“Self-directed support”
As members have indicated that they do not want to take a break just now, we will just press on.
We have a section 23 report on self-directed support. We have with us Caroline Gardner, the Auditor General for Scotland, who is accompanied by Fraser McKinlay, director and controller of audit, Claire Sweeney and Cathy MacGregor.
Welcome, Auditor General. Would you like to make an opening statement?
The report that we bring to the committee today looks at progress with implementation of a policy called self-directed support.
Self-directed support is a major change to the way in which people who have social care needs are supported in Scotland. It affects vital services that help people who have care needs, such as older people and people who have disabilities, to live their lives as fully as they can. To make the new policy work, people who need support will work as equal partners with professionals to plan their care, which might be delivered through different or innovative services or services that are more tailored to their individual and specific needs.
The Scottish Government and COSLA launched a 10-year strategy for self-directed support in 2010. The Social Care (Self-directed Support) (Scotland) Act 2013 was developed as part of that strategy. The act places a duty on councils from April this year to offer people who are newly assessed as needing social care a wider range of options for choosing and controlling their support. People who were already receiving social care before April this year will be offered those options the next time their needs are reviewed, but people who are newly assessed as needing care are now entitled to access the new way of planning and managing their support. The Scottish Government has allocated £42.2 million to help councils to prepare for self-directed support, and the intention is that it will reshape the way in which the annual total of £2.8 billion is spent on those services by councils across Scotland.
The report that is before the committee assesses readiness for the act together with progress in implementing the self-directed support strategy three years on. Implementation is at a relatively early stage and the report is intended to examine progress and help with implementation during the next few years. The report identifies risks, highlights examples of good practice and makes a series of recommendations for the Scottish Government and councils. The report is also relevant to the new integrated health and social care partnerships. NHS boards and councils need to be clear about the implications of self-directed support before they put their new partnership arrangements in place locally.
The report highlights that there is still a lot of work to do. Progress among councils varies. Some will have to move more quickly during the next few years to put in place the required cultural and practical changes. To do that, councils will need continuing support from the Scottish Government along with effective leadership from senior managers and councillors.
We found that councils have adopted different methods for allocating what they spend on social care support to people who have care needs. Exhibit 6 on page 33 of the report summarises each model, together with the risks and advantages of each. Councils also need to consider a series of broader financial risks as they implement self-directed support and the new ways of allocating money that it brings. Exhibit 7 on pages 36 and 37 provides more details. Councils need to manage those risks carefully so that they are managing their budgets well and ensuring that they do not unnecessarily limit people’s choice and control over the support that they receive.
Social care professionals have welcomed the self-directed support policy because it has the potential to improve the quality of people’s lives. Self-directed support will work best if a range of services and support is available locally so that people can choose the support that they receive. We highlight in the report that councils now need to work more closely with people who need support, and with their carers, providers and local communities, to develop those choices.
The report makes a number of recommendations to improve the implementation of self-directed support over the next few years as it comes fully into effect. We recommend that the Scottish Government should have a strategy to measure and report on progress and be able to demonstrate the effect that the policy is having on the lives of people with care needs. The Government should also continue to co-ordinate guidance and information to help councils with challenging areas and issues that they need to deal with as self-directed support is rolled out.
The report also highlights issues for councils and NHS boards to consider as they establish their new partnership arrangements for health and social care under the Public Bodies (Joint Working) (Scotland) Act 2014, which comes into effect this year.
As always, my colleagues and I are happy to answer questions.
Does Willie Coffey want to come in? I am aware that he was curtailed earlier.
Thanks, convener.
On the transitional funding of £42 million, is it still too early to indicate whether gains have been made? I know that quite a lot of the money has been allocated to providing the transition framework and so on to effect the changes, but how soon can we expect to see savings?
