Created on 25 November 2016

LDAS has now published its report on Self Directed Support two years on. Read the full report here.

Self Directed Support was the Scottish Government’s plan to transform social care in Scotland.

It had two main aims.  First it gave people more choice over who from and how they got their support from.

Second it was to make the lives of people with social care needs better by improving the “outcome” of the support they got.

Two years on from the implementation of the Self Directed Support Scotland Act we surveyed people with learning disabilities all over Scotland to find out what had happened.

Half of the people who responded to us had got a Self Directed Support Package and half hadn’t.   That allowed us to compare what difference SDS made.

CONTROL

This first chart shows the questions we asked about the control people had over their support and the planning of their care.

There were clear advantages in all four areas for those who had self directed support.  However the absolute results in the “right level of support” and “able to change service” indicated that there had been less progress here for people with learning disabilities than in other areas.

Both changes to care planning to involve people and providing more information in Easy Read and other systems have taken great strides in recent years and it would seem that these areas have been the ones that it has been easiest to address.

We have been in a period of unprecedented change in the delivery of social care in Scotland and it should not be surprising that there are many concerns about the level of support.

OUTCOMES

We asked a second set of questions about what outcomes people enjoyed from their support.

These were based on the “Talking Point” areas and on a similar POET survey that had taken place in England.

The most striking thing about these results is the closeness in the replies whether or not people get SDS.  Those without SDS had better outcomes in being kept healthy.  There was a dead heat in regard to doing good things during the day.   The other four outcomes saw better results for those with SDS packages.

Overall all types of support were most effective at “Helping People Keep Safe” and “Do things in their local area”.

This would suggest that Self Directed Support is not yet greatly more effective at helping people achieve good outcomes from their support than other methods of organising support.

This is where the headline for our report comes from.  People with Self Directed Support have more control over their support package and plans.  But this has not led to significantly better outcomes from their support.  They are Still Waiting for this to happen.

The report also contains much more information from each council in Scotland on Resource Allocation, Option 2 take up, Eligibility Criteria and much more.  You can download a copy of the report from our website for free.

 

Created on 25 October 2016

The Herald’s story on the shocking treatment of Margaret McEwan from Glasgow shows some of the real challenges that people with learning disabilities face in Scotland today.

Stephen Naysmith wrote on Saturday 25th Of October: “Margaret McEwan epitomises Scotland’s journey towards a more humane way of dealing with vulnerable elderly and disabled people. Her supporters hope she doesn’t end up being a symbol of the collapse of those hopes.  Freed from the notorious Lennox Castle 20 years ago, Margaret was taken into the bosom of a loving family, where her life has been transformed. But now she faces being denied that home life.”  Read More Here.  

Margaret who has learning disabilities and a visual impairment is being asked to move into a care home to save the council money.

In Scotland there is a new national strategy called the Keys to Life designed to prioritise the things that are important to people with learning disabilities.  It doesn’t seem to help in this case.   There is also a national strategy to promote Self Directed Support, a policy designed to give more choice to people who need support. It doesn’t seem to help in this case. It seems that councils can choose to do whatever they want instead of national policies.

Some of the results of this approach in Glasgow can be seen in this chart published by the Care Inspectorate last week.  It shows the change in Social Work spending in Glasgow and in Scotland over the last 9 years.

The figures in green show the areas that now spend proportionately more and those in the red the ones that spend less.   We can see that in most of Scotland spending on services for people with learning disability has gone up.  While in Glasgow spending on people with learning disabilities and other adult groups has been transferred over to services and support for children and older people.  Councillors often say that Glasgow has been cut, this chart says it is really about priorities.

Glasgow is making a choice in treating Margaret this way and it is the wrong choice!

 

Created on 14 October 2016

Significant worries were raised in Perth and Kinross recently when the local council announced a plan to consider care homes for everyone who Individual Budget came to 10% more than the cost of a care home place.  This arose out a plan to transform social care services.  But rather than improve things this ran the risk of taking things back to the last century.

The consultation process for this measure was wholly inappropriate and inadequate. The timescales given to family carers who lead incredibly busy and stressful caring roles were totally unrealistic. A letter was written on the 8th August 2016 and by the time the families received it there was less than 3 weeks to respond. The closing date was the 31st August 2016.

This type of proposal goes against all national government policies and legislation. It fundamentally breaches the United Nations Convention on the Rights of Persons with Disabilities supported within The Scottish Government’s Draft Delivery Plan 2016-2020. It is totally discriminatory and has placed huge stress on family carers who are supporting their family member to lead a valued and included life within their community.

Fortunately in the last week, Perth and Kinross have agreed to put things on hold and make no changes until there is much wider consultation.  The council said

“we accept our initial consultation process has raised concerns and therefore we are going to take much more time to discuss and consider all the options from stakeholders … we will shortly be communicating how and when we are going to undertake the work.”

Unfortunately this does not mean the proposal has gone away for good and disabled people and their families will have to keep aware about this.

Our Self Directed Support Survey

Created on 01 August 2016

in December we said in 11 councils people were getting less Direct Payments  after the Act came in than they had before.  New figures including the take up of other options were published in July 2016 and show that both Falkirk and Inverclyde actually did better than that getting more people into SDS packages than the previous year.   But the 8 of others were still doing worse than the year before SDS was introduced.

Glasgow has been undergoing its Personalisation process since 2009 and says that over 1700 people are now getting Option 2.  We think this shows a problem with just using numbers to explore SDS.   Glasgow worked out the cost of service for these people, then transferred that money to their existing social care provider in their name and declared that was their equivalent to Option 2.

After our earlier article Social Work Scotland wrote to us to complain that we were being unfair.   They said that SDS must be about more than just how many people make the choice, it must be about the outcomes people get.  We agree.  It’s a shame that councils’ don’t publish any information on the outcomes that people get from SDS.

As a result, the Learning Disability Alliance Scotland has decided to carry out its annual survey on the experience of people with learning disabilities with SDS.   We also welcome the views of family and paid carers.  You can be one of the first to complete our survey here.

 

 

Something strange was happening with Self Directed Support

Created on 17 March 2016

Glasgow City introduced personalisation in 2010 as part of a programme designed to save up to £6.4 million per year.  The first phase of this for people with learning disabilities was rapidly extended to other groups.  As individual budgets became the preferred method of managing support packages the council moved to close a number of day centres arguing that with individual budgets, less people would use these  services.

Actually it seems that less people now use any services in Glasgow.   Official figures from ESAY reports that the number of people with learning disabilities receiving any service from the council fell again in the last year, this time by 104 people  to just 2,306 in 2015.

Figures produced by the NHS suggest that others have been seeking out NHS help when they cannot get it from the council.    At around the time of the introduction of personalisation in Glasgow the number of “inpatient weeks” rose rapidly as can be seen in the chart.   By 2013, it was costing NHS Greater Glasgow & Clyde an additional £4.5 million per year.

It seems strange that a policy of that was presented as being about Choice And Control should be connected to less people getting any service and more people using  specialist hospital services.

