Cornes, M

Gray, Bill

Hunter, S

Kinder, T

Little, S

Manthorpe, J

Ridley, Julie

Rosengard, A

Spandler, Helen

English

CLoK

Main Findings■ Those who accessed SDS packages during the test sites, were positive about their support and satisfied with the flexibilityand choice that SDS had provided.   ■ The test sites improved access to SDS especially for people with learning disabilities, but did little to promote SDS to othergroups, for example, those with mental health problems, from Black or Minority Ethnic groups, older people, those who haveaddictions or homeless people. ■ In spite of considerable Scottish Government investment in SDS test sites, fewer than 150 new individual SDS arrangementswere set up. This suggests that significant time and investment in infrastructure are needed to implement major policyinitiatives.  ■ None of the test sites had directly addressed issues around mixed funding packages, so the potential to integrate or join upfunding streams e.g. with the NHS, could not be assessed.  ■ The paradox at the heart of SDS was a (mis)perception by staff, service users, and carers of SDS as an alternative to, directservices and even, Direct Payments (DPs).  New and parallel SDS systems to those delivering DPs were created by the testsites.  ■ Active promotion of SDS, including DPs, increased the numbers of people opting for payments instead of direct services topay for more flexible, individualised care and support. ■ All test sites invested in specialist SDS teams and project managers to support development of new systems andadministrative processes, as well as generating a body of practice expertise.  Consequently, some service users, carers andprofessionals perceived SDS as separate to both Social Work support and DPs.■ None of the test sites was able to cut ‘red tape’ or reduce bureaucratic or administrative requirements. Instead, by designingnew support systems for SDS, they experienced a (possibly temporary) increase in bureaucracy associated with assessmentand resource allocation. ■ Only one of the test sites used test site monies to invest in strategic service development.■ By the end of the test site period the 3 local authorities had resolved to move towards mainstreaming SDS with support fromtheir senior management and Councillors.Evaluation of Self-Directed Support Test Sites in Scotland Julie Ridley, Helen Spandler, Ann Rosengard, Simon Little, Michelle Cornes, Jill Manthorpe, Susan Hunter, TonyKinder & Bill GrayHealth and Community CareResearch FindingsNo.109/2011This evaluative study was commissioned to assess the impact of interventions implemented within 3 local authority test sitesto improve uptake of self-directed support (SDS).  The study, which lasted 2 years, used a mix of methods to involve andconsult service users, carers, social care professionals and representatives of various national organisations.  While careshould be taken in generalising the findings to other areas, our literature review clarified that many of the issues andchallenges that emerged were similar to, and reflect challenges other local authorities may encounter.IntroductionThis evaluation investigated how 3 local authority test sitesimplemented key Scottish Government themes to improveuptake of self-directed support (SDS), starting with abaseline assessment, and examining how and what theyimplemented.  The study also explored the issues that arosefor the test sites, and how their activities impacted uponservice users’ and carers’ experience, as well as the work offrontline social work staff. The evaluation brief was to: ■ Describe current SDS policy, activity and practice;■ Develop the evaluation tools with test site managers■ Examine the extent to which each test site addressed 3key areas■ Assess the impact of the 3 interventions in each test sitein progressing SDS■ Identify implications for policy and practice within thewider context■ Disseminate to relevant stakeholders. Policy ContextPromoting self-directed support (SDS) is part of the ScottishGovernment’s wider programme to increase individuals’choice and control over their community care and supportarrangements.  SDS is an approach to delivering care and support that isembedded within wider policy frameworks including those ofsocial inclusion, participation and more recently, ‘co-production’.  As an umbrella term, SDS encompasses manyconcepts and practices in social care including DirectPayments (DPs), as well as Individual Budgets (IBs).  DPs arepayments in lieu of services provided directly to individualsassessed as being in need of community care services.  IBsenable individuals to either purchase their own supportpackages to meet their assessed personal, social, and to alesser extent, healthcare needs, or at least to determine howthis budget will be spent on their support.Since the Community Care and Health (Scotland) Act 2002,it has been mandatory for everyone entitled to publiclyfunded community care services, with a few exclusions, tobe offered the option of a DP by the local authority.  While theearly evidence base shows that those in receipt of DPsgenerally consider the benefits far outweigh the challenges(Homer & Gilder, 2008; Witcher et al, 2000), implementationhas been slow in Scotland.  