Self-directed support (SDS) systems based on hourly rates remain a ‘fundamental challenge’ to person-centred social care delivery, as new research calls for more engagement and training around the underutilised option 2.

Research commissioned by In Control Scotland, a charity looking to make SDS more accessible, shows that, even in areas where option 2 is relatively well-embedded, active disincentives within the system continue to hold back its implementation.

The report calls for the Scottish government to revisit the definition of option 2 with a view of creating national standards to ensure local compliance that can be regulated.

Too much room for local interpretation has led to a postcode lottery in SDS implementation in six studied sites – Aberdeenshire, East Ayrshire, Edinburgh, Falkirk, Highland and the Scottish Borders - according to the report.

At a webinar to discuss the research held earlier this week, Director of the charity, Pauline Lunn, said option 2 can be “a wee bit of a mystery sometimes” and that often uptake is reliant on strong relationships and good support planning from “the earliest possible point in someone’s assessment”.

Just 4-7% of people using SDS currently opt for option 2, which allows a person receiving support to choose what support they receive, but the support budget is allocated to and managed by someone else.

Some consider option 2 “the best of both worlds” as it allows individuals, in theory, control over their care and also enables service providers to be flexible and more responsive to changes.

However a lack of progress around option two implementation is almost universal across Scotland, likely due to this being the most significantly different aspect of the 2013 legislation that introduced SDS.

Basing personal budgets around hourly rates – which can differ widely between provider and different options - was considered to be a fundamental issue in the take up of option 2, according to the report.

The report shows people’s frustration at a lack of progress in commissioning, as it recommends work be ‘urgently undertaken at national level’ to identify and address what is blocking meaningful change in the commissioning landscape.

A lack of awareness and understanding of option 2, among front line staff, managers and people using services, was raised by most sites, which highlighted the importance of ongoing training specifically on option 2.

Recent research commissioned by the Human Rights Commission also shows a fragmented picture of self-directed support.

Some participants said the way SDS has been implemented betrayed the very spirit and intention of this model of social care, and in practice support was limited to providing critical care, restricting significantly who can be supported and how.

Local authorities’ overly prescriptive and inflexible approach to how individual budgets were able to be used was also a common experience among some participants.

In-Control Scotland will soon embark on exploratory work to understand what barriers exist to embedding SDS in a broader range of services, like criminal justice, homelessness and drug and alcohol services.

Read more: A rebuttal to the National Care Service discontents; ILF: “We stand ready to reopen”; NCS: Time for the powerful to be radical

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