The £42 million runs over a four-year period that ends this year, in 2014-15, so in many ways it is not too soon to say what it has been spent on. We know that, for example, every council has used at least some of the money that it has received to put in place a co-ordinator for self-directed support. Most of the money for councils has been put into new staff and staff training to develop SDS.
What we do not know is the difference that that £42 million makes to the lives of people with care needs. That is why the recommendation about moving on from the seven success factors that the Government has identified for the policy, which are good and clear, to the measures that it will use to demonstrate the impact on people’s lives is so important. That is what the policy is all about. It is about reshaping the way in which the £2.8 billion is managed and spent in future, rather than the way in which the £42 million is used to influence that. That is the bigger issue.
When might we see evidence of that gain? Will it be next year, or the year after?
The Government is currently producing the measures that are intended to underpin the seven success factors that we set out in the report. I think that it is committed to starting to publish that information this year, so we will start to get the information. I expect that it will take a while for it to show the difference that is being made. Claire Sweeney may want to add to that.
The self-directed support options will be fully offered to people who are coming up for assessment. We heard from our case study councils that it will take a little while to get everybody through that system as their care needs are reassessed. It will take time for that to be offered to everybody with particular care needs in Scotland.
My second question is on risk assessment. Auditor General, your reports are always full of good recommendations for local authorities or whoever. At the back of the report, there is extensive advice on things such as risk assessment, risk planning and mitigation. Are the risk assessments that you produce shared and commonly held by the authorities to which you are delivering the message? You always talk about the need to plan and be aware of risk. Do you find that the commentary at the back of a report such as this is shared by the authorities that are charged with implementing the processes?
As always, the situation varies. We do not rely just on what is in the report. For most of our reports, we now also produce things such as checklists for elected members or NHS board members of the questions that they should ask in carrying out the role that you talked about with Douglas Sinclair earlier. We know from the follow-up work that our auditors do that some health boards and councils are great at picking those up and working through the implications, whereas others perhaps do not give it as much attention. One thing that we are focusing on as we think about our new strategy for public audit is how we can help to make a difference on that in future.
The report makes a number of comments about the fact that moving to SDS is not about providing services more cheaply, but it is happening at a time of falling budgets. Paragraph 11 of the report points out that
“council spending on social care services decreased by five per cent in real terms, from £2.97 billion to £2.84 billion”.
That was in just a few years. Have you been able to assess whether that is a concern that users and clients have about the move to SDS? Is that situation creating anxiety? Is it colouring their perception of the change to SDS?
I will ask Claire Sweeney to come in shortly and give you a bit more colour on that, but it is clearly one of the risks. The consensus among everybody involved is that, in principle, this is a great policy. Giving people who need care more choice and more say in the sort of support that they need and where it comes from can only be a good thing in helping them to live lives that are as near to what we all expect as possible, but doing that is tougher when money is tight and likely to continue to be so.
One thing that we think is key is the way in which councils and their partners in the NHS talk to the people who are directly affected, to the third sector and private organisations that are involved in delivering care services and to communities more widely about what the policy is about and involve them in shaping it. The report gives some examples of where that has been done really well and where it has been done less well, at least initially.
The suspicions that you describe have really picked up and, in some cases, have overshadowed the potential of the policy. That is not to say that the financial challenges are not real—they are and they will continue to be so, because of the financial constraints that we expect for the foreseeable future and the growing number of older people, in particular, who need care. Involving people, at individual level and at community level, so that they can understand SDS and help to shape it is key.
I ask Claire Sweeney whether she wants to add to my comments.
There are two aspects. There has to be a conversation with the local community about the services that they want and that need to be in place locally, but what also came through strongly when we carried out the work and talked to people who are involved in delivering front-line services is that there is a real passion for the increased focus on the quality of the conversation with the individual about their needs.
The report highlights that there are different points during that process when the money might be talked about. We saw that happening very differently across Scotland in the case study areas. In some areas, the money is not discussed until much later in the conversation about people’s needs and in others it happens much earlier. As we have said, it is about what comes first and it is about the focus. The principle of the policy is about putting the focus on assessing people’s needs and working out how best to meet those needs in ways that suit the person. There is a lot of enthusiasm about the policy’s potential among people who are involved in delivering services and among people who receive them.
