Self-directed support working for those who can get it

Putting individuals in charge of their support is yielding results but review shows access is uneven

Friday 28th June 2019

Regulators say self-directed support is leading to positive results when people participate but more needs to be done to make the new way of organising care and support accessible to all.

Scotland’s Care Inspectorate and Healthcare Improvement Scotland are carrying out a review of how the reform is working across the country.

Self-directed support sees people supported by carers – such as older or disabled people – are encouraged to make decisions about their care themselves, in some cases taking on responsibility for how their personal care budget gets spent.

Peter Macleod, chief executive of the Care Inspectorate, says health and social care partnerships (HSCPs) need to work together to overcome key challenges.

Inspectors looked at six HSCPs – East Lothian, East Ayrshire, West Dunbartonshire, Shetland, Moray and South Lanarkshire – selected  to provide a mix of circumstances.

In the report, they write: ‘In situations where self-directed support was effectively implemented, supported people found it transformational and experienced positive personal outcomes. However, effective self-directed support was not accessible to all.’

‘Most of the supported people and staff we met were very positive about self-directed support...In practice however, more needed to be done to inform, empower and enable people to fully participate,’ they add.

Self-directed support gives individuals more control of their care and lets them pick how they want to organise it.

A disability campaigner recently told healthandcare.scot that, when done right, it can give disabled people the “same freedom, choice and control in their lives as anyone else”.

The support ranges from someone taking control of their personal care budget and selecting the care services they want to allowing a social worker to choose and arrange their support.

As a combination, people can opt to decide how and when they want their support and ask the authority to organise this.

But the report warns access to these different options varies across the country.

Inspectors say it’s not clear people choosing to have their care arranged for them were fully informed about the alternatives.

While the direct payment approach is found to be ‘generally well established’, the report states support and advocacy is often needed to help people navigate the complex social care commissioning process. 

Peter Macleod, Care Inspectorate chief executive, says: “This overview report provides a summary of what we found across the partnerships we inspected and what that tells us about self-directed support in Scotland in general.

“In our analysis of the current challenges, we recognise that there are some issues that are bigger than any one partnership and will not be resolved by partnerships working alone. We present these issues here in this report as four topics for national debate involving interested parties from across Scotland.”