 

 

Created on 08 February 2016

The essence of Self Directed Support is meant to be having the freedom to spend an Individual Budget on the support and services that can truly meet your need.  In the early days, videos were produced of people spending their money on holidays abroad or on personal development courses or opportunities.  The argument was if you gave people the freedom to make their own choice, they would be better choices and in many cases would be cheaper.  For example, instead of paying a support worker to take you to a football game as well as buying a tickt, a friend, family member or volunteer could be induced to do this for just the price of the ticket

Over the last few years as SDS has been introduced in Scotland, that has rarely been the case.  Instead the use of Individual Budgets has been constrained by local authorities who have claimed that their duty to ensure the “public pound” is properly spent overrules thing else.  Budgets can only be spent on areas approved by councils.  85 page contracts have been drawn up to support new “freedoms” which set limits on anything creative.

Now Glasgow City Council is proposing to give “providers” the freedom to do it differently. Read the proposal here  No longer will providers have to provide a fixed number of hours for an Individual Budget instead as long as the needs of the individual are met, then the budget can be used to increase the wages given to staff so they can rise in line with the National Minimum Wage.

This proposal will be introduced in a pilot scheme for a range of adults in community care groups.  But for people with learning disabilities it will make life much harder.  Glasgow has made a range of reductions in support for peopel with learning disabilities.  They started with a cut in people with learning disabilities budgets of an average 20% with the introduction of personalisation, followed by a 5 year freeze in the value of RAS support packages.  Then a they shut most of the city’s day services.   Now they now propose to make people with learning disabilities pay for the Tory’s National Minimum Wage by cutting their support packages even further while pocketing further savings in the meantime.

Its not completely clear in the paper but it seems to suggest that the new National Minimum Wage will cost  £21 million  and that this amount should be diverted from social care users support packages into paying the new wage level.  There is then an indication at the , while there would be a further 5% reduction in total spend in support packages to be retained by the council.  However a third set of savings may be generated  “significant” reductions in council “administration and processes”

The Learning Disability Alliance Scotland views this proposal with some concern.  Support packages for social care users in Glasgow and in particular people with learning disabilities have been severely reduced over the last 6 years.   This proposal takes the good idea of further social integration into the community but ties it to real pressures on social care.  Providers are likely to have little choice but to go along with it.   In the report it does not mention that they asked service users what they think of this process.   Surely SDS is about the service user’s choice and decision making.  This appears to be completely absent from the proposal.  We are really disappointed that Glasgow City Council are not turning their focus on the UK government who had introduced this policy of the National Minimum Wage but failed to fund it.

 

Created on 15 January 2016

In our last newsletter we published a report on official government statistics published in November 2015 which showed that there had been slow progress with Direct Payments despite all the effort with the introduction of Self Directed Support.  We said in the article that we couldn’t be sure until further statistics were published in 2016.

This additional information should have more on the other options included in Self Directed Support and allow everyone to make a better judgement on what has been happening- although the Scottish Government has already said that this information will be partial and will be published as “Data Under Development”.   However Falkirk Council has contacted us to express their concern that these figures do not accurately reflect their work.

They have 24 people who are recorded as SDS Option 4 (mixed support options.) which if added to the 40 recorded in the Scottish Government statistics would mean that they had increased the number of Direct Payments users in 2014-15 to 64, an increase of 4 rather than a fall of 20.   Other councils may be in a similar position.

The changed position for Falkirk is made clear in the chart below.  The total number of Direct Payment recipients has increased in total by four in the last year.  However it is also true that the total number of Direct Payment recipients in Falkirk has increased in total by only 4 since 2005.  Overall hardly much of a change.    In fact, if Falkirk had been following the national trend of 10% increase in Direct Payments year on year before SDS, there should have been 66 people on Direct Payments and not 64!

The number of Direct Payment User in Falkirk over the last 10 years

 

Source:  Scottish Government Social Care Statistics 2015

Falkirk does have a very innovative Short Breaks service that really helps people make the most of respite opportunities.  This is the kind of project that many other councils should develop to make the most of Individual Service Funds.

However the point of our article in December was to demonstrate that despite the large amounts of investment (Falkirk alone received £1.43 million from 2012 to 2014) and the new law and plenty of guidance, the landscape of choice for people who need support has not been radically changed.  As we said in December “So far, the jury is still out on SDS and we will look forward to the publication of more detailed SDS information [later this] year.”

 

Created on 16 December 2015

In January 2015, we published a short report called “The Start” looking at the first 6 months of Self Directed Support and what was being planned.  It found a hesitant approach that showed that there had been few real developments in SDS.   We  said that when the social care statistics were published in late 2015, we would have a better national picture of how SDS was developing.

There was a total of 6,000  people on Direct Payments in 2013-14 before the introduction of SDS .  In 2014-15 this would need to rise to 6,600 just to keep up the momentum of development.

The figures have now been published.   And the number of people with Direct Payments has risen but ONLY to 6,450.  This is the first indication that the introduction of the Self Directed Support Act may not have increased user choice in control.

In fact further analysis shows that in a range of local authorities things have got worse.    In 11 local authorities the numbers of people receiving Direct Payments actually fell.

Aberdeenshire.  reduction of 100.

East Lothian.  reduction of 120.

Falkirk.  reduction of 20.

Glasgow City.  reduction of 60.

Inverclyde.  reduction of 20.

Midlothian.  reduction of 10.

 

Renfrewshire.  reduction of 20.

Scottish Borders.  reduction of 140.

Shetland Islands.  reduction of 10.

South Ayrshire.  reduction of 10.

South Lanarkshire.  reduction of 10.

DIrect Payment statistics

 

 

In four other local authorities (Argyll & Bute, Dundee, North Lanarkshire and Orkney Islands) the figures flat lined –  the same number received Direct Payments in both years.

Figures on the other SDS options may be published early next year. Some information has been published in council reports and this reflect the mixed picture that we have found above  Most councils  show slow progress.  For example, Aberdeen Council reported that no body had taken up Option 2 in the first 12 months.  South Lanarkshire Council reports that in 18 months only 1 person in the area has taken up Option 2.    Even Dumfries and Galloway who saw a big increase in uptake of Direct Payments had no one on Option 2 by December 2015.

A couple broke the trend with both Angus (82 people on Option 2) and Moray (27 people on option 2) making headway.

It may be claimed that people are still exercising choice when they choose Option 3, where they ask the local authority to organise services for them.  Questions would have to be asked if a policy designed to increase independence and choice resulted in less choice and more dependence on local councils to arrange services.   So far, the jury is still out on SDS and we will look forward to the publication of more detailed SDS information next year.

 

 

Our Findings on Assessment

Created on 05 January 2015

Just about every council in Scotland has introduced a new form of assessment for people who require care and support.

There are three main types:

1.1.      Points Based Questions – These are multiple choice assessments which attempt to carry out an overarching assessment in a small number of questions.   This assessment is usually marked with a points value being given to each answer.  The total value of the points leads to an estimated individual budgets with which to plan support services.  These have additional “free text” areas for differing views or comments from other people

For example, Argyll and Bute Council have introduced a new Supported Assessment Questionnaire which covers 9 areas that people need help in with 26 scored sub questions, each carrying a points value that leads to a final budget.    The person being assessed is encouraged to comment in each section and at the end of the form there is space for an unpaid carer, an advocate and the assessor to make overall comments.

1.2.      Outcome focussed assessments – These are new style of assessment that takes the approach that social work should help people meet particular outcomes in set areas.     Instead of focussing on areas of deficiency the assessment focuses on what the person wants in these areas.    Once the assessment is complete, the social worker uses the local system to decide on the level of service.