Another issue that you raise is about monitoring the success of the policy. In paragraph 36 onwards and in exhibit 4, the report refers to the measures of success. However, from what I see, at national level we do not seem to be measuring the percentage take-up of SDS or any milestones related to the percentage take-up along the way over the 10-year journey. Is that right?
We say in paragraph 38 that the Scottish Government is putting in place some measures that will let it assess progress against what are probably better called success factors, which are set out in exhibit 4. That work is under way, and the Scottish Government intends to publish that information from 2014 onwards.
Our recommendation makes the same point: the right success factor has to be that the policy delivers a better quality of life for individuals. However, how that is measured needs careful thought. More work, which is not yet complete, is required to demonstrate that the policy is doing that in ways that are manageable within the available resources and that are leading to new and more flexible services that better meet people’s needs. We think that that is key and we are told that the work is under way this year.
Paragraph 18 indicates that the number of people who have taken up direct payments is very small. Are you surprised by how small it is?
11:00
In some ways, I am surprised. It is important that we distinguish between direct payments and the wider objectives of the self-directed support policy. Given that direct payments have been in place for more than 10 years—they have been around for a long time—it is surprising that, as we say in the report, only 5,400 people received such payments in 2012-13. That is less than 5 per cent of the people who receive social care and accounts for only about 2 per cent of the money that is spent on social care, so it is a very small proportion.
We say in the report that figures are not available on people who receive what we describe as option 2, under which people have much more flexibility about the services that they receive to meet their needs but the council continues to manage the budget. There is no indication of the number of people who use that option. That is another important measure for understanding how well the policy is being rolled out and starting to understand its effect on people’s lives.
It is true that the self-directed support policy is a recognition that direct payments probably are not having the intended impact. The policy provides more flexibility in how money is used and gives people the option to have flexibility without taking the whole responsibility for managing a budget if they do not want to do that.
We do not know how many people have been asked whether they want to move to SDS, but we know that only 5 per cent are on direct payments. Do we know how many people have been taken through the process and declined direct payments but gone for council provision of services?
We do not know that in relation to direct payments. Offering self-directed support became a requirement for people who are newly assessed as requiring care only from April this year. The big unknown is the number of people who might have been in the category that you describe and the number who are entirely new to sitting down with a professional and talking through what they want their lives to look like and the care support that would help them to achieve that.
We looked at self-directed support early so that we could look at readiness for the 2013 act’s implications. When we carried out the work, we saw that arrangements are in place. Councils should be in a position to offer self-directed support to newly assessed people, in line with the act.
The bigger issue is the wholesale cultural change to deliver services differently. That involves different ways of working with people to assess their needs and think about options that have not been tried before. We saw good examples of innovative practice, but the cultural change will make the approach a success, which will take time.
Do you wish to see milestones? New applicants are being offered SDS, but do you expect the Government to set a number of existing service users who should be offered SDS?
The agreement between the Government and COSLA says that self-directed support is a long-term policy and that the 10 years from 2010 to 2020 are the window for embedding it fully with the cultural changes that Claire Sweeney talked about. When we did the audit work, the councils that we talked to pretty uniformly said that they expect to get through people who receive care in the more traditional way and give them the choice of the newer way—self-directed support—within the next three or four years.
It might help to make that expectation clearer, if that is agreed between COSLA and the Government. There will be challenges, because of the potential knock-on effect on existing services and the need to manage budgets in ways that are not fully understood at this stage, because they depend on people’s preferences and needs.
One of my questions has been answered in the responses to Ken Macintosh. The point is that self-directed support is not new; it was part of the Regulation of Care (Scotland) Act 2001, and regulations on direct payments were made in 2003. The approach is 11 years old and we are now four years into a 10-year strategy.
