ITEM 8 Self Directed Support
North Lanarkshire Council · 21 August 2024
Back to IJB Performance, Finance and Audit Committee — 21 August 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
1 REPORT Item No: 8 SUBJECT: Self-Directed Support Update TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Diane Fraser Chief Officer Adult Social Work NL HSCP Author(s) of Report Andrea Breen Senior Manager Adult Social Work Lisa Barbour Service Manager Adult Social Work DATE: 21 August 2024 1. PURPOSE OF REPORT This report provides an update on the progressive implementation of Self-Directed Support (SDS) nationally and the position locally with reference to the Self-Directed Support Framework of Standards updated by Social Work Scotland in May 2024. The report will reinforce the whole system approach to continuing to promote maximum choice and control for people living in North Lanarkshire. For approval ☐ For endorsement ☒ To note ☒ 2. ROUTE TO THE BOARD This paper has been: Prepared By: Lisa Barbour Service Manager Adult Social Work ☒ Reviewed By: Andrea Breen Senior Manager Adult Social Work ☒ Endorsed By: Diane Fraser Chief Officer Adult Social Work ☒
Page 2
2 3. RECOMMENDATIONS It is recommended that the IJB PFA: 1. Acknowledge the progress made in North Lanarkshire to promote choice and control through Self-Directed Support 2. Note that a future report will be brought to detail the findings of a Self- Evaluation and associated Action Plan 4. VARIATIONS TO DIRECTIONS? 5. BACKGROUND/SUMMARY OF KEY ISSUES: Background 5.1 Self-Directed Support in Scotland has its origins in North Lanarkshire. The opportunity to maximise choice and control for people and their families was recognised locally as far back as 2007 where concepts and approaches were tested on a small scale and evaluated through Lancaster University and form the basis of the work being done today. 5.2 Early drivers of a more personalised approach, including individualising funding to promote choice and control, recognised the increasing gap between assessed need for support services and available resources to deliver. At the time it was noted that there was a risk of being pushed down a route that limited access to resources to meet critical and substantial need only, missing the opportunity to intervene more proactively and prevent difficulty or crisis arising. 5.3 The fiscal challenges of today being experienced at a system wide level; within specific services and across the range of provision; and for individual people and their families; make the original drivers for change even more important. A whole system approach is being progressively implemented to mitigate as far as possible, the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. 5.4 A personalised approach, which includes the individual allocation of financial resource where that is needed, remains the preferred operating model for the whole system in North Lanarkshire and is being supported by some key actions described in the report. Yes ☐ No ☐ N/A ☒
Page 3
3 Legislation and National context 5.5 The Self-Directed Support (Scotland) Act 2013 promotes equality, autonomy and improves lives for people who need support. It is a crucial piece of legislation for children, adults and carers in Scotland, emphasising choice, control, and dignity in care and support. 5.6 Since the act was implemented in April 2014 both the Care Inspectorate and Audit Scotland have produced reports on Self Directed Support stating that whilst there is evidence of positive progress, there is an inconsistency of practice and process across Scotland (Care Inspectorate Thematic Review of self-directed support in Scotland: Transforming Lives June 2019; Audit Scotland 2017 progress report Self-directed Support). 5.7 In March 2021 the national framework of eleven standards for the implementation of Self-directed Support was developed and published by Social Work Scotland. The standards and action statements were developed to ensure consistency of outcomes and approaches in SDS practice across Scotland experienced by supported people (children and adults) and carers, building up a framework of good practice in assessment for support, support planning and in provision of care and support resources. The framework of standards was then updated in 2022 to become 12 standards and has been updated again in May 2024. 5.8 The foundation of the framework of standards is that Self-directed Support is not new or something to learn, it is not about resource allocation frameworks, and it is not only about an offer of the four SDS options. Crucially, SDS is about the implementation of core social work/practitioner values of human rights and relationships in practice, and it empowers social workers/practitioner to be autonomous in exercising their professional judgement, and using their own knowledge, skills and abilities, in partnership with supported people. The alignment of the framework of standards with the approach in North Lanarkshire reflects the direct involvement of key officers in their design and development. 5.9 Alongside the development of the standards, Social Work Scotland are finalising the format of self-evaluation to inform local improvement plans. As enthusiastic early adopters of this approach, it is the intention to work with all local stakeholders to undertake a self-evaluation in late summer / autumn. Honest reflection on strengths and challenges will define clear actions which are expected to maintain and strengthen the whole system approaches to promoting choice and control in North Lanarkshire. North Lanarkshire Profile 5.10 In 2024/25 3,029 people benefited from support arranged through the principles of self-directed support. The adults, children, young people and their families, were able to excerpt choice and control through understanding the resource available to them and making decisions about how best to use that resource to support the achievement of their outcomes.
