Statistics to shame.
Self-directed Support is the jewel in the crown of Scotland’s social care legislation. It is legislation which sets us apart as a nation which seeks to bestow increased control, choice and decision making onto those who need to access care and support. It has been rightly much vaunted and valued and it is quite clearly failing. The creation of such primary legislation requires vision, insight and not a little courage. However for vision to become reality requires equal energy, resourcing and robust implementation especially, as in this instance, where significant cultural change has to be fostered and resistance overcome. This clearly has not and is not happening. Legislation, however innovative, is merely words unless Government ensures robust enactment.
Three years into implementation the Scottish Government yesterday (11 July) published statistics on the progress of Self-directed Support which quite frankly should shame us. They describe a sorry and sad state of affairs two years into the legislation’s implementation.
They describe a situation where:
- Only 27% of people made an ‘informed choice’ about their care and support using SDS
- 86% of people over 65 chose Option 3 (Council managed arrangements)
- Clients who are Frail Older are 3.5 times more likely to choose option 3.
- 75% of all clients chose Option 3 (Council arranged services)
- Only 9% of total clients used Option 2
- Frail Older clients are least likely to chose Option 2.
What does all this mean?
Well of course the instant defence which will be presented is that these statistics describe a reform which is at an early stage of progress. That this is a long-term change in the delivery of care. That SDS is a 10 year strategy. All true statements but equally all inadequate explanations – or perhaps excuses – for the failure of a robust implementation of what has been described as a ‘flagship’ social care policy.
By launching the report, Self Directed Support: Your Choice, Your Right, together with others last week I offered some explanation for both these statistics – though we did not imagine they would be quite as bad – and the wider failure which SDS is in danger of becoming.
One of the reasons for this failure is that there has been a lack of robust implementation. We have allowed a two tier system to build up and the victims of such are quite clearly our older citizens who have been the last in the line of choice, the afterthought for exercising control over their care. There seems to be no real acceptance that the SDS Act was meant to sweep all former practice away, instituting a power shift and culture change in the way people receive social care. The system from initial assessment, through to budget allocation and to collaborative review is clearly failing. We are in a whole system crisis. Granted, SDS is working in glorious technicolor in parts of Scotland but in others the screen is blank.
In particular I am concerned that we are not involving older citizens by giving them the full range of choices available to them and the system is not working with providers to enable them to play their full part in this reform. We have no real evidence that information is being properly communicated in ways people know that they have a real choice. Do we know the 86% choosing Option 3 know that there were other options on the table for them? At Scottish Care we are hearing lots of stories to indicate that the transparency of choice is a mirage. I am continually hearing from Scottish Care members and families fighting against social work professionals who are wanting to restrict choice on Option 2 and present Option 3 where the Council arranges things as a fait accompli. The old power imbalance still permeates.
The promised creativity and widening of choice which the Act heralded has been strangled by bureaucracy, deliberate blockage and an unwillingness of statutory partners to embed the radical change which has been needed. Within all this obfuscation there is the systemic age discrimination which permeates the whole of our social care system in Scotland.
So what can we do? Well simply accepting the current situation where older Scots are at the back of a very long queue will not do. Simply allowing the keys to choice to be controlled by individuals who will not give up control, loosen the purse strings and give true, transparent information to people in order to allow them to choose will no longer be acceptable. We must, together, provider and supported person, advocate and community leaders, re-invigorate an Act which has the potential to transform, renew and reform.
Some of those first steps were offered last week in a seminar to launch the report I mentioned above, and I publish them again here:
1. We recommend that the Scottish Government ensure that all partners develop a human-rights based approach to the implementation of SDS and a human-rights based monitoring of the implementation of SDS. We further recommend that the Scottish Human Rights Commission be resourced and supported to undertake an assessment of this human-rights based implementation.
2. The accountability of local and national government for implementing SDS must be enforced.
3. Local authorities must move away from the time-allocation method of care assessment and delivery, which will always be at odds with any effective or meaningful implementation of SDS.
4. The use of electronic and other contract monitoring systems need to be examined in relation not only to fiscal savings but the negative impacts these have upon the well-being of the workforce and the dignity and rights of those receiving support. A rights-based approach to SDS has to be based on reciprocal trust and mutual respect rather than suspicion and distrust.
5. Access to information, and to all four SDS options, must be made available consistently across local authorities and in an independent, non-discriminatory way.
6. The Fair Work Framework should be used as a method of ensuring that individual workers’ rights are reciprocated and protected. This framework should be implemented and used by commissioning bodies, organisations and individual employers.
7. Greater focus needs to be placed on developing models of care and support that give autonomy, control, choice and decision-making to frontline workers and those whom they support rather than commissioners and contract managers.
Self-directed Support can still be rescued but at the moment the flagship is well and truly aground from the perspective of the majority of citizens in Scotland who require care and support and who happen to be over 65.
Dr Donald Macaskill