Self-directed Support

The Unpacking of Assessments

SCOVI Conference 24th June 2014

Suzanne Abbate

Welcome!1. Provide an overview of the Act and brief historical context.2. Confirm the principles and values of the Social Care (Self-directed

Support) (Scotland) Act 2013 (“The SDS)Act”.3. Help to demystify some aspects of self-directed support assessment4. Consider some of the implications of the duties of Act for

• practitioners• internal support services • partners• users of services

By the end of this session participants will have:• Increased awareness of SDS values, ethos and principles• Increased awareness of the key duties in the SDS Act• An increased awareness of the implications of the key duties for their

role/professional group

What is Self-directed Support?

An exciting and innovative approach to assessment and support planning that encourages collaboration and partnership with people.

Changes how we all do things and what we so to ensure people have more say in how formal support is designed and have control over how it is delivered.

Supported by new statutory duties, values and principles.

An opportunity for authorities, and those delegated to undertake SDS responsibilities to develop creative and more person centred systems and practices.

The Vision• The lives of people who require support are enriched through

greater independence, control, and choice that leads to improved or sustained health and well being, and the best outcomes possible.

• “Self-directed support should become the mainstream approach to the delivery of personal support. Building on the success of direct payments, every person eligible for statutory services should be able to make a genuinely informed choice and have a clear and transparent allocation of resources allowing them to decide how best to meet their needs. The choice should be available to all but imposed on no-one. “

Self-Directed support: A National Strategy, 2010)

Legislative and policy background1968- Social Work (Scotland) Act

‘Deficit’ modelThe state will provide (and decide…)

1990- NHS and Community Care Act (implemented 1993)

1995- Children (Scotland) Act

1995- Carers (Recognition and Services) Act

1996- Human Rights Act 1996- Community Care (Direct Payments) Act 1999- Modernising Social Work -White Paper

2001-Changing Lives 21st Century review of Social Work

2002 -Community Care and Health (Scotland) Act

2010-Equality Act2011- Christie Commission “ nothing about us, without us, is for us”

Influences: Independent living

• The Independent Living Movement started in the 1970s

• People wanted to be in control of their own care and support

• Services weren’t fulfilling what was important to people

• People wanted choice

Definition of Independent Living

The 14 rights:Full access to environmentFull access to transportTechnical aids and equipmentAccessible and adapted housingPersonal assistanceInclusive education and training

The 14 rights (cont’d)

An income, including access to benefits for those unable to work

Equal opportunities for employmentAccessible informationAdvocacy and self-advocacyCounselling, including peer counsellingAccessible and inclusive healthcareCommunication, appropriate communication

supportCivic participation

Co-production

• To do “with not for”• Values/ Assets• Goal focussed.• Person and/ or carer as

partner

9

Discussion

• Think for a few minutes about what choice and control mean to you in how you live your life

then• In pairs; share some of the

themes where choice and control influence (and help)you in your day to day routines.“

• You have 5 minutes

Values Principles FairnessFreedomSafetyIndependenceRespect

InvolvementCollaborationInformed ChoiceParticipation Dignity

The Self- Directed Support Values and Principles (for assessment, arranging support, for carers and supported people

Values and principles -their importance

• Reassurance-The values and principles are already embedded in practice , we know this.

• Drivers for change -They provide a powerful pathway for a shift in control and for innovation at all levels/

• Core and fundamental-give permission for enabling effective partnership and collaboration, different rules , better defined purpose.

What this means in practice ?For people For practitioners For local authorities

• being in control• Being a real partner in

assessment and support planning.

• More flexibility and choice

• Support that fits a person not the service.

• an opportunity to work in partnership.

• An approach that shares responsibility.

• More opportunities to be creative.

• An opportunity to ‘do what you trained for’ work within the values and principles well embedded in social work and in other public services.

• A need to revisit current service design

• A need to revisit current processes (e.g. finance, procurement, commissioning)

• Consideration of where other duties complement and guide the implementation

• An opportunity for new internal and external partnerships

Personal outcomes and goals- a new language for assessment

• Helps highlight the impact of any support put in place

• People are motivated by what matters most to them

• there are infinite ways of achieving outcomes that are both efficient and effective for people and for organisations.

What matters most to people

ChoiceHaving people to

rely on

Seeing friends and family

Treated with dignity and

respect

Feeling valued

Involved in communityFeeling safe

Having things to do

Being in control

Fulfilling ambitions

Keeping well

Assessment for Personal Care• I do not require help to meet my personal care

needs. I can attend to my needs by myself. I don’t regularly need support with things like going to the toilet, washing and dressing and mostly manage by myself.

• I occasionally need help with personal care. I need

someone to help me once a day. For example, someone to prompt me to take a shower or wear the right clothes.

• I need support now and then with personal care. I’m

OK for a while but need help with personal care every 3 or 4 hours.

• I often need help with personal care during the day; I

need someone to be there to help me every hour or so.

• I need a lot of support with personal care (with

washing and going to the toilet). I need someone else to help me at night - during the night - as well as during the day.

A. I am able to meet my personal needs and do not require any support in this area B. I am able to meet my personal care needs with occasional (not every day) physical / gestural / verbal support to maintain independence but ensure essential care needs are met C. I need significant (every day) physical / gestural / verbal support from another to meet my personal care needs To have essential personal care needs met D. I need frequent (several times per day) intimate support to meet my personal care needs To have essential personal care needs met E. I need constant intimate support to meet my personal care needs

Assessment for Eating and Drinking

• I don’t generally need help to eat or to drink.• I can prepare snacks and hot drinks, but need help to

prepare a main meal.• I wouldn’t be able to make a snack for myself / or I

need someone to help me to eat and drink. • • I need lots of help to eat and drink, I need to be fed

and given drinks or need to be supported to make sure I have enough to eat or don’t eat too much.

