Scottish Care

The Scottish Government has published its Statutory Guidance and Regulations for Self-Directed Support. See http://scottishcare.org/people-as-partners/news/government-publishes-sds-guidance-and-regulations/

The People as Partners project is currently engaging in its own response to the Guidance by running a range of workshops around the country. See http://scottishcare.org/people-as-partners/blog/2013/4/workshops-on-sds-guidance/

We appreciate that not everyone can attend these events and have created an online survey which provides you with the opportunity of sharing your views with us.

We will then collate these responses together with the issues raised at our events and develop a report which we will send to the Scottish Government.

It is important that we are able to share with the Government the views of independent sector providers on an issue of fundamental importance for the future of adult social care in Scotland.

The survey can be accessed at https://www.surveymonkey.com/s/7K5GXN8

Thank you

In the first of what we hope will be a series of Guest blogs on Self-Directed Support we are delighted to have a contribution from Judith Midgley , from IRISS’ Pilotlight project:

Working in Co-design Teams

Pilotlight is a project about co-designing pathways to self-directed support for groups of people who have so far been less engaged with the self-directed support agenda.

Co-design can be defined as, “the process of designing with people that will use or deliver a product or service.” (UK Design Council). Co-design may be seen as the first step in co-production, “which means delivering public services in an equal and reciprocal relationship between professionals, people using services, their families and their neighbours. Where activities are co-produced in this way, both services and neighbourhoods become far more effective agents of change.” (NESTA)

We have been working in co-design teams in Moray and the Scottish Borders throughout the two Pilotlight pathways since January 2013. In this blog post we want to talk about the way we work and some of the benefits of working in this way.

As a key principle of service design (the design approach being used throughout Pilotlight) we are using co-design to help us to:

• Deeply understand the barriers to accessing self-directed support for people with mental health problems in Moray and for people who require support with decision making in the Scottish Borders.
• Design solutions to these barriers to increase the capacity of support providers and people using the services to deliver self-directed support.

The Pilotlight co-design teams include people who use and deliver services. In Moray, the co-design team has helped us to conduct action research within their local community and practitioner groups and identify key barriers to people with mental health problems accessing self-directed support. We are now beginning to develop solutions with the group. Some of the creative tools we have used include:

• Asking co-design team members to find and present examples of effective information design (in any media) to the group, from which the team identified the components of good information design.
• Considering a general leaflet about self-directed support to identify how it could be enhanced to address the specific information needs of people with mental health problems.
• Asking each co-design team member to develop a ‘persona’ or character profile of someone who has lived experience of mental health problems or of a mental health practitioner and then developing these characters together for use in designing solutions.
• Building scenarios to identify where and how information about self-directed support should be provided.
• Engaging in role plays to identify how the generic SDS assessment process needs to be tailored for people with mental health problems.

Key to the success of co-design in Pilotlight is working from the basis that experiences of service users are of equal value to the knowledge and experience of professionals who deliver services.

On this basis, we spent time at the beginning of the project developing values and principles to guide us all in undertaking our Pilotlight work. These have been informed by the principles set out in the Scottish Government’s self-directed support strategy, which are based on a human rights approach.

Through using creative tools and designing our workshops to be as engaging and innovative as possible, we also hope to build co-design facilitation skills within the local authorities and provider organisations who we are working with.

The ideas of Professor Edgar Kahn are an inspiration to us. We think this video explains why co-production is worth doing. Enjoy!

The Guidance and Statutory Regulations for the new Self-Directed Support (SDS) Act are due to be published sometime over the next two weeks.  A twelve week consultation period will follow this, during which organisations and individuals will have the opportunity to make any recommendations or comments on the Guidance and Regulations.

Scottish Care, through the People as Partners project, is keen to ensure that the views of Scottish Care members are presented to the Government.  In order to achieve this, we will be undertaking the following two processes:

• An online survey, which will allow anyone to respond to specific questions on a range of issues raised by the Guidance.  This is likely to include a debate on whether or not residential care should be included within the service options available for use in individual budgets.

