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13 Feb 2016
John's Jolly Walking Group

The essence of Self Directed Support is meant to be having the freedom to spend an Individual Budget on the support and services that can truly meet your need.  In the early days, videos were produced of people spending their money on holidays abroad or on personal development courses or opportunities.  The argument was if you gave people the freedom to make their own choice, they would be better choices and in many cases would be cheaper.  For example, instead of paying a support worker to take you to a football game as well as buying a tickt, a friend, family member or volunteer could be induced to do this for just the price of the ticket

Over the last few years as SDS has been introduced in Scotland, that has rarely been the case.  Instead the use of Individual Budgets has been constrained by local authorities who have claimed that their duty to ensure the "public pound" is properly spent overrules thing else.  Budgets can only be spent on areas approved by councils.  85 page contracts have been drawn up to support new "freedoms" which set limits on anything creative.  

Now Glasgow City Council is proposing to give "providers" the freedom to do it differently. Read the proposal here  No longer will providers have to provide a fixed number of hours for an Individual Budget instead as long as the needs of the individual are met, then the budget can be used to increase the wages given to staff so they can rise in line with the National Minimum Wage.  

This proposal will be introduced in a pilot scheme for a range of adults in community care groups.  But for people with learning disabilities it will make life much harder.  Glasgow has made a range of reductions in support for peopel with learning disabilities.  They started with a cut in people with learning disabilities budgets of an average 20% with the introduction of personalisation, followed by a 5 year freeze in the value of RAS support packages.  Then a they shut most of the city’s day services.   Now they now propose to make people with learning disabilities pay for the Tory’s National Minimum Wage by cutting their support packages even further while pocketing further savings in the meantime.  

Its not completely clear in the paper but it seems to suggest that the new National Minimum Wage will cost  £21 million  and that this amount should be diverted from social care users support packages into paying the new wage level.  There is then an indication at the , while there would be a further 5% reduction in total spend in support packages to be retained by the council.  However a third set of savings may be generated  “significant” reductions in council “administration and processes”  

The Learning Disability Alliance Scotland views this proposal with some concern.  Support packages for social care users in Glasgow and in particular people with learning disabilities have been severely reduced over the last 6 years.   This proposal takes the good idea of further social integration into the community but ties it to real pressures on social care.  Providers are likely to have little choice but to go along with it.   In the report it does not mention that they asked service users what they think of this process.   Surely SDS is about the service user's choice and decision making.  This appears to be completely absent from the proposal.  We are really disappointed that Glasgow City Council are not turning their focus on the UK government who had introduced this policy of the National Minimum Wage but failed to fund it.

 

In January 2015, we published a short report called “The Start” looking at the first 6 months of Self Directed Support and what was being planned.  It found a hesitant approach that showed that there had been few real developments in SDS.   We  said that when the social care statistics were published in late 2015, we would have a better national picture of how SDS was developing.  

There was a total of 6,000  people on Direct Payments in 2013-14 before the introduction of SDS .     In 2014-15 this would need to rise to 6,600 just to keep up the momentum of development. 

The figures have now been published.   And the number of people with Direct Payments has risen but ONLY to 6,450.   This is the first indication that the introduction of the Self Directed Support Act may not have increased user choice in control.  

In fact further analysis shows that in a range of local authorities things have got worse.    In 11 local authorities the numbers of people receiving Direct Payments actually fell.

The Scottish Government has published its priorities for the next couple of years in the Keys to Life.  They say that they can't do everything so best to focus on 4 things that they can do really well.   

This document outlines the implementation framework for delivering The Keys to Life ~ Scotland’s Learning Disability Strategy. It sets out our vision, expected outcomes and highlights key themes to focus delivery during 2015/17.

 This approach has been welcomed by lots of important groups but some others have said to us that it misses out important priorities about having enough money to live on and getting the right support. The Scottish Government says it reflects the key messages they have had from people with learning disabilities, particularly the 14 members of the expert group of people who have learning disabilities about what is most important to them in implementing The Keys to Life recommendations.

The goal that the Scottish Government have picked to start with are:

First is a having A Healthy Life.

Lots of things make us healthy. Eating good food, taking exercise, having a good place to stay and friends and family all help us to be healthy.

Three things that they will do to help with this are 

These are systems that rely on the judgement of a professional social worker to establish the level of a budget.  They decide what support they would normally provide to a person with social care needs and then monetize that service so that it can be offered in the form of an indicative budget.

 

They start from the basis that it cannot be right to set a budget at any level unless there is good reason to believe that this level is reasonable and that someone could get their needs met with that budget.

Equivalence helps to show that the budget does reflect some real model of how a need might be met.   In this system Self Directed Support gives the opportunity to the service user to meet those needs in a way that is even better for them than might originally have been done.   They retain the option of asking the local authority to arrange a service of the “equivalent standard.”

18 councils are now running Equivalence in their area and we think it is possible to break these down into two different types of system. 

4.2.1          General equivalence – There is an assessment of need followed by the social worker deciding on support levels that the local authority should offer.   They then run this service through a ready reckoner for a budget and this discusses options with the client and offers the choice of the 4 options.  

Perth and Kinross Council have this sort of equivalence.  A person’s outcomes are agreed through an outcome focussed assessment, and the relevant amount for an Individual Budget is then calculated using the full cost of providing the care and support services identified in their personal outcome plan.

Midlothian Council are planning to adopt a similar system by following developments in Perth. 

4.2.2          Specific equivalence – There is an assessment of need followed by the social worker deciding on support levels that the local authority should offer.   The social worker then can offer variable budgets depending on the SDS option chosen to purchase these supports in the way that client wants. 

Highland NHS have this sort of system.  A person’s outcomes are agreed through an outcome focussed assessment, and the relevant amount for Direct Payments is agreed through a ready reckoner spread sheet.  Individual budgets for options 2 and 3 are assessed on an individual basis depending upon chosen service provider.

 

East Dunbartonshire Council also have this sort of system.   The individual budget is calculated by costing the supports in the service user’s support plan that have been agreed as supporting the individual to meet their needs. The use of a ‘Schedule of Rates’ will be utilised by practitioners to determine the most appropriate ‘standard rate’.  This will vary according to whether it is Option 1,2 or 3 and the type of service chosen.

These are systems that try to turn the allocation of funding into a science rather than an art.  It is based on the idea that there is mainly a smooth scale of needs, rising up slowly and that if you can work out how to give a points value to each need then you can allocate a budget fairly.  Everyone with the same points will have the same budget, even if it was different needs that got them those points.

 

This first budget is then used for planning processes and where it’s not enough or too much the budget is subsequently adjusted by a more or less arcane process.  This can involve a range of meetings with more senior social work staff to which the service user or their representative is unlikely to attend although in some cases, their care manager may make representations on their behalf.

Such systems are usually derived by a semi scientific method of removing “outliers” – those with expensive care packages and then averaging out care costs of between 100 and 300 people. 

The principle of people with similar needs requiring similar amounts of money of course has simplistic appeal. But it is likely to not work in social care where social care needs arise from the complex interplay of many factors.   Such systems are seen as the antidote to the 'professional gift', whereby the large variations in how much people get was put down to the behaviour of professionals.   There is a lack of supporting evidence for this view.  Anecdotes about the results are in themselves are not sufficient.

But perhaps the biggest concern is that such systems can build in distrust between councils and services and even their own staff.  Two councils told us they would not be giving us details on how their Resource Allocation System would work because services users would use this information to get higher scores and get more support than they need.