Dundee Council has created such an assessment that looks at 8 separate areas such as independent living and keeping safe.   In this case the outcomes part is wrapped around with a number of other more open descriptions on immediate life situations, risk assessments and further actions.

1.3.      Single Shared Assessment:   A number of local authorities have decided to continue using their current assessment system.   This assessment follows a decision on eligibility criteria.   This is a system that relies on current social work practice and experience to secure information about a client’s life and then the social worker uses their own judgement about the service offer to meet any identified needs.

Both East Renfrewshire and East Dunbartonshire have said that they will continue to do this and use their social worker’s professional judgement to make a service offer.  A method of “equivalency” is used to advise individuals about their options under the 4 SDS options.

Other issues emerged from the responses to our queries.

1.4       Wider Embedding.   It would be wrong to overemphasise the stand alone nature of these developments. A number of local authorities have embedded either the Supported Assessment Questionnaire or the Outcomes Focussed in a wider assessment.

The law in Scotland currently requires that a social work professional is involved in the assessment.   The level of that involvement may be open to interpretation but to ensure good practice, local authorities have often retained aspects of the previous assessments which contained social work observations and comments as well as self reported needs and wishes.

Councils such as Angus and Edinburgh embed points scoring questions in their wider assessments  “ALL ABOUT ME AND WHAT I NEED” and “My Steps To Support”, respectively.

Councils such as Fife in their Support Self Assessment Questionnaire and Falkirk in their Single Shared Assessment have built in sections of outcomes to be completed at the same time as collecting wider information.

1.5       Eligibility Criteria:   Many of the councils we heard from were worried about how to manage “Eligibility Criteria” for social care.  As the law in Scotland, currently stands anyone can present to the local authority and ask to have their needs met.  The authority can screen them to see if they have “eligible” needs that the council has agreed to meet.  If their needs are ineligible then the council has no obligation to meet these needs.  If the needs are eligible, then the council has to meet these through offering the person a choice of the 4 SDS options.

So far no council we are aware of has made significant changes to the national eligibility criteria framework.  Some councils have adopted it for the first time.

However two councils East Ayrshire and East Lothian have tied eligibility criteria into their assessment process.

  • East Ayrshire will assess each area of need and then give more points to those who are a “critical” level than those on a “moderate” level and so on.
  • East Lothian will use eligibility criteria against each area of need and commit to meet all needs at critical or substantial levels.  Areas of need at moderate or low levels may not be met by the local authority through this process.

Previous work by the Learning Disability Alliance Scotland has indicated that local authorities have been using eligibility criteria to reduce access to social care for a number of years.[1]  It is possible that this may accelerate due to these new processes.

1.6       Assessment Concerns: 

An individual assessment of need is just that – it is based on the premise that each person is unique, as are their needs for social care and the cost of meeting them.   Social care needs arise from the complex interplay of many factors. A good assessment focuses on identifying what the person’s needs and wishes are and what will best help them achieve the outcomes they identify for themselves.  Yet the way SDS is being implemented is working against this principle, making assessments more prescriptive and resource-led

There are a huge number of assessments carried out in Scotland each year.  We received figures from 30 local authorities on how many assessments were covered in the 4-6 month period.   Not all were able to give us the client group details for these so the total amount of assessments is higher than the total of the client groups shown.

Social Care Assessments and options April – October 2014
Client Group No of social care assessments
Dementia 3,479
Mental Health 2,036
Learning Disabilities 1,859
Physical Disabilities 11,652
Older People 17,196
Other 7,300
Total 42,053              (30 councils)
Carers Assessments 1,372                (21 councils)

 

Not all of these assessments related to Self Directed Support. Some would be for admission to Residential Care.   But some will be multiple assessments on the same individual.  Local authorities reported that they may be using as many as 3 assessments on one person – a basic screening assessment, a generic assessment, then a specific assessment.  Other assessments may be carried out by other local authority staff such as occupational therapists for the appropriate aids to independence.

Even where only one assessment is carried out on an individual, it may be a more complicated assessment with the embedding of particular specialist areas or multiple choice sections within it.

As Scotland does not routinely collect information on the number of assessments carried out and what their outcome may be, we are not in a position to assess whether the number of assessments per client has increased.  Over the last few years as personalisation in England has been introduced the number of assessments per client per year has risen to an average of 1.66 and it would be reasonable to assume this is the case here as well.

One council confirmed in a report they sent to us about the high number of assessments.  “There are concerns this information may not be quantitative as it would appear as there are more duplicated assessments than normal.  When explored, the reason for duplication was insufficient budget identified from the RAS, therefore staff were completing a second SAQ to revise the indicative budget.”[1]

Research by Beresford and Slasberg found that in England while the number of social workers carrying out assessments had risen, their productivity had gone down.  It is suggested that the reason for this is that they now have to spend longer doing assessments, planning and finalising budgets.  Social workers were spending more time “controlling” the process and the costs of this extra bureaucracy had risen by 65%.[1]

In addition to the assessment, social workers have a number of other internal meetings to attend and then a series of planning meetings to ensure that SDS options 1, 2 and 4 where chosen are being used properly.

If this additional workload turns out to be endemic to local authorities then Self Directed Support will have introduced a huge additional cost in extra fieldwork staff for local councils.

Moray council has suggested in a Freedom of Information reply that the cost of a full community care assessment was £1,300 each.  Such figures are not unreasonable allowing for an average rate of £30 per hour for a social work staff and an assessment to involve a total of 40 hours input from the lead care manager and supporting staff.  In one instance, a carer reported a total of 50 hours being spent on assessments, at the end of which they were told they did not meet eligibility criteria.

Applying this figure to the number of assessment carried out about would indicate a cost of £55 million in social care assessment in the first 4 -6 months of this year from most but not all councils.  We could expect this amount to be more than double that in a full year.

[1] How self directed support is failing to deliver personal budgets and personalisation, C Slasberg, P Beresford, P Schofield, Research, Policy and Planning 29 (3), 161-77Applying this figure to the number of assessment carried out about would indicate a cost of £55 million in social care assessment in the first 4 -6 months of this year from most but not all councils.  We could expect this amount to be more than double that in a full year

[1] Argyll & Bute Council, Highlight Report –   Implementation of the Social Care (Self-directed Support) (Scotland) Act 2013, 18 August 2014.

[1] http://www.ldascotland.org/index.php/stop-the-care-tax/108-20-000-lose-out-because-of-tightening-eligibility-criteria

 

New report on Self Directed Support published

Created on 05 January 2015

In late 2014, the Learning Disability Alliance Scotland along with a number of National Carers Organisations, the Coalition Of Carers in Scotland, Carers Trust UK, MECOPP and Carers Scotland sought information from each council in Scotland about how they were getting on.

We found that many of the developments in Self Directed Support show that it is making some changes around Scotland.  Yet the numbers affected by this remain very small compared to the hundreds of thousands of people who use social care support every year.

Concerns over liability, risk, managing expenditure seem to operate behind the scenes of the far more visible outcomes focussed assessment and creative support planning.

For a number of years, the development of the Single Shared Assessment introduced a standardised model of how social care needs would be assessed throughout Scotland.  Now with the introduction of SDS, we have almost 32 different methods of assessing social care needs.  Each values different things or takes different approaches.  While social work professionals will do their best, every craftsman knows they need the best tools.  Too many of these tools feel inadequate, with no real way of understanding what is missed or overlooked.