My experience is that anyone who has applied for direct payments in the past 11 years has done so mainly because they were dissatisfied with council services. That was not a positive move; it was done because people did not get the home care time that accorded with their assessment. That also led to accusations that councils wanted to retain their monopoly on provision.
The report says that, of the 152,000 people who receive social care services, 5,400 receive direct payments. Why do only 3 per cent of people control their home care? The first paragraph on page 5 says:
“SDS is based on ... fairness, respect, equality, dignity and autonomy for all.”
Every party supports that, but when I look at exhibit 7, I understand why things are difficult for local councils. Obviously, if they employ home care staff, they want to ensure that those staff have the hours of work; they do not want to make them redundant. I note that councils need to address a number of significant financial risks in implementing self-directed support.
After 11 years of legislation, why are only 3 per cent of people in control of their own home care and support? You have outlined on two pages of the report the financial risks that councils face. Do you think that your report and the financial risks will probably not lead to a significant increase in that number? Will they be an obstacle to more people taking up self-directed support over the next six years of the strategy?
I will deal with the first question and then ask colleagues to pick up the second one.
You are absolutely right: direct payments are not new at all. They have been around for more than 10 years, and take-up has been low. I think that that is because the direct payments policy was really about social work services saying, “We’ll carry on providing services as we have always done, but if you would like to take your share of the money, you can spend it as you will.” What is different about self-directed support is that the starting point for all that social care should be the needs and preferences of the individual, which puts them in the driving seat. Rather than being an opt-out, as I think you rightly described it, from the mainstream services, self-directed support turns that on its head and puts the person who needs care in the driving seat. It does not say to everybody, “You must take a budget and manage it,” although that is one available option. The second option is to say, “We’ll assess the budget and manage it on your behalf in conversation with you, or you can carry on as before and tap into the traditional services that we have offered, if that suits you.”
My expectation is that the approach will lead to much greater take-up, because it changes the starting point and works along from there. That must be a good thing: it gives people more choice and reflects the fact that we are all different and that different things matter to us. However, as you rightly said, it brings real challenges and risks that councils need to manage to be able to protect individuals and keep their services and budgets sustainable.
I ask Fraser McKinlay to pick up the second question and colleagues to chip in, if that would help.
To emphasise Caroline Gardner’s point, we tried to set out the self-directed support process in exhibit 1. It took me a while to get my head around the fact that it is not really a choice of taking self-directed support or not. Self-directed support is a completely different way of providing services. In a sense, the top line of the graphic in exhibit 1 is almost the more important bit of the process. That is where the really significant cultural change comes in. As was said, most of the different ways of delivering, shown in the bottom line of the graphic, are kind of in place, with the exception of option 2, which is a bit newer. The really big change is the whole process of discussion and starting with the user.
In that context, as Mary Scanlon rightly pointed out, we have tried in exhibit 7 to point out some of the things that councils and others need to think about when delivering SDS. However, the starting point must be the needs of the service user; everything follows from that. The important thing is the pretty fundamental mindset shift.
I cannot remember the 2001 act, but I seem to remember that either the council had a duty to provide or individuals had a right to ask. I cannot quite remember the balance, but I appreciate that things have gone further. A lot of work went into direct payments, and 11 years later, we have a figure of 3 per cent take-up, which is pretty disappointing.
My final question is about one of your key recommendations. The report says:
“The Scottish Government should ... engage and maintain contact with COSLA”
and
“the Association of Directors of Social Work”
to co-ordinate guidance and information to support self-directed services. The Government should also have
“a strategy to measure and report”.
Why is that a recommendation? Would we not expect the Government to do that anyway?
We would. The committee has focused in the past on strategies for measuring policies not always being robust enough to demonstrate that the policies are having the intended impact on people’s lives. That is almost always because that is difficult to do. For a policy as fundamental as this one, however, which can have such a significant effect on the lives of vulnerable people in society, we think it key that the Government moves beyond the general and laudable success factors on to how it will be possible for it to demonstrate that the policy is giving people much more choice over services and having an effect on their ability to live the lives that we would all hope to live.