Assessments for Daily living• I don’t need help with very much

around the home• I need help weekly with some things

around the home for example, I need some help with shopping, laundry, housework, managing finances, paying bills and general home maintenance

• I need help a few times a week with some things around the home : I need help every other day with practical tasks as I can’t currently attend to these.

• I need a lot of help every day and with most things around the home: I need lots of help with my shopping, laundry, housework, managing finances, paying bills and general home maintenance.

A. I do not need support in this aspect of my life or I do not have my own tenancy and I am not planning on having my own tenancy

B. I need occasional (once a week or less) support to run and maintain my home To maintain my tenancy and manage the day to day tasks involved in running a home C. I need regular (e.g. At least once a week) support to run and maintain my home To maintain my tenancy and manage day to day tasks involved in running a home D. I need frequent (several times per week) support to run and maintain my home To maintain my tenancy and manage the day to day tasks involved in running a home E. I always need significant (every day) support to run and maintain my home

What do you think about SDS?

In pairs/ at your tables take 5 minutes to discuss what you think SDS will mean for people who live with visual impairments or deafblindness.

What’s new? the six duties 1. We must have regard to the general principles stated the Act when

carrying out assessment and the provision of support.

2. Power to provide support to carers(of adults) following carers assessment .

3. We have a duty to offer 4 choices to persons assessed as eligible for funded support to how that support is delivered:

– Option 1 direct payment

– Option 2 the person directs the available support

– Option 3 the local authority arranges the support

– Option 4 a mix of the above.

4. We must take steps to explain the ‘nature and effect’ of each option.

5. We must provide information, assistance and support – to express any views (how to manage the support and where to get help.)

6. We must, as far as is reasonably practicable, promote a range of providers and types of support (commissioning/procurement.)

Group Exercise

Identify some of the benefits that this will bring for the

people who require support

You have 5 minutes

Any questions, comments or observations?

Who can be offered the 4 options?

• The offer of the 4 options can be given to anyone who is eligible for social care funded support.This is only available after a full outcomes focussed assessment has been completedAND after alternative supports have been explored (natural supports, universals services, re-enablement support

Are there exceptions?

• Local authority have discretionary powers to not offer option 1 and 4 in these circumstances:

• People in Residential Care (Option 1)

• Person whose safety is at risk (Option 1 or 4)

When will it start?

• The Act commenced in April 2014

• The duties will apply from April to people new to the system

• People already receiving services or who are “in the systems” must be offered the four options when their package is reviewed

How SDS fits with other legislation

• The SDS Act does not replace any of our existing duties.

• The SDS Act aims to complement and support other legislation.

• There may at times be conflict between duties within other legislation that will require to be negotiated.

• Protective duties will remain paramount. • SDS Act resonates strongly with Human Rights and

Equalities legislation.• Statutory Guidance is available aims to support

implementation and inform practice.

Chronically Sick and Disabled Person’s

Act 1972

Human Rights

Act 1998

Equalities Act 2010

Data Protection Act 1998

Local Government in Scotland Act 2003

Freedom of Information

Scotland Act 2002

Education Scotland

Additional Support for Learning Act

2009

Public Service Reform

Scotland 2010

Children’s Hearings Act 2011

Children Scotland Act 1995

Adults with

Incapacity Scotland Act 2000

Mental Health Care &

Treatment Act 2003Social

Work Scotland Act 1968

Direct Payment Act 1996

Protection of

Vulnerable Groups

Scotland Act 2007

Disability Discriminat

ion Act 1995

Patients Rights

Scotland Act 2011

Domestic Abuse

Scotland Act 2011

NHS & Community

Care (Scotland) Act 1990

Adult Support & Protection Act 2007

Welfare Reform Act

2012

Housing Scotland Act 2010National

Assistance Act 1948 Regulation

of Care Scotland Act 2001

Community Care &

Health Act Scotland

2002Social Care (Self-directed Support)

(Scotland) Act 2013

In Summary

• The majority of legal powers and duties will fall to local authorities. • Where a health board is discharging social care duties on a

delegated basis the duties in the Act apply.• Duties and legally binding and cannot be ignored. • Self directed support, is intended to support, promote and protect

human rights.• Support should be delivered in a way that supports choice and

control.• Cultural and system change will be required to support successful

implementation. • It is complicated but legislation, statutory and best practice

guidance is there inform practice.

Useful links

• Statutory Guidance & Regulations ‘The Social Care (Self-Directed Support) (Scotland) Act 2013’ – Scottish Government http://www.scotland.gov.uk/Publications/2013/11/3923

• Current eligibility for adults in Scotland http://www.scotland.gov.uk/topics/health/suphttp://www.careandhealthlaw.com/Public/LawDatabaseCasesDesc.aspx?IndexType=2&Id=171port-social-care/support/older.people/free-personal nursing-care/guidance

• Self-Directed Support Scotland http://www.sdsscotland.org.uk/

• A Guide to Receiving Direct Payments (Scotland) NHS http://www.sehd.scot.nhs.uk/publications/grdps/grdps-01.htm

• Disability Rights UK www.disabilityrightsuk.org

• Belinda Schwehr – Legal judgments for England that can support SDS delivery in Scotland http://www.careandhealthlaw.com/Public/LawDatabaseCasesDesc.aspx?IndexType=2&Id=171

Thank you for your time, thoughts and attention today

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