Page 4
4 5.11 Information provided to Public Health Scotland as part of the Annual Return Summary demonstrates the spread across ages in Figure 1 below. Figure 1 5.12 The individual budgets put in place are outlined below in the number of people opting to manage a direct payment, direct their own support or have the local authority put arrangements in place. Figure 2 offering the detail of the numbers of people across localities and Figure 3 providing the financial information. Figure 2 Figure 3
Page 5
5 5.13 As previously reported to the Committee Mosaic will replace SWIS as the line of business operating platform. The design work is taking into account the benefits of enhanced data analysis and significantly improved reporting capacity. 5.14 The number of people and financial values indicated above all represent unique stories and significant achievements in supporting people with complex needs in the community. Individual arrangements range from people who have support at all times of the day and night, to people who receive more modest supports over small parts of the day. Support arrangements include non- standard use of resources in the form of bespoke purchases to meet need reflecting genuinely individualised nature of planning and intervention. Future reporting will increasingly be able to show the breadth and depth of information to practitioners, localities, commissioning staff as well as to the governing committees. Partnerships 5.15 Self-directed support at times becomes synonymous with individual budgets but it is much more of an overarching approach to people living well connected lives within their communities, which may or may not include the need for an individual budget. 5.16 Third and voluntary sector partners play a crucial role in supporting the whole system response. Inspiring Scotland who were the fund manager of the Scottish Government Support in the Right Direction monies facilitated the opportunity for the North Lanarkshire Disability Forum, Equals Advocacy and Voluntary Action North Lanarkshire to empower people and carers to be equal partners in their care ensuring real choice and control over their lives including how they live and the services/supports they receive; participating in fulfilling activities and in their communities, and pursuing employment if that was what was important. 5.17 The fund of £460,000 between 2019-2024 supported 2,576 people to be Better prepared and more confident in participation in assessment Informed and listened to Creative and flexible in the plans around their life Confident in the management of their own support and individual budgets Generally, more knowledgeable and understanding of self-directed support principles and options for them 5.18 The experience and learning from the SIRD achievements has directly influenced the creation of the Community Connector role which increases the capacity to support people in the community to be resourceful and use their own resources well, as well as support people to participate as equal partners in the more formal responses to their support where needed. 5.19 The Community Connectors role, also hosted by the North Lanarkshire Disability Forum utilises £600k identified through the Winter Planning and Enhanced Support funding stream as well as the Improving Cancer Journey
Page 6
6 monies. The capacity to support the work in each locality is significantly enhanced through 10 Community Connectors. 5.20 The importance of whole life planning is being explored through the Getting It Right for Everyone (GIRFE) Pathfinder work North Lanarkshire is engaged with. The role of the third and voluntary sector is crucial in supporting a broader approach to helping people plan for the long term without “medicalising” or “clientising” into more formal services and supports before that is needed, but equipping people well for when that is the right response. 5.21 Self-directed support also needs resilient communities that are welcoming and inclusive. Community Solutions works to the principles of self-directed support and promotes the ambition of people having well connected lives through all the work undertaken through their themed work as well as through their community consortia. 5.22 Work with Enterprise colleagues is exploring opportunity through community wealth building within health and social care. Using the NHSL and Council anchor status and considering community wealth building will not only promote choice and control for people who have support needs but will draw a focus on employee-owned business, small provider development, entrepreneurship and supporting existing providers. 5.23 The vast majority of the £93m supporting people to live full and active lives involves support through independent sector providers. The 10-year framework agreement supporting individualised funding arrangements is an important example of ethical commissioning with strong partnerships and active participation in the development of responses in North Lanarkshire. There are currently 56 providers on the framework supporting genuine choice. 5.24 The quality of provision remains high and is subject to separate, more detailed reporting. 5.25 The cost-of-living pressures, recruitment and retention of a skilled and flexible workforce remains a challenge for the independent sector in the same way that it impacts in other parts of the whole health and social care partnership. Work to support the sector has included the allocation of non-recurring resources through the Winter Planning, Enhanced Support monies to impact on infrastructure responses and capacity building which has been welcomed by the sector. 5.26 Partnership working with independent sector providers is also supporting the achievement of the Coming Home work, a welcome approach to supporting people locally rather than in hospital or out of authority resources disconnected from family and friends. 5.27 The successes of a truly self-directed support approach to care and support and the examples of how people’s lives have been transformed continues to inspire and build confidences. There are a relatively small number of people in North Lanarkshire who sit on the Coming Home register, and work continues to