We welcome the move away from the pseudo-scientific approach of Resource Allocation Systems by some councils.  This was a concern and worry for thousands of vulnerable people and their families.

Matching points to questions in the way that Points Based RASs do has the outward appearance of rationality, yet overlooks the key question of context.  When people in one part of Glasgow or Edinburgh die on average 10-15 years earlier than in another part of the same city, how much more important must the social context of vulnerable people be when it comes to assessing social need.  Yet so much of this is missed from the new assessments.

The “Equivalence” models are no panacea for social care but they avoid the worst of the budget cutting approach that might have developed by an over reliance on computer technology.  However it is not yet clear how much change will emerge from those councils using the equivalence model.

Much of the opportunity for change the landscape of social care in Scotland lies with the development of Individual Service Funds and more flexible ways of spending these funds.  As we have shown few councils have yet committed to taking a flexible approach and this really raises the question of what will, in reality, change.

The biggest challenge in introducing Self Directed Support will be assuming that those who currently receive support are looking for more control or a change in their service.  Most just want to keep getting good support.  Imposing change on people through reduced budgets or a new system could end up creating new problems which is why we welcome the efforts of a few councils to consider how to speedily resolve differences of opinion over social care.

You can download the full report which starts with an Easy Read Summary here.  

You can download just the East Read Report here. 

 

Created on 22 July 2014

In a surprising move, the UK government will not roll out a scheme to provide disabled people with integrated personal budgets after an evaluation found no evidence of improved outcomes.

Incoming minister for disabled people Mark Harper announced the decision not to roll out the Right to Control scheme in a written statement to Parliament last week.

Right to Control was designed to enable disabled people to pool resources from up to six funding streams – adult social care, Supporting People, Independent Living Fund, Disabled Facilities Grant, Work Choice and Access to Work – and exercise choice and control over how the combined budget was spent. It was tested in seven “trailblazer” areas from 2010-2013.

An evaluation published last year found outcomes for people using Right to Control, in relation to choice and control and wellbeing, were similar to people in a control group who were not using the scheme, meaning there was no evidence of positive impact.

The main suggested reasons for the lack of impact was that, in practice, Right to Control did not work as intended, and many service users received the same service they would have done before.

“While the evaluation of this pilot may not have resulted in any measurable impact on outcomes, it was popular with those individuals who exercised their right to control and they valued the greater flexibilities it gave them. It also acted as a catalyst to developing local relationships and partnerships,” the minister said.

Read a longer article in Community Care

 

Created on 17 March 2014

Terri McCue, from the South Side, is taking legal action because she says her 19-year-old son Andrew, who has Down’s syndrome, is not being assessed in the right way.

After filling out the Self Evaluation Questionnaire (SEQ) with a social worker, mum-of-two Terri was offered £9500 a year to pay for Andrew’s support needs. She queried the outcome and was allocated £10,300.  However, Ms McCue says Andrew needs around £17,000, which would pay for 32 nights of respite care as well as other aspects of his care.

The 56-year-old grand-mother-of-one said: “I feel I’ve had no option but to take legal action on behalf of my son. “In one of the SEQ questions the council said Andrew needed help once a week. But he needs help every day. If it’s once a week then I’m asking them what day is it he needs help? Is it a Monday? Or a Saturday?

“It’s just a tick box exercise and they are not taking into account Andrew as a person.” The first hearing is due to take place at the Court of Session in Edinburgh on May 9. The family is being represented by Tony Kelly of Coatbridge-based law firm Taylor and Kelly.

Read More

 

Created on 23 January 2014

Recently the LDAS coordinator delivered a short presentation to the service users and carers group in South Lanarkshire on issues that need to be considered in the development of Self Directed Support by local authorities.

It began:

What the Scottish Government says.

It has passed the Self Directed Support Act 2013 which:

  • Sets out 4 options for the provision of support which the council has a duty to offer
  • Duty to offer the choices and act on the person’s choice (adults, carers and children)
  • Duty to explain nature and effect of options & to signpost people to information & support
  • Power to offer support to carers

New regulations will be published soon:

  • Specifying categories of people ineligible for Direct Payments
  • Allowing easier employment of close relatives
  • Stopping any of all charges for carers for  any services provided through SDS.

BUT

The Act sets out some general principles.  It is up to each local council to decide on details

You can see the slides for the rest of the presentation here.  

Created on 29 October 2013

THE political head of ­Scotland’s largest social work department has been removed from his role, in a move opposition politicians claim is a sacking after a turbulent year.   Glasgow’s Matt Kerr will now become the city council’s executive member for personnel, a post vacated following the death earlier this month of fellow Labour councillor George Ryan.

Glasgow social work has been subject to a lot of questions and scrutiny over the implementation of a controversial version of personalisation.  Many users and carers felt this was more about cuts than giving people choice.  Only last Friday a number of carers spoke to the Glasgow Herald over concerns about their care services and their concerns about bullying.

 

A Fair and Reasonable Explanation

Created on 16 September 2013

A recent legal case decided in the Supreme Court is very important for people who have been through the personalisation process or are about to go through it.

KM v Cambridgeshire County Council (2012) was about the level of service that KM, a profoundly disabled man was to get after the council chose to use a Resource Allocation System (RAS) to plan his budget.  KM lost the case but the judgement in the case clarified the law in an important way.

This RAS model is similar to that being used in Glasgow, North Lanarkshire and being planned in many other council areas.  People who go through this can now expect the following:

  1. The local authority must provide an explanation of how they arrived at the final budget to be offered to an individual and must relate that explanation to the level of needs that the individual had been assessed as having.
  2. The local authority must provide a second explanation detailing how this budget can be used to meet the assessed needs.  This must be a real explanation based on actual costs of service that the individual could purchase with that budget and should also include an explanation of what support will be provided by family or friends (referred to in the judgement as “Natural Supports”)

The level of detail needed should list the required services and assumed timings, together with the assumed hourly cost. Some recipients require more complicated arrangements which would call for more expansive explanations.

An individual with a final budget need not choose to spend their money in the way the council has described but the council must satisfy itself that the support that it has assessed the individual as needing can actually be supplied within the budget.

Where an individual, their family or another legal guardian who is unsatisfied with either the individual budget they have been awarded or the explanation they have been given should now write to the awarding council to ask them for an explanation quoting the KM legal case.

If it is helpful, please use parts of this note in your request.

A Fair Assessment Of Needs

There is another issue raised in the judgement that will be of particular importance to social workers and care managers carrying out assessments.

Both Lord Wilson and Lord Hale in their judgements on the KM v Cambridgeshire case commented on a previous legal case, R v Gloucestershire County Council, ex parte Barry[1997] AC 584 .

Their comments stand as an important clarification in the law regarding when local authorities can take into account the resources that are available to them.

Both Justices were clear that assessments had to be carried out without attention to the available resources to meet needs.

Local authorities could take the resources available to them into account when setting eligibility criteria and when deciding how much resources should be made available to individuals but it could not allow the level of available resources to interfere with a free and fair assessment.

At a recent meeting, reports were offered that some social workers had been asked to alter assessments because there were not sufficient resources to meet the needs identified.  This report is unconfirmed.