Research has continued tohighlight differences in uptake across community caregroups:  people with physical disabilities who are under 65years are still more likely to be in receipt of DPs than anyother group (Scottish Government Statistics, 2010). As part of its activities to promote SDS, the ScottishGovernment selected 3 local authorities – Dumfries &Galloway, City of Glasgow and Highland – to act as test sitesto trial targeted activities to address 3 themes in order toincrease the uptake of SDS.  The 3 target themes –leadership and training; cutting ‘red tape’; and bridgingfinance – were based on past research.  The test sites werefunded between January 2009 and March 2011).SDS: An Evolving ConceptA fundamental issue from the start of the test sites and theevaluation was that SDS was an evolving concept, and therewere different ideas about what it was.  Initially, SDS and DPswere referred to almost synonymously.  There was muchdebate between the test sites and Scottish Governmentabout SDS and what this should mean in the test sites.  The consensus of opinion from early stakeholder interviewsat national and local levels, was that SDS refers to aspectrum of options ranging from the ‘sharpness’ or ‘purity’of DPs at one end to more individually tailored local authorityprovided services at the other.  The key requirement,regardless of the mechanism chosen to deliver the support,was that the individual could exercise more choice andcontrol over his/her social care than had previously beenpossible.  During the lifetime of the research, Scottish Government andCOSLA published a 10-year strategy for SDS in Scotland,which aimed to set out and drive a cultural shift towards SDSbecoming the mainstream approach in social care.  Thenational Strategy defines SDS as: “The process for deciding on support through SDS is throughco-production…The mechanisms for getting support throughSDS can be through a Direct Payment (DP) or through theperson deciding how their individual budget is allocated bythe council to arrange support from a provider….” (ScottishGovernment, 2010, p7).Given such a broad definition the evaluation needed to movefrom simply counting numbers of DPs to looking at individualexperiences, as well as the processes set up to implementan SDS approach.  Stage 1: BaselineA key finding at this stage was that at local test site level,and to an extent at the national level, DPs were perceived asfailing to deliver choice, flexibility and control and  to beoverly prescriptive, bureaucratic, and using ‘old style’ caremanagement processes.  2Across Scotland, implementation of SDS, and DPs inparticular, was inconsistent.  Local leadership to promoteSDS via DPs was perceived to vary greatly, and, other thansome notable exceptions, local authorities had not taken astrategic or holistic approach to implementing SDS.  Inadequate, or even non-existent, support infrastructures forservice users and carers were a major barrier toimplementing SDS across Scotland.  Linked to this, was theview that at local level in particular, the development of SDSpolicy had not enlisted sufficient input from service user andcarer organisations and was in danger of being professional-led.  Some service user and carer groups were thussceptical that implementing SDS was a cost-cutting exercise.  Stage 2: Evaluating Process &ImpactWhile operational definitions of SDS were broader than DPs,in practice, the majority of SDS packages in all 3 test sitesinvolved a cash transfer, either direct to the service user ora third party, usually a family member.  However, there wasa misperception by service users, carers and staff that SDSwas an alternative to DPs, and test sites ran parallel SDS andDP systems throughout the period.  All 3 test sites created a project lead/manager role and thispost was critical to taking developments forward.  They alsoall created SDS teams and had project boards, althoughGlasgow initially planned for the project manager to workwith existing teams.  While this strategy worked well for thetest sites in relation to supporting the small numbers ofservice users and staff involved with new systems, it mayhave limited the extent of systemic change.  In relation to cutting red tape, the local SDS teams’ effortswent into designing or re-designing systems for assessmentand resource allocation that were more ‘fit for purpose’,which in all cases created a parallel, and therefore, additionalbureaucracy.  In the short term, this was felt to be necessaryuntil new systems were accepted and assimilated into thelocal authority but it did create an additional burden forservice users and staff.  On the whole, test site activities were short on specificsregarding addressing the theme of bridging finance.  Theimpact of this theme was therefore, difficult to ascertain.  Individual Experiences of SDSWhile the experience of the quality of assessment processesvaried, overall, carers and service users interviewed felt theassessment had been comprehensive and inclusive, withoutcomes based upon what the individual wanted.  Therewere, however, differences between the test sites in thedegree of flexibility experienced in terms of, for example,employing relatives and the appropriateness of fundingparticular activities. SDS had expanded choice and control for the vast majorityof those we interviewed.  