Page 7
7 successfully supports people to move from institutional, buildings based services to arrangements which much better take account of individual lifestyles, communication styles and support of positive behaviours. 5.28 Increasingly the complexity of people’s health care needs in the community involves interesting discussion about the design and delivery of safe care, including, but not limited to ventilation and respiratory care and supporting people with end-of-life care. The development of safe operating procedures and active care management remains a fluid and learning environment to getting it right for everyone. 5.29 The importance of the partnership approach to achieving the best possible outcomes for people is being further strengthened within the review of overarching meeting structures and governance. The active participation of representative from Scottish Care, People’s own voice, Communities, Carers and Trade Unions will be strengthened at all levels. Resilient workforce 5.30 Scottish Government Self-directed Support Implementation Study 2018. Report 3: Self-directed Support Case Studies included analysis of the North Lanarkshire approach as one of the case studies. The report noted that whilst the four self-directed support options are a gateway to choice and control, evidence was that equally important was: The quality of assessment, including a genuinely ‘good conversation’; The degree to which there is a focus on outcomes; The budgets available to meet these outcomes and the availability of local providers able to deliver the support required; and The enabled creativity and authority of supported people, practitioners and the care market to find solutions to meet those outcomes. 5.31 Whilst there is good progress on many reflections from this report, a Self- Evaluation against current standards will help channel actions to greatest impact. In the meantime, there have been some key developments achieved. 5.32 A learning and development plan is in place to support new and existing practitioners, team leaders and seniors, managers and wider stakeholders. Practitioners, people who have support arrangement in place, family carers, independent sector providers and third and voluntary sector providers are also actively involved in the delivery of more formal training as well as in the ongoing refresh of the plan. 5.33 Work is ongoing with colleagues involved in the delivery of both local authority and independent sector Home Support service to Increase choice and control through individualising arrangements and planning with people to meet changing needs flexibly and responsively, understanding the focus on frailty. 5.34 In keeping with a place-based approach to empowering localities and facilitating decision making closest to the person, changes to the authorisation of individual budgets within an enabling approach to localities has been introduced. This
Page 8
8 approach has increased the speed of decision making, empowered practitioners and leaders, and increased the creativity and flexibility that underpins good SDS. 6. CONCLUSIONS: 6.1 Self-directed support is the approach threading through all of the wok of the Health and Social Care partnership. The ability to respond to people uniquely and continue to individualise responses including where an individual budget supports choice and control will remain the route to mitigate the impact of demographic change, cost of living challenges, workforce pressures and shared pressures across health services. 6.2 The priority of work over the next 12 months, informed by the completion of a Self-Evaluation will be building resilience and sustainability: In communities – helping people to help themselves first, ensuring the best information, advice and access to self-assessment / self help In the Sector – recognising the importance of partnerships with all stakeholders, articulating that through good market facilitation and a focus on community wealth building In the workforce – training and development, fully using the care academy and developing the role of Scottish Care 7. IMPLICATIONS Financial 7.1 Balancing the available resources with demand is a key feature of supporting local decisions about best use of resources and supporting the flexible and imaginative use of the resource available. 8. NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒
Page 9
9 Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 9. ASSOCIATED MEASURE(S) 10. FINANCIAL 10.1 Measures described throughout the report are being introduced to support the demand and ensure equitable distribution of allocated funding. Future reporting will demonstrate the impact of changed ways of working. This paper has been reviewed by Finance: 11. RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner N/A Choose an item. 12. ENGAGEMENT & PARTICPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details regarding the engagement and participation that was undertaken. Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Representative on all forums exploring the ongoing improvement of SDS in North Lanarkshire ☐ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Partnership working underpins all of the work supporting SDS and is undertaken in a range of ways to maximise engagement and impact ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☐ Provide regular feedback on how stakeholder engagement and participation is Yes ☒ No ☐ N/A ☐
Page 10
10 shaping and influencing service development and delivery ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 13. INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: EQIA added to website: 14. BACKGROUND PAPERS None. 15. APPENDICES None. Yes ☐ No ☐ N/A ☒ Yes / Date added ☐ No ☐ N/A ☒
Page 11
11 Diane Fraser Chief Officer / Head of Service (Adult Social Work Services) CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Diane Fraser, Chief Officer / Head of Service (Adult Social Work Services) FraserDi@northlan.gov.uk
Page 12
12 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2024/2108-08 2 Report Title Self-Directed Support 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed