Scottish councils have not made transition to giving people choice over their care, Accounts Commission finds

Carer - Image credit: Gareth Williams via Flickr

Councils in Scotland are not giving people the choice over their care that they have a right to, an Accounts Commission report has found.

According to the acting chair of the public spending watchdog, there is “no evidence” of local authorities in Scotland making the transition necessary to fully implement self-directed support (SDS), which they have a legal duty to offer.

While the Accounts Commission reports that most people rate their social care services highly and there are examples of “positive progress” in implementing SDS, it adds that “not everyone is getting the choice and control envisaged in the SDS strategy”, seven years after the strategy was introduced.

Care provider membership organisation Scottish Care called the report “an indictment on the failure of the social care system at local government and integrated joint board level”, while third sector health and social care organisation ALLIANCE said more needs to be done to speed up the pace of change.

Self-directed support is a personalised model of social care, where the person in need of support or their carers have more control over what kind of care they receive, when and how it is provided and who provides that care.

The Scottish Government has invested nearly £70m in SDS and is seven years into a joint ten-year SDS strategy with local government body COSLA, which they launched in 2010.

SDS is also a legal requirement for councils. The Social Care (Self-directed Support) (Scotland) Act 2013, which came into force in April 2014, places a duty on council social work departments to offer people who are eligible for social care a range of choices over how they receive their support.

But only around an estimated 53,000 people – around a quarter of the 208,000 adults receiving non-residential care in Scotland – receive their care through SDS, with just 7,530 getting direct payments.

The Accounts Commission called for people needing support and their carers to get better information about SDS and said more reliable data should be kept about the number of people opting for it – something that should have been done earlier.

Ronnie Hinds, acting chair of the Accounts Commission, said: “There is a growing body of evidence that SDS is helping many people with support needs to live more fulfilling lives.

“However, there is no evidence of the transformation required to fully implement the policy.

“Radical change of this kind is never easy but we are in the seventh year of the 10-year SDS strategy, and it's been three years since the legislation was introduced.

“Authorities must respond more fully to provide services that make choice and control a reality for everyone who needs social care."

Among the challenges to fully implementing SDS mentioned in the report are that a “significant minority” of frontline social work staff either do not understand or do not feel confident in making decisions alongside the people needing support.

Due to increasing demand and limited budgets for social care services, councils have been slow to change their approach to commissioning services that would allow for more choice and there are variations in the options offered from one area to another, the Accounts Commission reports.

There are tensions for care service providers too, it says, in putting additional pressure on care staff by introducing customer flexibility at a time of challenge for the sector in terms of recruiting and retaining staff.

It also reports that self-directed support implementation stalled during the recent integration of health and social care.

COSLA’s health and wellbeing spokesperson Councillor Peter Johnston said: “COSLA welcomes Audit Scotland’s report which highlights the scale of the challenge councils and integration authorities are facing and acknowledges we are being asked to deliver transformational change against a backdrop of increasing demand and tighter budgets. 

“Shifting to new models of care and support inevitably means facing the dual running costs of continuing, or slowly winding down, existing services until new models are fully in place.

“The squeeze on local government funding has undoubtedly impacted on the pace at which some areas are able to progress this.

“However, despite these challenges, Audit Scotland also found that most people rate their social care services highly – evidence that councils and integration authorities are continuing to deliver for our communities in the most difficult of circumstances.”

Minister for Public Health and Sport, Aileen Campbell, welcomed the report and the evidence that people are benefitting from being able to make decisions about their own care and support.

However, she added: “[T]he report’s recommendations give clear direction on what must be done to ensure that self-directed support becomes embedded as Scotland’s mainstream approach to social care.

“We expect local authorities, who are responsible for implementing self-directed support, to make progress on implementing these recommendations.

“People must be able to make decisions about what is important to them within their social care support.”

Campbell added that she had asked the Care Inspectorate to lead a review of SDS, which will focus on how local authorities and their partners are implementing the legislation and the impact on improved choice and control for supported individuals.

She also announced today that the Scottish Government will extend funding for independent SDS information, advice and advocacy projects funded under Support in the Right Direction and Innovation funds by an additional six months to September 2018.

It will also begin the process of designing the next round of funding, running from October 2018 until March 2021.

Scottish Labour criticised the level of support the Scottish Government had provided for SDS.

Labour’s social care spokesperson Colin Smyth MSP said: “We know that local authorities have had their budgets slashed under the SNP and this report highlights that experienced staff are also being lost through early retirement and voluntary severance schemes as the pressures on budgets mount.”

He continued: “It is worrying that the report states that the government has seriously underestimated the levels of investment required to fully implement the self-directed support strategy.
“This is compounded by the fact they have yet to offer any assurances about the amount of support, or in fact if there will be any support to further support SDS implementation from 2018/19 onwards.”

Some in the care sector have also been critical.

Scottish Care CEO Dr Donald Macaskill said: “This report is an indictment on the failure of the social care system at local government and integrated joint board level to adequately support the rights of older Scots to access choice and control over their care.

“The current Scottish Government has led on this pioneering policy and has invested significant additional resource at local authority level to enable the change to happen.  

“We do not believe that resource has been well used. The report clearly indicates that the failures thus far lie squarely at the door of our local authorities and their partners in the integrated joint boards.

“It is deeply regrettable that practices still remain at local authority level, especially the way procurement and commissioning happens, which breach this legislation and act against the rights of older Scots.”

The Health and Social Care Alliance Scotland (the ALLIANCE) said the Accounts Commission findings demonstrate there are “too many barriers for people who require support to live independently and participate equally in society”.

It added that the report’s conclusions corroborated its own recent research on people’s experience of self-directed support, which found “a very mixed picture” across the country.

Ian Welsh, Chief Executive at the ALLIANCE, commented: “I welcome Audit Scotland’s recommendations calling for a collaborative effort from the Scotland Government and local authorities to increase awareness of self-directed support and train social work staff to enable people to have full choice and control over their support, but more must be done to quicken the pace of change.

“Recent ALLIANCE research highlighted long delays in accessing self-directed support, a crucial component in supporting people to live independently. 

“We intend to further monitor the implementation of SDS and its impact on our members, and we call on the Scottish Government to improve data collection in order to ascertain whether SDS does lead to improved outcomes for everyone who requires support and act on the findings.”

Holyrood event: Self-Directed Support - Empowering People Through Choice