I will pick up the Accounts Commission’s earlier evidence about leadership and the understandable points that Douglas Sinclair made about the corporate responsibilities of senior elected members and senior council officials. If I read paragraph 26 right, it says that, over the past couple of years, only nine out of 32 councils are providing detailed updates to their elected members through committee papers. Is that not a damning indictment of exactly what Douglas Sinclair was talking about?
For a policy that is this fundamental to the provision of social care and how it is thought about, we would expect, at all councils, officers to be engaged fully with councillors about how the service is being planned and delivered locally, the progress that is being made with that and the results that the service is having.
We say in the report that there is a lot for councils to do in general. It is also the case that some are doing better than others. This is a great example of a policy where you would expect a continuing discussion between members and officers.
Absolutely. In a year’s time, will the other 23 councils that do not provide information to their elected members do so? What will make them do that?
This report is a contribution to that. The local auditors that the commission appoints to all 32 councils will be keeping an eye on the situation because of the policy’s impact on people’s lives and the financial risks that it brings.
I agree. As Claire Sweeney said, we are looking at the matter relatively early on in the formal implementation of the policy and, therefore, without pre-judging any decisions that the Auditor General and the commission might want to make, it would be surprising if we did not want to return to the issue at some point in the next few years.
As Mary Scanlon rightly said, we are four years into a 10-year strategy, but 23 councils are not considering the matter regularly.
Indeed.
There is something way wrong there, is there not?
As you say, given the fundamental nature of the change, we would expect the situation to be better than that for sure.
On that same point, is it not the case that one issue that councillors are getting a lot of information on, both from their council and the NHS, is the integration of social care. Does that not rank higher than self-directed support in the context of priorities that elected members must deal with?
I am not in a position to say whether that matter ranks higher. I guess that the integration of social care is a more immediate and obvious issue for councillors to grapple with. There is a decision for them to make about what model of health and social care integration they want. Once they have agreed on a governance model, we would want to see them very quickly get into what that means in the context of polices such as self-directed support, how that will work and what the opportunities are to make that better.
In an ideal world, you would hope that the conversation might have been the other way around and that councils would be thinking about the implications of self-directed support as they were making the decision on the model. We have not done the work to comment on the extent to which that has happened or not, but there is a very close connection between those two issues and we will be keeping a very close eye on how the different models of health and social care integration are impacting on councils’ ability to deliver the new policy change.
I agree. It is not possible to separate out the integration of health and social care and self-directed support. The way that you do one will affect the way that you do the other. We highlight in the report questions about the way in which people may have more choice over how their health support is planned and funded to give them a pot or a package of care that hangs together. I would not prioritise one as more important than the other. Self-directed support is not quite as wide-reaching initially as the integration of health and social care, but the two issues should be being discussed together.
To make sure that the situation changes over the next year, there might be some point to the committee asking COSLA how widely this is being dealt with at council level. Based on paragraph 26 of your report, there is an awful lot more to do quickly to ensure that senior elected members know what is going on. Would that be fair?
Keeping oversight of what is happening locally and looking at how the different integration models are working, including the opportunities that they throw up and the problems that they may entail, would be well worth while.
11:15
In paragraph 2, on page 7, you say:
“Councils have adopted different methods of allocating the money”.
That raises the thought that someone moving from one council area to another might receive a very different service. Is that the point that is being made there?
That is not our primary point, although it is a risk and I will ask the team to come in on that in a moment. The point that we are making refers to the different methods for allocating budgets to individuals that we have set out in exhibit 6, on page 33 of the report. We have seen two mainstream approaches in the work. One is a points-based system that assesses someone’s needs and assigns them a score depending on the intensity of those needs, which translates into a budget that can be used to buy different forms of care and support to reflect the person’s choices. The other approach assesses someone’s needs and allocates a budget that is aligned to what the traditional services would have looked like.