However this kind of action would now be deemed illegal by the judges’ decision and any social worker who carried out such an action might be subject to both legal action and a report to the Scottish Social Services Council who have the power to remove a social worker from the register.

Individuals who believe that their assessment or that of someone they care for may have been altered in this way should contact their local authority to make a formal complaint and request that the circumstances surrounding the assessment be investigated.

 

Created on 16 September 2013

The assessment process in Glasgow.

The backbone of the personalisation process in Glasgow is a short form of assessment that was originally issued as a “Self Assessment Questionnaire” but in its latest version has been issued as a “Self Evaluation Questionnaire”, (SEQ).

This is designed as a simple assessment that can outline the needs of service users relatively quickly by looking at where people need help to achieve a range of social care “outcomes”.  This SEQ is then used to allocate a number of points depending on particular answers to each question.  The total number of points allocated is then used to establish an Indicative Budget which should form the basis for meeting a person’s needs.

A number of concerns have arisen over the assessment:

  • It has not involved the service user themselves in most cases
  • It was originally intended for use by trained social work staff but was in practice, carried out be staff employed by providers.
  • Training given to providers was limited and there was no guarantee that staff completing had been trained
  • Some staff did not have a full understanding of the needs of the service user being assessed.
  • Many of the questions were vague or ambiguous.
  • Some staff completing assessments ignored the views or interests of welfare guardians
  • The SEQ was inadequate as an assessment of need and should have been used as a supplementary assessment.
  • There was an abrogation of responsibility by the local authority in its duty to carry out an assessment of people in need of community care services.

Two other points worth noting indicate that a number of the weaknesses of the form and method of the SEQ used for the 1,200 service users of provider organisations in Glasgow are already recognised by the local authority.

  1. While the SEQ is being treated as sufficient when Indicative Budgets based on the SEQ are lower than current service cost, when the Indicative Budgets are higher than current costs then the local authority is requiring a full Single Shared Assessment to be carried out.
  2. A draft SEQ version 10 is being produced which has been significantly amended to include aspects of the Single Shared Assessment.  This has been done following complaints and comments from carers.  However when it is eventually produced it will only be used for new Personalisation assessments – it will not be applied retrospectively.

There can be debate over whether this is good practice or a legitimate response to extraordinary financial challenges but there is a serious challenge possible on the legality of these actions.

The Legal Situation

Community Care assessments in Scotland made under sections 12A and 12AA of the Social Work (Scotland) Act 1968:

  • Section 12A(1)(a) requires that the Respondents “shall make an assessment of the needs of that person for those services.” And
  • Section 12AA(1) & (2) requires the authority to comply with a request “to make an assessment (“the carer’s assessment”) of the carer’s ability to provide or continue to provide such cares for that person”.
  • Reference to making an assessment means making a proper and adequate assessment.

Assessments must be more than a narration of some of the facts; there  should be a proper “assessment” of needs; with appropriate input from health professionals to assess psychological and other mental health needs. R v North and East Devon Health Authority ex p Coughlan [2001] makes clear that even where only simple nursing services may be required then appropriate health professionals should be involved in a multidisciplinary assessment.

An assessment should also look at needs in the short term and in the longer term.  The assessment should include an assessment of the priority for a placement, why a particular placement or support package might be necessary and in what time frame.

Local Authority practice on assessment is covered by guidance that it is issued under s.5 of the Social Work [Scotland] Act 1968. This section of the 1968 Act stipulates that local authorities must perform their functions under the general guidance of the Secretary of State [eg Circular CCD 8/2001: Single shared assessment of community care needs]. Such guidance is enforceable by the courts.

R v North and East Devon Health Authority ex p Coughlan [2001]

Robertson v Fife Council [2002]

R (Savva) v Kensington & Chelsea Royal London Borough Council [2010]  , the House of Lords [Lord Hope] expressed his agreement with the view expressed by the English High Court [ R v Islington London Borough Council, ex p Rixon], that this meant that “local authorities are required to follow the path charted … by the guidance, with liberty to deviate from it where the local authority judges on admissible grounds that there is good reason to do so, but without freedom to take a substantially different course”.

Further in  R (Savva) v Kensington & Chelsea Royal London Borough Council [2010]  it was made clear that even where the local authority was to carry out “a consideration of the relationship between the assessed eligible needs of a particular applicant and the assessed eligible needs of others in the same local authority area”, this could not be done simply on a points system but had to include a identification of people’s needs.

The Guidance on Assessment

The key principles in the Guidance that influence how a local authority must carry out this assessment are:

  • People who use services and their carers should be actively involved and enabled to participate.
  • The type(s) of assessment should be appropriate to the person’s indicated needs:
  • Simple assessment
  • Comprehensive assessment
  • Specialist assessment
  • Self-assessment.
  • Assessment should be undertaken by the most appropriate lead professional.
  • The assessor should be appropriately skilled and qualified to deal with the type and level of assessment.
  • Appropriate information should be shared by informed consent of the person or the person’s representative.
  • Single, Shared Assessment must facilitate access to all community care services.
  • Other professionals and agencies must accept the results.

Assessment is a Local Authority Responsibility

Legal advice received by the ADASS in England and Wales  and accepted by the Scottish Government is that self assessment is not lawful.  A local authority cannot surrender its duty to carry out an assessment.  In a recent charging case, R (B) v Cornwall County Council (2009) 12 CCLR 381, the judge ruled as unlawful the practice of self-assessment standing alone as the only assessment. Here it was stated that:

Furthermore, it is right that the views of the service user and family carers are sought as to his needs and the steps the authority propose to take in respect of those needs. The relevant guidance requires that. The user may of course also be able to produce evidence of a particular need. But the [local] authority cannot avoid its obligation to assess needs etc by failing to make an appropriate assessment themselves, in favour of simply requiring the service user himself to provide evidence of his needs.

Assessing the scale of deviation

Only legal action is the courts can determine in any single case if there has been a breach of these conditions.  Courts would use the remainder of the list to consider whether the form of assessment used in Glasgow deviated substantially from the course laid down in the guidance.

An assessment could be seen to  be flawed and open to challenge if:

  • users and carers have not been involved in the process,
  • their preferences not  ascertained
  • those with communication or mental capacity difficulties have not been given help with representation to express their views
  • It was not led by an appropriate lead professional
  • the person carrying out the assessment was not suitably skilled and qualified for this particular form of assessment .

As a result there is a strong case to be made over that legal challenge by many of the individuals subject to at least the early forms of SEQ assessment would be successful.

Ian Hood, Coordinator

Thursday 24th March 2011

DISCLAIMER:  Nothing in this document should be taken as legal statement of fact. Opinions may vary and new court finding regularly arise.    Full legal advice should be sought from an independent legal adviser before action is taken.  This document may be freely used to start some of the thinking over what legal action might involve.

Note: English and Scottish case law.  We have quoted two examples  English case law in this document. The  legal position is that where the legislation is identical or very similar in England and Scotland, English High Court and Court of Appeal cases will be persuasive in a Scottish court; whereas a House of Lords decision will be binding. Conversely, Scottish Court of Session cases [Outer House or Inner House], are persuasive in England, and a Scottish case reaching the House of Lords is binding in England. Both  cases quoted here are likely to be at least “persuasive” and probably “binding”

 

Is Personalisation Dead?

by Simon Duffy

Created on 16 September 2013

In this essay the author explores some of the implementation problems that are currently limiting the successful implementation of personalisation and the use of Individual Budgets.