• Visits to as many branches/regions of Scottish Care, undertaken by Donald Macaskill.

After all the events have been completed, a report based on feedback will be written up and submitted to Government.

In addition, we will be providing opportunities at these events for you to find out more about Scottish Care work being undertaken on Reshaping Care for Older People and Workforce Matters.

The Scottish Government has awarded Scottish Care, through Workforce Matters, a grant with the aim to assist “social services providers in the independent sector to fully contribute to the national workforce development agenda and maximise their capacity to self-manage the development of their workforce.”

This will build on the previous work of Scottish Care’s Workforce Initiative and focus on the workforce development implications arising from the key Scottish Government policy areas which affect the care and support of older people, including personalisation, reshaping care for older people, the integration of health and social care, self-directed support, the dementia strategy and strategic joint commissioning.

There will be an opportunity at these sessions to find out more about the work from David Rennie, who has worked with Scottish Care as workforce consultant for some time and is the lead person on this project.

We have now identified locations and times for these visits and you can book a place at the short workshops by following the Eventbrite link beside each venue. (If a venue is not listed for your event, please visit back as these will be updated as soon as possible.)

We have had to combine some areas into one event, and have tried to set locations which are accessible to all in those areas. We have indicated the combinations below.  However, if you would prefer to attend another event because it is more accessible for you, you are most welcome to do so and should simply follow the appropriate booking link.

Friday 19th April – Glasgow.   Book place

9.30 to 12.00pm

Venue: The Renfield Centre, Bath Street, Glasgow

Thursday 25th April – West of Scotland.  Book place

9.30am to 12.00pm

Venue:  To be confirmed

Wednesday 1st May – Grampian (& Moray).  Book place

11.00am to 2.00pm

Venue: Copthorne Hotel, Aberdeen

Thursday 2nd May – Perth, Fife, Angus, Dundee (& Stirling and Falkirk).  

Book place

2.00pm to 4.00 pm.

Venue: Blackfriars Development Centre, Perth

Friday 10th May – Highland (& Moray).  Book place

11.00am to 2.00 pm

Venue: Inshes Church, Inverness

Wednesday 15^th May – Edinburgh, Lothians and Borders (& Stirling and Falkirk).  Book place

9.30am to 12.00pm

 Venue: Murrayfield Care Home, Edinburgh

Friday 17th May – Ayrshire (& Dumfries and Galloway).  Book place

9.30am to 12.00pm.

Venue: Ayr Hospital Lecture Theatre, Ayr

Thursday 23rd May – North and South Lanarkshire.  Book place

9.30am to 12.00pm

Venue: To be confirmed

Scotland in care crisis?

 Ruth Wishart writing in the Herald this week has raised some interesting points in relation to Self -directed support .

Care Inspection and SDS workshop report

The following is a brief report with slides of the presentations at our recent workshop.

Over a hundred people attended the first People as Partners workshop of 2013.

Held at the Hilton Hotel, Glasgow, the workshop focused on issues of care inspection and regulation in light of the Self-Directed Support Act.

The power point slides for each of the presentations are available here.

The first contributor was Ian Kerr, Senior Inspector with the Care Inspectorate who reminded individuals that in essence the SDS Act did not radically alter social care provision but placed particular duties on local authorities to ensure that the range of choice available for individuals was communicated to those who were assessed as needing social care services.  Ian then highlighted the importance of local authorities training and resourcing staff to deliver the changes  envisaged  within the Act stating that the creation of SDS teams at local  authority level was an indication of a growing commitment and awareness of the implications  of the Act.

Ian described the four available options which are encompassed within the Act and highlighted that although Direct Payments have been a potential route since 1996 that their use had been sporadic at best but that he envisaged that there was real potential for growth in this regard. It remains to be seen the degree to which individuals will use other options or continue to receive support from local authority provision.

Ian highlighted that the SDS Act was a continuation of a long developing model of the greater involvement and inclusion of individuals who received services in the services which were both commissioned by local authorities and delivered by providers.