In terms of fairness and equity and managing the risk on the overall budget, both approaches have pros and cons, which we have tried to set out in the report. The approaches need to be flexible enough to respond to the growing number of people who are likely to need social care and to changes in the form of services that may well be needed, as people choose new forms of care and move away from some of the traditional things, such as day centres, that often have been the focus of social care in the past.
We were focusing on that, rather than the risks of people moving between areas, although that also needs to be considered.
Are there methods other than the two that you referred to?
We found one more, which is also in exhibit 6, in Perth and Kinross Council.
That is right. Perth and Kinross’s solution-led model, which we mentioned in exhibit 6, is slightly different from the other models that the Auditor General described. It is more of a bottom-up approach, in which the conversation with the person about their need comes first and the discussion about the resources needed to fit around their package of care, in its broader sense, comes much later in the conversation. The focus is on building it up from the bottom: thinking about what is needed, then thinking about the finances as you go through the process.
The advantage of having that conversation and being aware of the options and what some of the affordability issues might be is that it puts a lot of trust in front-line social work. One of the risks, which we highlight in the report, is that the approach needs really good financial controls. An example in the report says a bit more about what is happening in Perth and Kinross. In the early stages of the move to this approach we saw weekly financial management meetings and constant discussions between social workers and finance teams, to keep a very close eye on the implications for resources of giving front-line social workers much more responsibility for having those discussions with individuals.
In essence, the self-directed support policy is trying to achieve a close connection with regard to building a very individualised package of support and care services for a person, but there are risks around that. We only saw that happening in Perth and Kinross. We did not see that elsewhere in Scotland.
Given the different systems, are you satisfied that they are adequately transparent? Can people see how the allocations are made? I think that that is very important.
One of the issues that we tried to draw out in the report is the need for clarity about that discussion.
So it is not there now.
In a sense, self-directed support brings that, because it is about an individualised package and more clarity on the care that someone could get, what the options are and how much that might cost to provide.
How the package is put together surely is the critical thing. The transparency of that process is very important for confidence.
Absolutely. As self-directed support is rolled out more broadly across Scotland, we would certainly see that that would start to become an advantage of the policy. It is not happening for everybody yet, but that should happen as part of the discussions that people have about their care.
Paragraph 18 on page 12 says that
“five per cent of eligible social care users”
use direct payments, but that
“Direct payments accounted for ... 2.4 per cent of councils’ social care spending”.
That would imply to me—tell me if I am wrong—that those who have taken up direct payments are perhaps those with less profound needs than others, because they are absorbing far less than their proportionate share of the budget.
That is our assumption, but we do not know whether it is the case given the information that is—or is not—available at present. It will have clear implications in the next three to four years as self-directed support is rolled out to everyone who gets social care.
As the needs of each person—both new users and those already in the system—are assessed, ensuring that there is an understanding of their relative needs and of the impact on the overall budget and the overall shape of services, is a key part of the roll-out. That is why we have focused on the importance of being clear about people’s needs and managing the risks in ways that mean that the budget will not be bust and that people are treated fairly over time.
Have councils produced any projections for the take-up?
We saw the issue of take-up as a risk when we carried out our work. We saw that some areas were slightly slower off the mark, and one issue was uncertainty about which options people might choose. The move to self-directed support is a big change, and there was a lack of clarity in those areas about how many people would opt for the services that they were getting anyway and how many would choose something different. We saw that a lot of work was going in to support front-line social work staff to have those conversations with people.
There are a number of examples in the report, which we have not yet mentioned, that try to bring to life what self-directed support will look like for people who need care and support services. We found, when we talked to staff who are involved on the front line, that seeing those examples and sharing them, even with elected members, brought the issues to life and gave people a much better understanding of what is possible and achievable with self-directed support. That will take time to spread.