Is Personalisation Dead?

Well, of course it all depends what you mean by personalisation.

In fact the term personalisation, while potentially useful, is highly ambiguous. A cynic might even say that this was exactly why Charles Leadbeater chose the term – it seems so inoffensive and reasonable – Who could be against personalisation?

 Not personalisation, but citizenship

The term personalisation was applied backwards, to describe ideas and practices that have always been challenging and difficult, and all of which were developed before the term personalisation was used to describe them:

  • Independent Living
  • Direct Payments
  • Individual Budgets
  • Supported Living
  • Person-Centred Planning
  • Peer Support

and many other important innovations….In fact what all these innovations have in common is that:

  • They were all developed by disabled people, families and their allies and
  • Their goal is not personalisation, but Independent Living and the achievement of full citizenship
  • So while the term personalisation is attractive, it is also very dangerous, because it doesn’t help people really think things through

Individual Budgets

One of the most important examples of this inability to think things through is the history of Individual Budgets. (See the note on terminology below.) Individual budgets were designed to give disabled people control of any support they need to achieve Independent Living. In practice I still think that their development, and their use by local authorities, has been broadly positive:

  • Many more people do now control their own budgets.
  • Many more people are getting better lives
  • Government and others have accepted (to some degree) the idea that people are entitled to be in control of their own lives

In fact this last point is important. In 2006 the typical response of civil servants to the idea of Individual Budgets was to argue that they would not work and they were against current government policy. At that point the consensus in the Department of Health seemed to be that in the future there would be:

  • Increased use of block contracts
  • Increased use of big service providers
  • Increased use of congregate provision

Often, when we rightly criticise some of the poor practice in the implementation of personalisation, we can forget how negative Whitehall’s previous policy had been.

By 2007 government policy had made a 180 degree turn. Personalisation and the use of Individual Budgets are now taken for granted as central to any future policy-making in Adult Social Care.  Well – sort of.

And this is the great problem: the innovation has been accepted, but it is not always understood. This then leads to poor implementation in local areas and poor policy-making by central government.

What Kind of Entitlement?

The central problem is that there is no agreement about how to define the entitlements that are at the centre of social care.  Before I explain this point I want to share a little anecdote.

Shortly after Ivan Lewis took over as Minister responsible for Adult Social Care at the Department of Health I was asked to talk to him about Individual Budgets. Whilst sitting outside his office one of the senior civil servants rushed into the room to insist that I did not describe ‘Individual Budgets’ as entitlements. I was told the government were against ‘entitlements’ and that this was not how the idea was to be understood. Shortly afterwards we were ushered into Ivan Lewis’ office and Ivan began the meeting: “So let me get this straight – the basic idea is that people are told their entitlement up-front and then supported to spend it how they wish…” I smiled, “Yes,that’s right Minister…”

However the battle for a decent system of entitlements has not yet been won.  In England entitlement to social care is very limited indeed:

  • There are very high eligibility criteria which mean that you can have very significant needs and still be entitled to nothing.
  • Even if you are eligible the level of support received can be very poor and insufficient to protect you from indignity.
  • And what you are entitled to are not resources, but services.

This last point may not seem important – but it is in fact vital – because it is only by having an entitlement to the budget that we can ensure that our right to support is compatible with our right to self-determination. If we are only entitled to services then we are dependent upon someone else’s decision about what qualifies as ‘legitimate support’. In other words the disabled person becomes subject to control by the professional.

An interesting way to illustrate this point is to remember how the courts, using principles of natural justice, determine compensation for victims of accidents. The courts do not tell people what services they require, instead the courts determine what is a fair allocation of resources, what is sufficient to enable the person to live independently, with dignity and respect. They settle on a cash sum and they, quite rightly, assume that the person (with any necessary support or representation) will know best how to spend this sum. The courts do not send people to residential care, day centres or respite services.

For a short period, under Ivan Lewis, there seemed to be an opportunity for England to move towards a more respectful model of social care. However, once Ivan lost his place in the Department of Health the old assumptions returned.

The current situation is not necessary and hopefully this government or a future government can be persuaded to revisit this issue.  If so they could choose to take one of the following options:

  1. Reform the current adult social proposals to make clear that entitlements are to a level of resources sufficient to ensure active citizenship, or
  2. Reform both health and social care law and end the false distinction between health needs and social care needs and in its place create a distinction between commissioned services and self-directed budgets.

Although it is easy to blame local government for problems in implementation the real problems starts with inadequate legislation and incoherent policy.

Implementation problems

Not every local area is implementing Individual Budgets badly. For example, I am always impressed by efforts in Barnsley to maintain a genuine understanding of the core principles. However, in my experience, many local areas are struggling with Individual Budgets.

Amongst the many problems that exist are:

  • The rationing process (known as the RAS) is often too bureaucratic and too complex and yet ambiguous
  • The RAS is also being used to make cuts in ways that seem unreasonable and are possibly illegal
  • The planning process has become more burdensome, with disabled people and families forced to get their own plans through a panel of managers
  • Expensive monitoring systems  take away real flexibility and damage independence
  • Little effort has been made to redesign systems to make them more workable for people or social workers
  • Some people are assigned budgets, but lack the means to control them
  • At times it is hard to stay positive. Much has been achieved; but so much more could be achieved.

The Centre for Welfare Reform continues to work with those who want genuine and positive change. For anyone interested in finding some practical solutions to these problems there are a range of resources available on the site and a list on the right-hand side of this page.

Our current situation

Most of these developments took place under the previous government. Instead of treating Individual Budgets (and the other associated innovations) as emerging innovations, that needed time to develop and better legal frameworks to support them, there was a ‘rush to implementation’. In my view this was a mistake.

I think much of the extra £0.5 billion given for the implementation of personalisation was wasted. It led instead to an over-dependence on consultants and increased bureaucracy. The real challenge was to simplify and clarify processes and to bring about the major legislative changes required for a fairer system.

And the situation is getting worse.

By 2014-15 the government will have cut over £11 billion from local government’s annual budget, and adult social care is the biggest element of local government spending. This is an unprecedented attack on the rights of disabled people – we have never seen anything like this. This attack is combined with an £18 billion cut to benefits for disabled people and people living in poverty. Together 60% of all government cuts fall on disabled people or people in poverty.

I cannot see how minor tinkering with systems will help. It is for this reason I have tried to give as much time as I can to the Campaign for a Fair Society. If now is not the time to stick up for citizenship, for Independent Living and the rights of disabled people when is?

I don’t know if it’s useful to think of personalisation as dead or alive – but the rightful demand of disabled people to live as citizens, with support that is respectful and under their own control is certainly not dead and will not go away.

An Apology

Since establishing The Centre for Welfare Reform in 2009 I have been able to work and think with other people about some of the judgements I made in the past. And, I believe I should make a written apology for two mistakes that are having increasingly negative consequences:

  • Complex Resource Allocation Systems (RAS) – using questionnaires, points, weightings and formulas to calculate a fair budget
  • Support Plans – which are now being abused and which are undermining the autonomy of disabled people and families

The Complex RAS

I continue to think that knowing your budget, as soon as possible, is a useful way of enabling you to take more direct control over your own life and your own supports. It promotes autonomy, creativity and a rightful sense of entitlement.