Ian’s slides are available here.

Ian Kerr presentation

Rosie Lawrence, senior inspector, then shared with the audience her conviction that the Act sought to further an existing and growing emphasis in social care upon outcomes and a concentration on the needs and wishes of the person who uses services.  She indicated that developing inspection under SDS would continue to focus on the degree to which provides we’re involving individuals not solely in the design of overarching services but in the specific design and delivery of the slice which centred pin themselves.

Rosie’s slides are available here.

Rosie Lawrence presentation

Heather Dall, the development officer within the Care Inspectorate who has been focusing on SDS and will shortly take up duties leading on the development of the new National Care Standards, then spoke about the positive benefits and challenges of increased use of and employment of PAs as a result of the Act. Heather also spoke about some of the key themes which will be important for inspection in relation to individual budgets and SDS.

Heather’s slides are available here.

Heather Dall presentation

Those attending then spent some time in table discussion before a plenary Q and A session when a range of questions and issues were raised. Susan Castle,  Acting Director of Programming, Co-operation and Registration, also joined the discussion at this stage.

Included amongst the issues was a concern about the safeguarding of vulnerable adults at the hands of workers who were not screened or registered, not least after the recent Staffordshire incidents; a discussion about the registration of PAs; debate about the degree to which commissioners of services who concentrated on time and task were likely to be true to the SDS Act; the role of the Inspectorate in holding local authorities to account for enabling real choice; the on-going debate about whether or not it would be possible to include residential care within the SDS options. etc.

The workshop ended with a brief presentation by Rosie Lawrence about the developing new models of integrated joint assessment. These issues can be seen in her earlier set of slides.

We would be delighted if you left any comments from reading the slides and indeed share with us your thoughts on the issues raised.

It is hoped that the next workshop on ‘Self-Directed Support and Care At Home services’ will take place in mid June 2013. Please keep visiting the website for information on this.

Over the last few months there has been much debate amongst the partners of the People as Partners project about whether or not residential care will be included as an option for people under the new Self-Directed Support Act.

This issue will form a core part of the twelve-week Consultation on Guidance and regulations which is likely to start from mid-March 2013.

As part of contributing to the debate Donald Macaskill presented a paper to a shared stakeholder group on Older Peoples Service Development.

The paper can be accessed here.     Paper on SDS and residential care challenges

The paper highlights and explores a number of the issues, concerns and challenges of extending and not extending Self-Directed Support to residential settings.

Feel free to leave your comments here and look out for our own consultation workshops where there will be opportunity for you to share your thoughts with Government.

New Report highlights risk of Self-Directed Support lottery across Scotland.

The Learning Disability Alliance Scotland (LDAS) has produced an excellent and highly readable review of where they consider Scottish local authorities are in preparing for Self-Directed Support with a particular focus on where LDAS considers local authority area is with their plans to make SDS the mainstream option for people receiving social care services.

According to the LDAS research, 5 local councils are ’well on the way’ to implementing SDS, 8 councils are at the ’advanced testing stage’ for SDS and 19 councils are still at the ‘planning stage’ for SDS.  

The report concentrates in some depth on the issue of resource allocation. It highlights that the majority of local authorities in Scotland are planning to set up a points based Resource Allocation System (RAS) to allocate personal or individual budgets.

The report raises concerns over what it suggests is a lack of transparency in relation to informing those who use services about which system of resource allocation is under consideration by a local authority. It states:

‘Some of the reasons that have emerged for the reticence to share this information are

• A fear that people will view the RAS system as a set of entitlements.

• A view that changes to early versions of RAS will later be judged inappropriately by services users, carers and providers

• A worry that contingency set asides will be seen as cuts.

• A worry that early RAS systems will not scale up properly or result in excessive spending.

Nonetheless we find it worrying that such essential information has been withheld. The council with the most biggest SDS programme (Glasgow) has never tried to hide its RAS, always emphasising that such budgets are only a starting point. Have other councils missed this essential point?’

