Foundations for self-directed support in Scotland
Foundations for self-directed support in Scotland

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Foundations for self-directed support in Scotland

1.11 What does self-directed support mean in practice?

Figure 1.20: Choice is a key element self-directed support

Direct Payments have been available in Scotland (as well as England and Wales) since the Community Care (Direct Payments) Act 1996 which enabled local authorities to provide funds (' direct payments ') so that service users could, for the first time, buy their own services. The Community Care and Health (Scotland) Act 2002, introduced after devolution, steadily widened entitlement to direct payments. However, take-up of direct payments has been slow in Scotland, compared to England and Wales. In 2009/10, Scottish local authorities were only spending 1.4 per cent of their income on direct payments and take-up varied considerably in different parts of Scotland.

(Scottish Parliament Information Centre, 2012, p. 5).

In 2010, the government published Self-directed Support: A National Strategy for Scotland (Scottish Government, 2010), a ten-year plan to increase the number of people actively directing their support. The Social Care (Self-directed Support) (Scotland) Act 2013 goes one step further by enshrining self-directed support as a means to all individuals having more choice and control over their support.

You will have noticed that we are mainly focusing at the moment on social work and social care services. This is because the Act relates specifically to social care. This does not mean that personalisation is not a live issue in Scottish health services – it certainly is – but there is not (yet) any legislation requiring health services to offer self-directed support. However, there are also other policy changes afoot, including a major shift towards breaking down organisational barriers by integrating health and social care services in Scotland which may result in a greater focus on personalisation in health services. Personalisation is also relevant to other services, such as education and housing. Sections 5 [Tip: hold Ctrl and click a link to open it in a new tab. (Hide tip)]   and 6 explore the roles of different professionals and organisations, and how they can best work together to put service users at the centre of their care and support arrangements.

Activity 1.8 provides an opportunity to find out about self-directed support in practice.

Activity 1.8: What does self-directed support mean to you?

(Allow about 30 minutes)

In this activity you will listen to service users, carers and professionals talking about what self-directed support means to them. You have the opportunity to listen to three podcasts about self-directed support in relation to young people and their families and/or a short video in which adults with learning disabilities and their carers talk about their understandings of self-directed support. Then use your learning log to identify:

  • the benefits
  • potential challenges of directing one's own support.

You will hear four voices:

  • Mamta Kanabar, Children's Services Service Manager at the Barnardo's Scotland project, Apna
  • Duncan and Betsy McKendrick, parents of Cameron a young man with autism, supported by Enable Scotland
  • Mrs Choudhary, the parent of a young person (now 23) with additional needs
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Mamta Kanabar
My name is Mamta Kanabar and I work as Children’s Service Manager for one of the Barnardo’s projects called Apna. Apna means ours, and we provide a lot of services to children with the special needs, and services ranges from home care, personal care, befriending, one to one support, support in the community, and we also run after school club and play schemes for special needs children.
Everybody thinks that self-directed support means, oh you control your own funding, but that’s just a part of it. It’s more about your service user being in more control, exercising their rights, having choices and getting really actively involved in designing their own care and all that, and also it’s not just about those individual families or service users, it’s more about how you can change the whole environment you live in, your whole community, how you can support the community to use their resources. And also a lot of time we don’t see the resources the community has got to offer and nobody supports the community in order to enhance those resources.
So, self-directed support one of the things is building capacity of the community where the service user come from so they can use the resources there, which I don’t think anybody is talking about this just now though. The focus just now is very much on getting the family go on self-directed funding. In terms of Barnardo’s readiness to deal with it I think we have changed the way we work. Our practice is now much more based on outcome, and if somebody decided to go through self-directed support we support the family. We tell them that, “This is your right. There are three options you can choose from. Either you ask social work to manage your budget, or you manage it, or do half/half. So this is your choice. Social work has to agree with it”. Obviously they do the assessment of the parents or the guardians just to determine that if they are competent to manage the funds and this is something I don’t have any control, it’s just between social work and the families, but we try to make sure that family, at least they know what’s their right and where they stand with this and all that.
We should be doing more, but the problem just now it’s all about resources. Honestly our home care service is very, very, very busy because we are so flexible. If I show you a timesheet – we prepare a weekly timesheet, the timesheet on Monday and the timesheet on Thursday, all the chops and changes and all that, you won’t be able to read it, yeah so a lot of time we are spending on managing that flexibility and also all our staff, sessional staff who work directly with children, they are very well supported. They get one to one supervision, they get group supervision and all the training and things, so the home care coordinator has to manage everything.
And also because we are very responsive if social work say that, “Oh tomorrow can you start the service for this child whose mum has got cancer and she’s just going blah, blah,” we will start the service tomorrow and all the paperwork and things. So that’s done very quickly and then I just feel that you are not getting enough time to work with the community and all that, but still every now and then we do,
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Duncan McKendrick
My name is Duncan McKendrick and I live in KirkCaldy, Fife in Scotland. We have a son, Cameron, who will be 19 in July. Cameron was chosen for the self-directed Support pilot scheme because he was going through transition from school to college. Ah, we had a bit of trouble with the school who had decided which college he was going to, and Cameron did not like that at all. We took him round to three colleges, and he decided from the curriculum from seeing the college which one he wanted to go to. And to help him with that, we arranged that he used the self-directed Support to pay for his taxi to take him to college and home again, which the school originally said we would have to do which would have been a twenty mile round trip a day.
Betsy McKendrick
My name’s Betsy McKendrick. The benefits of having this self-directed Support have been, well, it’s really been like a miracle hasn’t it?
Duncan McKendrick
Hmm, yeah.
Betsy McKendrick
It is something I’d heard of but I wasn’t quite sure how the whys and the wherefores and how it worked. But once it was explained, I thought it was a really good idea because it gives the person the choice and control of what they want to do and where they see what they want to do. He’s got four members of a team who come at regular intervals and they take him to do an activity, or go to the cinema, or go out for a meal.
Duncan McKendrick
It’s his budget and he has the choice of what he wants to do with his money, which is the whole ethos. He has a choice of what he wants to spend his money on, within obvious limits. So he goes to college four days a week and on a Monday, when he’s not at college, he goes out with somebody from, one of his supporters, from Enable. Aye, he goes archery, horse-riding, cinema.
Betsy McKendrick
I think it’s helped a lot. Also the fact that Cameron has got to go to the college that he wanted to because we couldn’t see why he couldn’t go to the college. But it was like doors shutting, doors shutting. His voice wasn’t heard. Our voices weren’t heard. But finally somebody’s heard them.
Duncan McKendrick
We have been helping to redo the paperwork to make it a bit simpler for lay people where an awful lot of social work expressions and we’ve tried to simplify it as much as possible.
Betsy McKendrick
Yes.
Duncan McKendrick
If we hadn’t had the local area co-ordinator, I think we would have really been struggling.
Betsy McKendrick
Input outcomes, throughputs…what? (laughter)
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Naheed Choudhry
My name is Naheed Choudhry. I live in Glasgow. I have four children. My youngest daughter is with a disability. She’s mentally and physically disabled. Now she’s 23½ years old. I would recommend all carers, like all mothers to get this direct payment, it’s very very good. It gives you control of your child’s life actually. You can buy support for where you really are happy.
When I took Siddrah’s direct payment there was so much involved. The lawyer was involved. I had to take out the guardianship, but I was quite looking forward for this because I wanted, I thought maybe my daughter’s life will change that I can buy the services for her. Her life will be a lot better. So that year when I had struggled, after a year when I got the direct self-payment support and she got a place in day centre, after maybe a couple of months I was very, very happy. I thought what I had struggled, what I went through is really worth it.
So that hasn’t changed and you haven’t had to go back and do more assessments.
Naheed Choudhry
I have paperwork that I do every three months that I hand into social department, but I’m quite happy. My daughter’s very happy as well. What she is happy is that she got Bernardo’s workers back.
I did have worries that how will I cope with all this and what will come up next. But after a year it was just a normal routine after three months I would do all this paperwork, hand it back into social work department that’s all.
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You will hear service users, carers and professionals talking about their understanding and experiences of self-directed support.

Self-directed support: what itmeans to you (SCLD )

Discussion

The accounts of service users, carers and professionals in these short videos present a positive picture of self-directed support. Some of the benefits mentioned for service users and carers include:

  • having control over decision-making about care and support
  • being actively involved in designing a service that meets the person's particular needs
  • being able to determine when and how support is provided e.g. to go to the cinema or gym
  • some service users feeling happier or more fulfilled because they were engaged in satisfying activities and relationships
  • opportunities for holidays and short breaks, with or without family members.
  • access to opportunities that otherwise would not be possible e.g. attending college
  • making better use of community resources
  • a better quality of life for carers

You may have thought about a number of challenges while you were watching:

  • Are there sufficient resources to meet everyone’s support needs in this way?
  • What happens if a personal assistant leaves, becomes unwell or does not provide the right kind of support?
  • What happens if a service user is not able to direct their support, and there is no one available to support them to do this safely?
  • How do services work together when people are directing their own support?
  • Won't service users and carers get bogged down with all the jargon and paperwork that could be involved in managing care and support?
  • Isn't it difficult to organise services that work in such flexible and responsive ways?

You will be exploring both the outcomes of forms of personalisation such as self-directed support and these kinds of challenges as you work through this course.

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