2011). The key messages from the Audit Scotland progress report included:
- Self-directed support implementation stalled during the integration of health and social care services.
- Local authorities are experiencing pressures due to increasing demand and limited budgets for social care services. Within this context, approaches to commissioning can have the effect of restricting how much choice and control people may have.
- Most people rate their social care services highly and there are many examples of people being supported in new and effective ways through self-directed support.
- Despite many examples of positive progress, there is no evidence that the transformation required to fully implement the Self-directed Support Strategy 2010-2020 has yet been made. Not everyone is getting the choice and control envisaged in the Strategy.
- Those using social care services need better information and help to understand self-directed support and make choices.
Audit Scotland’s key findings very much reflect those of this study and many of the issues set out above have had a direct impact on a number of the SIRD projects.
Progress on embedding choice and control in social care
Funding applications for the second round of SIRD funding were developed and submitted in the second half of 2014; this was in the fourth year of the national Self-directed Support Strategy. At the point of developing their funding proposals, a number of the projects made assumptions about progress in embedding self-directed support as the norm for social care in the local authorities in which they were planning to work. Frequently reported challenges have been that:
- Some projects had made an assumption that self-directed support would be fully implemented for managing social care budgets across the full range of client groups during, and indeed early on, in the second-round funding period. For many, their experience has been very different. A number of projects reported that the implementation of self-directed support in their area(s) has been slower than they hoped for or expected. This has tended to apply across all client groups.
- A number of the projects working with certain client groups reported seeing little if any evidence of those with a social care budget being given choice about or control over how that budget is used. These included: those with mental health issues; people on the autistic spectrum; clients of community justice services; and clients of homelessness services.
- Projects have generally found that knowledge and practice related to choice and control and the self-direct support options can vary significantly within individual local authority areas. This has included between different social work teams and individual members of staff.
- Some service users and SIRD projects reported that not all of the four options are available in their local authority areas. For example, there were suggestions that some local authorities may be seeking to avoid clients moving away from using their social care services (Option 3). Conversely, it was suggested that in some areas clients have effectively been told they will have to take Option 1.
Local authorities tended to report that implementation was on track within their area, albeit sometimes noting that it is yet to extend across all clients and client groups. They tend to suggest that the principles of choice and control were recognised as being at the heart of best practice going forward. Although sometimes acknowledging that ongoing work is required, a number of local authority interviewees highlighted that staff training is being or has been delivered.
Impact of Health and Social Care Integration
Many study participants highlighted the impact of health and social care integration on self-directed support implementation. Particular issues which SIRD projects identified as being connected to integration included:
- Some key personnel, including those in posts focusing on the transition to self-directed support have moved on to integration-related posts. Also, and very much reflecting the budgetary pressures discussed below, some experienced staff have taken early retirement or a redundancy package.
- Overall, some felt that local authorities’ focus has shifted away from delivering the choice and control expected and onto the very considerable body of work and system change required for integration.
Overall, some felt that integration has caused self-directed support implementation progress to stall. Some felt that it may even have had the effect of rolling back the progress which had been made.
Budgetary pressures on local authorities
The Audit Scotland report notes that public sector budgets are under significant pressure owing to ongoing financial constraints, increasing expectations and rising demand for health and social care services, and social care workforce shortages. Local authority interviewees often noted the very considerable budgetary pressures on their services and that there must be a clear focus on addressing the most significant needs.
A number of SIRD projects noted that they are seeing the impact of ongoing pressures on social care budgets. This included several reporting changes to eligibility criteria in their area which meant that only those with very significant or severe social care support needs are now in receipt of a budget.
These funding pressures were also reported as sometimes resulting in service users being awarded a smaller budget than they had expected based on conversations at an assessment meeting. There was some suggestion that this has arisen when senior staff had reviewed the assessments of frontline staff with a view to making savings. There were reports of existing social care budgets (including those which had previously been taken by the client as a direct payment) being reduced at review. This was generally understood as being because new eligibility criteria had been put in place since their original assessment.
The impact of budgetary pressures was recognised across the range of research participants. Many of the projects and some clients appreciated that these are very challenging times for local authorities, but nevertheless often felt very frustrated about how this is impacting on those applying for, or already in receipt of, a social care budget. Their concerns were around both whether people are being assessed as requiring support at all and also in relation to the choice and control being offered to those who are entitled to a budget.
There were some suggestions that choice is either not being offered or is being restricted in response to financial pressures within local authorities. For example, as noted above it was suggested that some clients who are effectively on Option 3 report not having been told that other options were available to them. Some projects felt that choice is not being offered or promoted because those choices could undermine the viability of local authority-delivered services.
Local authority participants offered an alternative perspective; that some of the SIRD projects may be amongst a wider group of third sector organisations which are offering self-directed support-related information and advice that are unrealistic in the current financial climate and which risk raising expectations amongst members of the public that local authorities are not in a position to meet.
Impact of the local context on SIRD projects
As noted, many of the SIRD projects have reported that they have found themselves working in a very different delivery environment to that which they had expected. In particular, a number of the projects had anticipated receiving large numbers of referrals from social work teams. In reality, this tends not to be happening to the extent expected. Where referrals are being made, they are often not at the early stages of application or assessment, as projects may have planned for, but are instead associated with the practical aspects of taking Option 1.
Projects that are experiencing fewer or no referrals tend to put this down to a lack of local progress in delivering social care services built on the underlying principles of choice and control. Combined with rising eligibility criteria for a budget, a number of projects have found there are simply fewer people applying for and being awarded social care budgets than they had expected.
Other issues which projects identified as contributing to fewer than anticipated referrals or signposting on included:
- Frontline social work staff having insufficient understanding of self-directed support requirements and options. It was suggested that not all social workers are having the required good conversations with their clients. By extension the social worker is then unlikely to refer on for independent information or support.
- Staff in a small number of the SIRD projects felt that one or two of the frontline social workers known to them did not want clients to be fully aware of their rights or supported in challenging an assessment or other decisions.
- Lack of awareness of the type of support the SIRD project can offer and to whom. This was often connected with changes in key personnel within the local authority. In particular, some projects reported that key staff who had been aware of the work they were doing, and who had sometimes been champions of the role of independent information and advice services, had moved on. Without these links into local authority services, particularly at a senior level, some projects reported finding it more difficult than expected to ‘spread the word’ about the work they were doing despite their often extensive efforts.
Sometimes in response to this range of challenges, a number of the SIRD projects have been reviewing and revising the focus of some of their work. This has tended to be an iterative process and has included:
- Looking to build stronger working relationships with key local services, including local authority services and other third sector providers. This has sometimes included helping to set up and run multi-agency working groups to support the further implementation of self-directed support in their area(s).
- Increasing the amount of awareness raising work being done with professionals, including with frontline social work staff. Some projects have also been holding information giving or training sessions for social work staff and others.
- Extending the package of awareness raising and capacity building work with local communities or communities of interest. The focus has tended to be on making connections with people who are unlikely to be assessed as eligible for a budget but who might welcome information or support in relation to other services or opportunities available.