It presents a varied picture across Scotland, for instance:

However, some local authorities have chosen to reject the use of a points based Resource Allocation System:

• Dumfries and Galloway rejected the In Control RAS 4 system as they ‘did not find that it gave realistic amounts for people to plan within’.
• East Renfrewshire have rejected the ADASS RAS model ‘as being incompatible with an outcomes focused assessment approach’.
• Highland had opted for an ‘equivalency’ approach where budgets are allocated based on the cost for the council to provide the same level of support. 

In conclusion the Report states:-

‘Self Directed Support is developing steadily across Scotland. It is likely that the SDS Act will be fully implemented in April 2014 and that a further five years will be given to allow full implementation of its terms.

At the end of this process, everybody who receives social care will have been offered an Self Directed Support option. The options available to people mean that not everyone will have taken up either a Direct Payment or an Individual Service Budget.

However it is likely that almost everyone will have a Notional Budget that determines the values of the various supports that they receive and that there will be some use of “outcomes” in determining what support they receive.

Self-Directed Support is being approached differently by EVERY local authority and given different importance by each as well. Some treat this as a central development; others see it as one of a number of modernisation initiatives. Some are enthusiastic while other remain sceptical about what change will actually develop.

Over the next 6 years this is likely to see quite divergent systems begin to emerge in different local authorities within Scotland. Orkney Islands Council flagged a serious problem when they said there was a real danger of a new postcode lottery in social care emerging.
We share the concerns of LDAS.at the heart of the principles embedded in the Bill which will be at the heart of the act are those of equality, transparency and control. These principles will become very difficult to evidence in a process where there is a risk that the implementation of SDS in Stornaway will be markedly different from SDS in Stranraer.

Donald Macaskill.
the full report can be read here http://www.ldascotland.org/docs/Whats%20going%20on%20%20Self%20Directed%20Support%20in%20Scotland%20Jan%202013.pdf

Organisational and infrastructure challenges re SDS in care homes.

The Making the Journey process is a project which is following and supporting twelve provider organisations through the journey from commencement to implementation of Self-Directed Support in Scotland with a particular focus upon older people’s support and care.

The providers are divided into three geographical area groups – one West, East and one in the North of the country.

They represent a range of providers of care home, home care and supported housing provision and range in size from national providers to small scale operators.

Over the course of the next year we hope to develop models of best practice and share with you what we have been learning and discovering together about the opportunities and challenges of Self-Directed Support for the sector and those who use services for older people.

Many of those who took part in our initial meetings in late 2012 felt that whilst there may be some difficulties inherent within embedding Self-Directed Support within the care at home sector, there was also a sense in which the systems were already largely in place or at least potentially adaptable to enable this to be a potential benefit to the sector.

The real set of challenges, however, relate to residential care and the development of self-directed support within the care home sector.

Amongst the challenges and questions for care home providers which participants have  identified were the following:-

• Can SDS fit a residential setting where we have the National Care Home agreement?
• Will the NCHA survive a situation where local authorities will offer different amount of monies for supporting an individual after they have undertaken the initial assessment and RAS process?
• Is the residential setting not in itself ‘self-directed’?
• Is it fair to raise expectations in people about a flexible provision and market which is not there and unlikely to exist in the near future?
• Will we not just turn care homes into hotels with nursing support?
• Is there a danger that care homes will just become supported residential settings providing bed and breakfast and evening meals?
• If someone uses a service in my residential setting what control do I have over the staff of that service who come into my establishment?
• Who is responsible in terms of insurance and inspection for the conduct of such staff in my environment?
• Doesn’t this provide us with a real opportunity to create more responsive, local, flexible services for people in 2013 rather than using a 1980s model of care homes?
• How is it possible to scope the cost of an individual who only uses my service for its residential and hospitality elements?
• Are there not significant implications for staffing when I am no longer able to determine whether most of my staff need skills in nursing, support, hospitality etc.? How do I recruit and retain?
• Do I need to individually register distinct elements of any new service I may wish to develop?
• Is it possible to run a profitable organisation where there is a lack of clear commissioning and placement?

