1.11 What does self-directed support mean in practice?
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.
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 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?
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
You will hear service users, carers and professionals talking about their understanding and experiences of self-directed support.
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.