We heard from our case study councils that they do not necessarily expect people to make a single decision and then stick with it. Self-directed support may snowball or grow as people realise what is possible with some of the options. It is quite hard to make predictions when people might come back and change their mind, and try something different or learn from other people whom they know.
It is early days, and we just have to wait and see how things develop.
It is an interesting time, so soon after the 2013 act has been passed, to look into self-directed support. As a parliamentarian, I find Audit Scotland’s work on the subject incredibly valuable. You have given us a good starting point and a foundation so that, when we come back to look at the issue again, we will know where we are coming from.
The focus so far has been on what the councils are doing, but I want to flip back to what the Government is doing. It is clear that, in relation to option 2 in exhibit 1, which you describe as
“ask others to arrange my chosen support”,
there are issues for councils about the guidance on delivery that they receive. At paragraph 31, you describe the risk that some councils
“will interpret the rules and regulations so cautiously that they may limit the choice and control people have over their own support.”
If we are to move on from the low starting point of 3 per cent, which is why the 2013 act exists, the guidance will be an important area to consider.
You are asking the Government to develop the guidance. Can you give us a flavour of what you think it might look like, to help the Government to push it forward a little?
The Government has done a good job in consulting and involving the people who are affected by the change in developing its guidance. The effect of that work was that the guidance came out a bit later than some people might have liked, but our sense is that it is robust and has been well worked through because of the time that has been taken on it. The £42 million of transitional funding has been targeted well to councils and to the third and voluntary sector and carers to help them to understand what the change means for them and to enable them to engage with the process.
Nevertheless, we expect that some areas will be particularly tricky either for individual councils or for all of them. We spoke just now with Colin Beattie about the potential implications of the different ways of allocating resources. Some people will do that very well, and there will be opportunities to spread good practice among councils, as the committee discussed earlier with Douglas Sinclair. However, councils will struggle with the change either because they have particular challenges in their areas or because they have not tapped into the networks of support and expertise that may exist elsewhere. Their role, first of all, is simply to monitor progress and to identify where there might be room to spread expertise and experience.
There may also be areas in which the guidance itself needs to be refined, tightened or refreshed as the policy is rolled out and people find new and better ways of delivering self-directed support. Cathy MacGregor or Claire Sweeney may wish to highlight specific areas.
Because option 2 is so new, it is expected that, as councils learn, they will share their experience and the guidance will get better. It will be an evolutionary process.
The issues that our case-study councils raised with us concerned practical and contractual matters such as the relationships with providers that manage or administer somebody’s budget on their behalf. That may involve not simply providing services and taking money out of the budget, but using the budget to buy services from other providers. Various complex relationships are involved in that process and councils retain responsibility for ensuring that people get the right care and that good use is made of public money, so they need to keep an eye on how the process works and ensure that it works properly.
Until some of those things are tried, it is hard for the Government to set out clear guidance for councils without possibly precluding some of the options that people have not yet thought about.
How soon does the Government need to produce the guidance to allow things to move on?
It is likely to be a continuing process. As Cathy MacGregor said, people are developing their processes in different ways in response to different local circumstances. That is a good thing, but councils need to keep a close eye on that and look for particular good examples that should be spread or particular problems that were not foreseen. It is important that councils are flexible and responsive in that regard.
I get that. You are saying that the change needs to bed in, to allow a bit more time to see where councils are developing best practice. The Government can then use that information to provide guidance to help other councils to get to where they need to be.
We tried to draw out points from what we saw. A lot of effort was going into having a community and sharing good practice, and there was a real emphasis on partnership working between the Scottish Government, local authorities, the voluntary and private sectors and the people who need care and support in thinking about what was possible under self-directed support and where that might go in the future. It was a good, strong partnership arrangement. Some areas felt that guidance was coming out too late for them, but it was sent out in draft form and there was real consultation on what the implications might be, which we saw as a good thing.
