The Scottish Parliament’s Health, Social Care and Sport Committee is undertaking an enquiry into how the Social Care (Self-directed Support) (Scotland) Act 2013 has worked since it came into force. We submitted our response and would invite you to read it below. If you would like to discuss any of the topics raised, get in touch: info@in-controlscotland.org.uk

 

For more than a decade, In Control Scotland has supported local authorities, support providers, disabled people and unpaid carers get to grips with SDS, providing training, problem-solving, and coaching, as well as developing research, supporting the development of local and national improvement plans, and contributing to the evidence for rights-based approaches.

 

Scotland has much to be proud of with our legislation, which positions us as a nation that focuses on the human rights and inclusion of our citizens, and the Self-Directed Support Act is a great example of this. As Scotland’s national policy for social care it gives us incredible strength and opportunity to drive forward the equality of disabled people and those who care for them, and as well as working to embed SDS in Scotland for 15 years our many years of international work lead us to believe that it is an approach that many nations admire and aspire to.

 

As an overall caveat to this response it is worth noting that it is impossible to look at SDS in isolation: the social care landscape is complex, because it intersects with policy that concerns health, human rights, welfare benefits, employment, geography, procurement, and countless others. The idea that we can accurately manage this type of complexity is a fallacy, especially when the myriad people doing so are individuals with their own thoughts, feelings, and experiences, and so it is important to realise that SDS is an evolving system with many moving parts that is contingent on human behaviour, and we must consider it holistically in order to understand it. Self-directed support is something we do, not something we have or give.

 

In the early days of SDS there was a huge amount of investment in implementation, as local authorities and support providers alike explored pilot projects to develop and embed the approach. Today there remains some confusion however around what self-directed support is, and who it is for. What we have noticed since then is that those areas where original investment was prioritised – namely around support for people with learning disabilities and physical disabilities – have seen the most success in ensuring that rights-based and person-centred approaches are prioritised. For other areas of social care, such as for children and families, older people, mental health, homelessness, neurological conditions, and addictions, the confidence in practitioners to have conversations around SDS is more limited. This leads to inequity of opportunity for some people, most keenly felt where there are other system pressures such as recruitment challenges or limiting procurement processes. Over the subsequent years, in the face of these pressures, some areas have focussed on their compliance with eligibility and decision making, rather than how well they are meeting the expectations of the SDS Act overall. We have recognised that there are more process discussions than value-based discussions in some areas, and this is deeply concerning.

 

Conversations on SDS routinely focus on options 1 and 2, with practitioners often seemingly forgetting that the principles of SDS apply to all options. This was explored in depth in our research published in November 2023, titled ‘Emerging Good Practice in Option 3’,  As an organisation we have also carried out significant development work in improving option 2, publishing six case studies of local authorities last year in our research paper ‘How Are We Doing with Option 2’  The common theme across both of these papers is that there is excellent practice taking place across Scotland, but it is not consistent: it has often emerged from pilot projects which have not been rolled out across all care groups or geographic areas, and so the learning has been held in isolation without being systematically embedded for all. This historical perspective adds to another pattern we have noticed: that self-directed support is often seen as something different to social care, and not ‘the way we do things’ for the vast majority of social care. The need for that value-based focus to link and connect every interaction and service is key. In areas where we are seeing good leadership that avoids disjointed, contradictory responses from the system, it is still fragile, as with changes it can be undone. We need to see the values of the Act reflected throughout all areas of practice if the levels of power shift and answerability needed are to be achieved.

 

In the current context, the challenge is significantly compounded by difficulties with recruitment and retention for social care and social work. Local authorities tell us that they are so busy ‘fire-fighting’ that they have limited opportunity to explore creative solutions, and providers are handing back contracts that they cannot fulfil, meaning that option 3 services – which offer the least opportunity for flexibility - are becoming the default position. There is need for development work in this area to ensure that the principles of choice, control, flexibility and dignity apply to all of social care, not just those using options 1 and 2.

 

This is a complex challenge that is felt across almost all local authorities we engage with, which highlights several issues that require investment and exploration. In our Option 3 research, practitioners spoke about feeling as though they are on a ‘hamster wheel’, pushing people through the system as quickly as possible in order to reach the next person. Practitioners are burnt out by this, and disillusioned by the burden of simply processing people as fast as they can without being able to spend time building relationships. After all, social workers sign up to the career because they want to help people, not because they believe in bureaucracy.

 

In addition to this, the social care workforce needs significant investment to ensure that it is a strong, viable, and empowered vehicle for rights-based and person-centred approaches. Social care needs to be seen as an aspirational career which reflects the responsibility and complexity of the role, and offers fair pay and conditions, no matter what part of the sector you work in.