However this does not require a Complex RAS.

The reason that we started to develop a Complex RAS was primarily because senior managers said directly or indirectly “we don’t trust our social workers to make judgements about what is fair and reasonable”.

I feel particularly guilty about this because I know that when people with more power say that they do not trust those with less power, this is never because those with less power are not trustworthy. Rather, it is because of the incompetence of those with more power. Yet, in the desire to get individual budgets into the hands of disabled people and families, I supported the development of increasingly more complex versions of the RAS.

Sceptics rightly pointed to the likely problems:

  • The process would disempower social workers and service providers
  • The process would keep breaking – it was too ambitious
  • The process would be used to disguise unfair cuts and cap budgets
  • Local authorities would not show how they did their calculations
  • The process would not empower disabled people and families

Time has shown that the sceptics were right. These problems grew as local authorities started to adopt these approaches unthinkingly, without reference to the value of social work or to human rights. These problems further accelerated in 2010, as the new government imposed its 25% cut on social care, and as authorities began to use any tool possible to make these unfair cuts.

Today the Complex RAS is a disaster area. The only sensible approach is to go back to basics and to help social workers set budgets in ways that are clear, legal and in tune with the basic principles of the social work profession.

The current cuts to social care are unjust and will only cause deep and painful problems. They need to be resisted by every means possible. The Complex RAS is not a solution; it is just a distraction.

The Support Plan

I invented the concept of a Support Plan in North Lanarkshire in 2000 when developing an early version of self-directed support.  The idea was invented to resolve a problem that was created by the system itself:

  • People could not take control of their funding unless there was a Care Plan
  • The Care Plan had to be completed by the Care Manager

So, at the time, I thought a good solution was to propose:

  • The person produce their own Support Plan
  • then the Care Manager could just sign it off
  • and so the Support Plan became the Care Plan

This seemed like a clever solution to a sticky system problem. Little did I understand what would follow in its wake. Today there appears to be a whole industry dedicated to a series of absurd propositions:

  • Disabled people need plans even when the rest of us get on fine without them
  • Disabled people should plan their whole life out and be made to stick to it
  • Disabled people need support planners, brokers and facilitators in order to plan
  • Disabled people need their plans checked by panels of local authority managers

This is all crazy. At best, a person’s plan is just one way of getting some rather limited evidence that the person, or their representative, is able to manage their own budget and can be trusted to get on with living their life.

After that the plan should be thrown in the bin where it belongs. Local authorities have no more right to plan for a disabled person than they have for any other citizen.

Solving the wrong problem

The Complex RAS and the Support Plan were solutions to the wrong problem.

The Complex RAS was the solution to a problem that only existed because of a failure of trust within social care – solving it only made the basic problem greater – increasing the centralisation of power and a sense of mutual mistrust.

The Support Plan was a solution to a problem that only existed because the policy of requiring a Care Plan was flawed – solving it only maintained the illusion that a document, sitting in a local authority computer system or filing cabinet, is a guarantee of good support. The creation of Support Plans simply opened the door to further waste and paternalism.

So, how do we move forward?

  • To make progress we have to try and do several things at the same time:
  • Avoid solving false problems, problems that are not real but are just symptoms of a flawed system
  • Keep innovating, finding simpler and more respectful solutions to real problems
  • Challenge injustice, don’t accept unfair cuts or damaging policies
  • Build community, share our ideas and be prepared to listen, learn and change

The Centre for Welfare Reform will continue to try and make a positive contribution to building a fairer society. Our social work reform project draws together many of our current ideas on how to do things better. We would welcome any new ideas on how to tackle real problems and challenge injustice.

In order to give someone an Individual Budget there needs to be some kind of Resource Allocation System, that is some set of rules that helps people define a budget that is sufficient to meet their needs – before the person begins to plan. Unfortunately these systems are now becoming too complicated. The Centre for Welfare Reform and ibk Initiatives has begun to develop a new and radically simplified approach in partnership with Barnsley Council.

The Problem of Complexity

The first published RAS was developed by Simon Duffy in 2003, working with Wigan Council, and it filled one side of A4. This model was based upon on earlier work in Scotland where the RAS was based upon a professional judgement of sufficiency – what amount of money is enough to effectively meet a person’s needs. However the RAS has continued to change since 2003; unfortunately it seems to have become increasingly:

  • Long – there are now models with 40 pages
  • Complex – some models involve getting multiple perspectives on one simple question
  • Ambiguous – some models ask lots of questions, and still give no clear budget
  • Restrictive – often models slip back into prescribing how someone should be supported

Given the cost, confusion and difficulties of greater complexity it may be surprising that the RAS has become increasingly complicated; but there are at least 3 reasons why this has happened:

  1. Failure of trust – setting a budget in advance means trusting both front-line professionals and citizens with information about what is reasonable. If we don’t trust people then we will try to compensate by asking more questions and by reducing any reliance on judgement, experience and common-sense.
  2. Centralised control – increasingly the RAS has been seen as a new mechanism for shaping and protecting spending in public bodies. As the ambitions about personalisation have grown so to has the desire to centralise decisions about the RAS – moving them away from the front-line and towards senior officers.
  3. Phoney rationality – using questions, points, weighting systems and sampling methodologies lends an air of rationality to the internal mechanisms of the RAS. It is easy to feel that something so complicated must be more rational despite the fact that there has been no evidence that we need these more complex systems.

The appearance of rationality is often deceptive – more complex doesn’t mean more reasonable. In particular it is very damaging to front-line workers and citizens to feel that important decisions about people’s lives are now being made on the basis of obscure mathematical formulae that are decided ‘up there’.

So we need some fresh thinking.

Reducing Complexity

We could reduce the complexity of the RAS if we paid more attention to the purpose of the RAS. As the figure below suggests – it is not algorithms, formulae or ‘rules’ that determine whether a RAS is fair or reasonable – it is whether the RAS gives people enough money for support so that we can achieve the desired outcomes – in this case – to meet our needs.

What is more important than questions, points and weighting is whether the RAS focuses on:

  1. Outcomes – is the budget sufficient to meet the needs of the person (or prevent need)?
  2. Supports – can a professional suggest some affordable support solution within that budget?
  3. Resources – is the budget affordable for the public body?
  4. Principles – are there clear and public principles describing how budgets are set?

Any system that helps answer those four questions will provide an adequate RAS; and ideally it should do so in a way that citizens and professionals can easily understand.

It is particularly important to remember that the ‘indicative’ quality of any Individual Budget means that the first guess provided by a citizen or a professional will still be tested by trying to develop a suitable service ‘within’ that budget. If it proves impossible to provide a suitable service within that budget this does not mean the RAS is wrong – it simply means that – in this case – the initial judgement must be amended. And this can be done by agreeing a new budget at a different level. It may be that the desire to ‘get it right first time’ has also driven the desire for a more complicated RAS – but instead it may be more sensible to allow for a degree of human judgement and common-sense instead of pushing for more complexity.

A Possible New Model

We have set out a possible new model below. This model avoids complexity and, it seems to us at least, has many other possible advantages over other prevalent RAS models. It still needs testing and further work. But it is published here – in its early form – because we believe too many places and too many people are struggling with unworkable systems – it’s time to try something new.

This model was developed for disabled children – there would be differences for adults and for people with different needs – but these different systems would be easy to develop by working in partnership with citizens and front-line professionals.