I have a couple of questions. First, in the second paragraph of case study 6 on page 24, you state:
“There have been some tensions between the council and providers, who feel they were not fully involved in developing the strategy.”
I would like to know a wee bit more about the problems that were found in that case and whether there have been similar instances in other councils around the country.
I will kick off and will ask colleagues to address the specifics of Edinburgh in a moment.
In a sense, it is not surprising that those tensions would arise. Councils are required to work with a range of private and voluntary sector providers, as well as with their own in-house services, to discuss changes that might be quite far-reaching in terms of the type of services that are needed and the way in which they are provided.
In order to do that, councils not only have to build a partnership, as Claire Sweeney mentioned, but must recognise that some of those service providers will be competing with each other in due course. The fact that the tensions are not unexpected places a premium on managing them well and being clear about what is and is not up for discussion. Claire Sweeney or Cathy MacGregor can address the specifics of case study 6.
In that case study, the council had developed a draft strategy and then shared it widely with providers. There was a lot of consultation at that point, but it was felt that the strategy document had not been developed in partnership. Nevertheless, that was a consultation draft, and the engagement began from there. In case study 6 on page 24, we say that providers reported to us that they felt that they had not had a say. However, it is an iterative process and the final strategy is expected to take on board some of the comments that providers have raised since the draft strategy was issued.
At the back of my mind, I thought that the council was saying, “This is the service that we want,” and that the provider was saying, “Well, there is actually a better way of doing that.” That is my assumption about where the problem started. Is my assumption wrong?
That may have been the feeling in the early stages of development, but the providers have reported to us that they now feel much more involved and that the council is trying hard to involve them, listen to them and take on board some of the new things that they are bringing to the table. It is a relatively positive example that we have included in the report.
11:30
In paragraph 53, you talk about councils needing to develop strategies for their areas. The last sentence of that paragraph caught my attention. It states:
“The risk is also greater for specialised types of services that relatively few people need, such as care for people with Huntington’s Disease, neurological illnesses or acquired brain injuries.”
Obviously, that is a sensitive area as well. We cannot have people falling through the gaps. How are councils across the country approaching such problems? Has that problem not been identified apart from in your report, or has it been identified and are actions being taken to close those gaps?
Our case-study examples include some good examples of practices in remote and rural communities where, historically, some of the options have not been available. There are some quite innovative ways of thinking about how best to meet the needs of local communities, and we identify in the report some examples of working with business and social enterprise communities to develop things that have not existed before.
In essence, your question is about planning and commissioning arrangements, which we have definitely highlighted in previous reports on commissioning social care and care for older people, and I am sure that the issue will come up again in relation to the new partnership arrangements between health and social care services. There is a need for local authorities, health boards and the voluntary and private sectors to work together with people who need support in order to ensure that people get the support that they need and nobody falls through the gaps, that there is clarity and that everybody has access to the services that they require.
When people reach the point at which they have to decide on the way forward—whether they want self-directed support in the purest sense or to stay with the local authority—do the local authorities have the arrangements in place to signpost people to the options that are available to those with their own particular difficulties?
The stage that self-directed support had reached when we wrote the report meant that we saw those signposting arrangements in some places but not in all areas of Scotland. It is a big focus in the implementation of self-directed support. It has been acknowledged that, for groups of people who are less familiar with a personalised service—for example, there has traditionally been less take-up of some of those options among older people—there is a job to be done in ensuring that they are clear about the options that are available to them and that they are able to play a full part in the open conversation about the options that they might want to pursue in the future.
Highlighting what self-directed support means in practice has been a learning process throughout the system—for the people who need to access support, for their carers, for the people who provide the support and for local authorities. It is a journey that they are still on, and there has been a lot of focus and attention on the need to improve the information that people receive about what is possible.
That takes us back to one of the first questions that we asked: do people understand what self-directed support is?
I thank the Auditor General and her staff for their input to the meeting on the issue.