Self-directed Support; a slow burner

Colin reflects on new Scottish Government statistics which shed light on the implementation of Self-directed Support (SDS).

Being a strong advocate of Self-directed Support I welcome the, albeit slight, increase in the number of people making an informed choice over their social care in the past year.  New Scottish Government statistics released in June show that 27 per cent of people who access social care had been given the option of how their support is delivered through SDS.  This is up 7 per cent on the first annual statistical release published in June 2016, which would indicate that there is a steady adoption of SDS nationally across Scotland.

However, at risk of repeating a comment I made last year, having less than a third of recipients of social care receiving their support through SDS after 7 years into the SDS strategy does not inspire confidence that the ambition of the Scottish Government to offer choice and control to those accessing social care by 2020 will be met.

It is equally discouraging that Option 3 of SDS, which typically suggests the continuation of local authority provided services, remains the most chosen option at 75 per cent.  While I accept that in principle all options should be offered in such a way that empowers all recipients of social care to have choice and control, the ALLIANCE has found, through research with over 100 people accessing social care, that those on Option 3 were the least likely to have been informed of their rights to choose support that best meets their needs.  This has implications for understanding people’s preferences for using their support to meet their desired outcomes.

Looking at how people use their SDS broken down by which option they chose, the ALLIANCE found that the largest group, around 70 per cent, of those on Option 1 use their budget for personal care, which is much higher than those on Options 2 and 3. These findings could suggest that the more control people have over who and how their support is provided, the wider a range of support services they will choose and the more likely they are to use it to meet their personal care needs.  However, with Scottish Government statistics showing that Local Authorities continue to be the predominant support mechanism, further exploration is needed to determine how people are using Local Authority services and whether such use is in accordance with the principle of control enshrined in the Social Care (Self-directed Support) (Scotland) Act 2013.

Interestingly, when comparing the proportion of SDS users by the ‘client groups’ in which they fall, there has been a decrease or no change in most categories in the proportion of people accessing their social care through SDS, such as people with a physical disability and those with dementia.  The only category, apart from ‘other’, that has increased the proportion of ‘clients’ on SDS is ‘Frail Older People’.  This would be somewhat welcomed, because older people have been less represented in accessing SDS even though they are the requiring social care, if it weren’t for my more sceptical side which would urge caution.

Cross-referenced with the proportion of older people on each option, the fact that 87 per cent are on Option 3 could suggest that the rise in the number of older people being assessed for SDS is not matched by the proportion of those having made an informed choice that could have increased their control over how their support is delivered.  It is difficult to compare the Scottish Government’s statistics with the ALLIANCE’s findings, without data referring to individuals’ satisfaction levels, but we found that people who were 65 and over who had been moved on to Option 1 and 2 had greatly increased satisfaction from their social care.

Due to the disparities between data sets published by the Scottish Government and the ALLIANCE, it is difficult to draw direct comparison.  There are however key points to be taken from both, namely the encouraging proportion of people who are aware of SDS, as shown through the ALLIANCE’s research, and a steady growth of people making a choice of support demonstrated by the Government’s statistics, which suggests that we are heading in the right direction.  Going forward, we need to be mindful however not to see increased uptake and awareness of SDS as an indication of successful implementation, but to dig deeper into whether its uptake is enabling people to be in control of their support.

While it has been acknowledged that there has been a slight increase in the number of people who have had a choice over their SDS, the ALLIANCE’s first recommendation to come out of the ‘Personal Experiences of SDS’ report still stands.  We believe that the Scottish Government has a role to play in encouraging Local Authorities to progress the implementation of SDS throughout Scotland.  However, this must be backed up by robust evidence that implementation is leading to people having increased choice and control over their support.  That is why the ALLIANCE is recommending that in-depth qualitative research is regularly conducted in order to ensure that the ambitions of the SDS strategy are being realised in the day-to-day lives of disabled people.

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