More flexible support was beingoffered and there were positive outcomes for individuals.From the individual accounts however, it was not alwaysclear whether positive comments related solely to the modelof SDS or because the test sites had enabled access tosome who had not been eligible for services previously, or tohigher levels of social work support.  Stage 3: Implications andlessonsGiven that some similar concerns emerged across all 3 testsites, it seems likely that these are not specific to the testsites but are more general challenges facing all localauthorities attempting to make changes in the direction ofSDS. The implementation of SDS using a managerial and projectbased model rather than a strategic approach hadlimitations:  a specialist SDS or personalisation teamoffered expertise and management of the ‘SDS project’ butalso created the impression that SDS was separate from,and operated differently to, the local authority and othersystems, such as DPs.  There was a risk of unhelpfulduplication and confusion.  Unless senior managers take alead role, there is always the danger that initiatives will bemarginalised, regardless of the commitment of thosemanaging and involved in it.The new SDS processes created by the test sites workedextremely well overall for the selected individuals whobenefited from SDS during the test site period, offeringincreased choice, flexibility and control.  The uptake of SDSand of DPs had increased as a result, and through the workof dedicated teams, the local authorities found they couldbe more creative and innovative in the ways they workedwith people.  The key issue now is maintaining suchinnovation and flexibility for greater numbers of individuals.  Clearly involvement of service user and carer organisationsand investment in the necessary support infrastructures areessential as well as continued availability of funding for thecare packages themselves.  In the foreword to the nationalStrategy, political leaders state that “more of the same willnot work”.  It will be essential therefore for all localauthorities to grapple with the challenges faced by thesetest sites, and to find a way to implement this shift fromexisting service provision to greater involvement and co-production of care and support.  The outcomes of thisStrategy are worthy of continuing assessment.  3This document, along with full research report of the project, and further information about social and policyresearch commissioned and published on behalf of the Scottish Government, can be viewed on the Internet at:http://www.scotland.gov.uk/socialresearch.  If you have any further queries about social research, or would like further copies of this research findings summary document, please contact us atsocialresearch@scotland.gsi.gov.uk or on 0131-244 7560. 4ISBN 978-1-78045-416-09 781780 454160Research Design & MethodsThe evaluation had 3 main stages: Stage 1) establishing thebaseline; Stage 2) evaluating process and impact; and Stage3) reflecting on findings for wider policy and practice.Various methods were used to gather data including: ■ Literature review (Manthorpe et al 2011)■ Collation and analysis of secondary information about SDSand community care services■ Interviews with test site local stakeholders ■ Interviews with national stakeholders■ Learning Sets in each test site ■ Monitoring framework – quarterly monitoring of test siteaction plans and collection of test site information aboutrecipients of SDS packages ■ Case studies – 30 individuals, their carers andassessors/care managers were interviewed■ Evaluation stakeholder event -March 2011■ Analysis of all findings from the test sites.Although a cost-analysis of the test sites was not possible forvarious reasons, interviews were conducted with financeofficers in the 3 sites at Stages 1 and 2, to discuss theirperspectives, especially about how national (CIPFA)guidelines on introducing ‘light touch’ monitoring were beingimplemented by the test sites.  Also, although not a keyrequirement of the evaluation brief, the relationship betweenAdult Protection (AP) and SDS was explored in very generalterms and this revealed that greater links needed to be madebetween these areas of work.ReferencesHomer, T. & Gilder, P. (2008), A Review of Self DirectedSupport in Scotland, Social Research Report, Edinburgh:Scottish Government. Manthorpe, J., Hindes, J., Martineau, S., Cornes, M., Ridley,J., Rosengard, A., Hunter, S., Little, S. & Gray, B. (2011) SelfDirected Support: A Review of the Barriers and Facilitators,Edinburgh, Scottish Government Social Research. Scottish Government (2010), Self-directed Support (DirectPayments), Scotland, 2010, A National Statistics Publicationfor Scotland, Edinburgh: Scottish Government.   Scottish Government (2010), Self Directed Support: ANational Strategy for Scotland, Edinburgh: The ScottishGovernment.Witcher, S., Stalker, K., Roadburg, M., & Jones, C. 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Self-directed Support (Direct Payments),

Evaluation of self directed support test sites in Scotland

Evaluation of self directed support test sites in Scotland

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