 

Providers work best when they are trusted partners in the design and delivery of social care, and have contracts that allow them flexibility and creativity to make decisions in the best interests of the people they serve. Our current legislation does not support this fully, although we see excellent emerging examples of alliances and partnerships (such as the Granite Care Consortium) which are developing approaches for place-based support for high volume services, with the providers trusted to flex and change support as needed. For true place-based commissioning to be enabled there is need for reform in the way that social care services are registered. For example, we are currently supporting one very rural area to explore a place-based approach, where it is simply not viable for multiple specialist providers to support the very small and geographically disparate community. To have one provider work across a geographic ‘patch’ is currently only possible via multiple registrations with the Care Inspectorate to cover the different support needs, which is expensive and bureaucratically limiting. We are engaging the regulator in these conversations but again it shows the complexity of implementing SDS in a landscape with many moving parts.

 

We are encouraged by the current national conversations on eligibility criteria, as we can clearly see how they diminish the opportunity to build good relationships and intervene earlier. Practitioners regularly tell us that they feel they have to ‘game the system’ to get supported people the help they know they need, meaning that people are pushed into a process – often with a hugely lengthy waiting time for assessment and decisions – because that is the only mechanism for practitioners to be able to support them, resulting in one more person on the hamster wheel each time. The systems and processes that have been built to ensure accountability and fairness have become meaningless in a pressure cooker of demand, it is time to revisit these and put our faith in people.

 

The theme of education and understanding is a strong one in our feedback: we are commissioned to deliver training regularly to practitioners, and they tell us that self-directed support is barely covered in social work education. This needs to change, as these demonstrate areas where we could (and should) be explicit about what we expect and need to work consistently in this way.

 

Our work supporting people with complex needs – such as those highlighted in the Scottish Government’s Coming Home report – is separate to our Scottish Government-funded work, but has shown us that there is a lack of understanding of self-directed support in clinical settings. Over twenty years ago Scotland embarked on a hugely ambitious programme of closing long-stay institutions such as Lennox Castle and Gogarburn, and we fear that the current climate of limited resource and system pressures, compounded by a lack of understanding, is leading to a slide backwards for these citizens, who are least likely to experience choice, control, and flexibility in their support, and have decisions made for them based on risk and fear. There is a need for education on self-directed support in clinical settings to ensure that Scotland’s national policy for social care is understood by all, alongside fair investment in the highly skilled practitioners who can support those who are most marginalised. There is a worrying lack of challenge to some of the institutional patterns which continue to deny people their rights. In addition to squandering Health budgets, there is often not a willingness to move away from replicating a power and control model when supporting people to move to the community.

 

Over the many years of our involvement in embedding SDS we have seen a huge amount of excellent practice by local authorities. We see this most often when there is strong, supportive leadership which actively leads from the front and prioritises curiosity, ambition, confidence, and creativity in the practice of individual workers. Having external support from organisations like ours and our partners (Social Work Scotland, SDSS) is invaluable in providing opportunities for coproduction, ideas from our national evidence base, and a critical friend, allow local authorities to be challenged to do better for their communities. There are numerous local authorities which have developed fair processes for resource allocation, strengths-based assessments, and person-centred support planning, which are facilitated via equal conversations where there is a respect for all involved. The strongest practice we see is where self-directed support is seen as a continuous process of learning and exploration, and not a ‘one-time’ improvement in a single area of practice or process.

 

For disabled people and those who care for them, we have heard countless stories of people living brilliant lives through the personalised support that SDS offers them: where their natural supports and intrinsic assets are maximised to build resilience, confidence, and community, and paid supports fill the remaining gap without being the focus of what makes a good life. When SDS is used to the full extent of the legislation it is transformative.

 

In summary, we wholeheartedly believe that self-directed support is the right approach, and our legislation is strong and greatly admired by many. However, it is crucial that there continues to be investment in this change process, as there is still much to do. The expectation from Scottish Government and from people receiving support must be clear and unequivocal, there must be a continued active move towards the expansion of quality, choice, and provision of options, with an emphasis on the power shift towards the individual and decision making by professionals as close to the person as possible. At the moment the effort amongst those trying to effect these changes is usually disproportionately greater than those maintaining a process based, crisis focused approach. This is burning out many passionate practitioners and frustrating individuals and their families. The learning from the last 10 years must be applied to all areas of social care, including those ‘roads less travelled’ such as mental health, addictions, and homelessness, allowing the myths and misconceptions to be shattered. Practitioners and supported people alike should have access to training, resources, and support to build confidence and enhance outcomes for all, with a focus on community-first and not service-led responses, with equal and fair compensation for all concerned.

 

Over the last ten years have gathered the evidence about what works and how to achieve it, we need to join up the best practice and ensure that we support a continuous improvement loop which is more powerful than the institutional pull towards stagnation. We must reaffirm our faith in supported people and practitioners in their ability to coproduce support that leads to a good life that maximises people’s potential and strengths, reducing the belief that long complex assessments and multiple checks are what keep people safe and well supported. Through self-directed support we can achieve better results more simply, cost effectively and with greater integrity.