Just some of the questions and issues we are exploring. Please join our conversation by leaving any comments on these issues and in particular we would be delighted to hear from you if you have come across a care home or home care service which is putting self-directed support into practice.

Donald Macaskill

Well it has finally been passed! After months of debate and deliberation, cogitation and consideration, the Social Care (Self-directed Support) (Scotland)  Bill has been approved by the Scottish Parliament.

In what many commentators believe will herald in the most significant change to social care in the last sixty years on Wednesday 28^th November 2012 the Parliament debated the Third Stage of the Bill. All that waits now is for the Bill to receive Royal Assent and for a date for its enactment and commencement to be announced.

The Bill was passed unanimously by the parliament at Holyrood.

The legislation aims to give adults and children – including carers – more choice and control over how their needs are met.

Public Health Minister Michael Matheson said: “It is right to give people more control of their own lives and the support they need to change their lives for the better.

“This bill highlights our commitment to empowering people to live their lives as equal citizens and contribute to and participate in society.”

The Labour Party expressed concern that there was a danger that family members and others might use the new law to leave individuals in receipt of care more vulnerable.

According to Labour public health spokesman Dr Richard Simpson the Law Society believes the Social Care (Self-directed Support)(Scotland) Bill does not contain the necessary safeguards to protect less-severely disabled people from being cared for by unsuitable people. However Public Health minister Michael Matheson said he intends to address these concerns in statutory guidance but said inserting tougher restrictions into the Bill would limit disabled people’s choice.

He rejected Labour’s “well intentioned” bid to insert safeguards into the Bill and Dr Simpson’s amendment was subsequently voted down by the SNP majority Scottish Parliament.

Dr Simpson sought to insert “a requirement to take reasonable steps to ensure that any person appointed to assist will be suitable”, adding: “This is to ensure that we have a situation in which those who do not qualify under the Adults With Incapacity Act or under the Vulnerable Adults Bill, but who are nevertheless possibly vulnerable and not completely robust in their disability are protected from undue influence from individuals who might be unsuitable.

“We know that there have been cases of this sort reported in the press where the situation has been unsatisfactory, and this does provide the protection which the Law Society regards as being important to put on the face of this Bill.”

Mr Matheson said the amendment “would place a duty on the local authority to be satisfied that the supported person is not going to come under undue influence” and to address “any likely conflict of interest between the person and the supported person”, as well as “any likely undue concentration in the person of power over the supported person”.

“Richard Simpson’s amendments are well-intentioned,” said Mr Matheson. “He stated that some relatives can act in a manner that is overly restrictive on individuals that have incapacity.”

Positively some amendments were accepted, these included placing a duty on local authorities to promote a variety of providers and the range of support available.
The Minister welcomed this amendment noting that to ‘deliver real choice, local authorities must strive to encourage suitable diversity in the choices that are available to people.’

A further accepted amendment places a duty on local authorities to provide information about independent advocacy wherever the council considers it appropriate to do so.  This amendment builds on the Mental Health (Care and Treatment) (Scotland) Act 2003 which already provides a right to advocacy to anyone with a ‘mental disorder’ including people with mental ill health and people with learning disabilities.

Importantly the Minister added: “The provision in this Bill is to enable and encourage local authorities to maximise individuals capability to understand, make decisions and to communicate decisions. They are to identify persons who, with the agreement of the supported person, can assist. The challenge in this respect is to define and articulate in statutory guidance appropriate and inappropriate forms of assistance. I intend to elaborate on this in statutory guidance which will accompany the Bill.”

People as Partners is delighted the Bill has reached this stage. In some sense we can now start getting ready and moving ahead in preparing the care home and care at home sector to be prepared for the implementation of the Bill at a date which has yet to be determined. The Guidance  which will support the bill when it becomes an Act will be critically important – it will add the flesh to the bare legislative bones! We will keep you aware and informed of when that is due to be published.

Over the next few weeks and months we hope to be publishing on the website some details of the work we have been undertaking across the country – so please visit often.