Assessment – Budgets are set after the statutory assessment which is captured in a reasonably comprehensive and holistic report. The social worker (or other lead professional) then makes a judgement based upon their assessment of what would be a fair allocation for the family to reflect their circumstances and the needs of the disabled child. If an existing assessment is already mandated then it makes most sense to build on this and not demand additional assessments as part of determining the individual budget.

Entitlement – The lead professional clarifies what the family is entitled to receive – from Level A to Level L:

Simple RAS Model

Level     Individual Budget             Expected Number of People      Total Spend at that Level              Support

A             0              50           0              sign-post

B             0              30           0              sign-post and extra support

C             £500       30           £15,000 grant

D             £1,000   20           £20,000 grant

E              £1,500   20           £30,000 grant

F              £2,000   20           £40,000 = low level home care

G             £3,000   20           £60,000 = 1 night respite pm

H             £4,500   5              £22,500 = 1 night pm, plus care

I               £6,000   3              £18,000 = 2 nights

J              £8,000   3              £24,000 = 2 nights, plus care

K             £12,000 2              £24,000 = 4 nights

L              £15,000 1              £15,000 = 4 nights, plus care

Exceptional         £30,000 1              £30,000 complex package

Totals for Team                 205 People          £298,500

Planning – Families should then be able to use their budget flexibly to meet their needs. For grants the funding is agreed and payment made ASAP. For Individual Budgets families must provide a simple plan describing how they intend to use their budget – if this looks sensible then professional can get payment paid to an agreed schedule (the default would be monthly). All of this should be possible without the use of panels or undue bureaucratic delay.

NB – It also may be better to start giving clear renewal dates for all budgets, with short-term individual budgets being renewed more quickly than budgets where there is a long-term expectation of on-going need.

Ground rules – Families must know that they can safely plan up to the agreed level without having their plan picked over. Families must also know that if their plan is over-budget it will need further discussion and may not be agreed. There needs to be a strong incentive for co-production and the opportunity for families to get better value from the same level of budget. The system would not stop individual budgets being set at levels not specified in the table – and this would be for some agreed reason.

Disputes – Families must know that they are entitled to challenge their allocation and how to do so.

Expected Number of Users – The figure showing the expected rate of uptake of a certain level cannot be used to fix allocations. It is only used as a reminder of typical patterns of need and supports the professional team to manage their whole budget. It is useful because it allows for different approaches within different teams and it helps to keep responsibility for making sensible judgements at a team and professional level (not at a corporate or centralised level).

Equivalency – The Level of a budget must be sufficient to purchase a suitable service that is sufficient to meet the needs of the disabled child and family in the view of the social worker. It cannot be right to set a budget at a level unless you have good reason to believe that this level is reasonable and that someone could get their needs met with that budget. Clarifying an equivalency in this way is not meant to discourage innovation – quite the opposite – but it does help avoid legal challenge, because it shows that the budget does reflect some real model of how a need might be met.

The opportunity for the family is to meet those needs in a way that is even better for them as a family that the system would have done. Moreover, as new standards for good support are set by self-directing families then these levels and their equivalences will need to be reviewed and changed. These levels are not fixed, they are snapshots based on the state of knowledge about how best to meet needs at a point in time.

Legality – although UK law on the right to support is weaker than it should be it is still vitally important that we build on all the guarantees it provides – for children and for adults. This approach may make it easier to clarify how an eligible need is being defined and what level of resource is being treated as appropriate to meet that need. More complex approaches to the RAS seem in danger of inserting new – but legally unfounded – principles into the allocation of the budget.

This model has not been tested yet and it has been designed with a specific team in mind. It still needs testing and is NOT a local policy. It is published on the principle that it is better to share good ideas so that they can be improved. Please feel free to adapt this model and to try it locally. Please let The Centre know if you have any success or find you can make any useful changes.

Personalisation or Entitlements?

Personalisation is a peculiar word. Personal services used to be a euphemism for something rather naughty and, personally, I don’t want a personalised number plate. One of the reasons that people may prefer the word personalisation is that it keeps things vague and it avoids more practical things – like money.

Money is not everything – I prefer love over money – but I’d much rather have love and money.

What about the money?

For more than 30 years there has been a world-wide movement trying to shift the control of the money from government and towards disabled people. In 1996 there was a big breakthrough in the UK, after campaigning by disabled people, when the government finally allowed funding for social care to be provided through a Direct Payment.

However, for most people with learning difficulties, Direct Payments made little difference to their lives. Direct Payments were good – much better than the old system of social care – but they were still not good enough.

Some of the major problems with Direct Payments were:

  1. Out of bounds – People with learning difficulties and many others were told that they couldn’t access Direct Payments because they lacked capacity.
  2. Prescribed – If you did have a Direct Payment your care manager would still prescribe how you could use it in a Care Plan that they wrote.
  3. Unfair – You would only get 75% (or less) of the money that was paid to other people with the same needs.
  4. Limited – You could employ personal assistants, but were not allowed to use the money to purchase other services or use it creatively.
  5. Privatised – You could opt out of local authority services, but you couldn’t use your Direct Payment to purchase services funded by government.
  6. Burdensome – There was no budget for your management costs, so you couldn’t purchase support to be an employer, pay salaries or manage your accounts.
  7. Disrespectful – You were made to keep your money in a separate bank account, manage detailed accounts and if you saved any money it would be ‘clawed-back’.
  8. Gifted – Your money was not treated as an entitlement it was treated like a gift.

This analysis may seem harsh. Direct Payments was a big step in the right direction and much better than the old system of social care. But people with learning difficulties and their families deserved a better system.

What would a better system be like?

  • Self-Directed Support was designed to tackle these problems and to create a new system for everyone using social care. The aim was to create a system that was:
  • Universal – Everyone should get the an Individual Budget, but this could be managed in different ways depending on what kind of help you needed.
  • Self-Directed – You should be able to make your own plans, in your own way, nobody should be able to dictate how you live or how you are supported.
  • Fair – Everyone should get a fair budget, enough money to enable independent living and full citizenship.
  • Flexible – It is your budget and you know best how to use it, if you want to use it for health, housing, mainstream services or anything else then you should be able to.
  • Public – You should not have to choose between using public and private services, if you want to use your budget to buy public services then you should do so.
  • Fully-costed – Not only can you spend the money on support but you should also be able to purchase management, payroll services or personnel services.
  • Respectful – Once the money is agreed and transferred to you it should become your money, with no claw-backs and without separate bank accounts and auditing.
  • Entitlement – You have human rights which entitle you to enough support and the right to control it as you see fit.

What happened?

From 2003 until 2009 I was part of an interesting project called In Control. This project existed at the overlap between three different groups. First there were people like me, paid professionals (although in my case without any professional qualification or training), then people with learning difficulties and their families and then government people – from both local and central government.

At its best In Control served a useful purpose. It took the existing system, with all its laws, regulations and habits, and it managed to bend it creatively into new shapes that resembled the better system I described above. It challenged old forms of practice and it showed what could be possible.

Here are just a few examples of what it managed to demonstrate:

  • There are other ways budgets could be managed, and families can sometimes be good representatives for people.
  • Budgets can be set more quickly, up-front, so people can make better decisions about how to use them.
  • Instead of controlling how someone uses their budget it is better to focus on ensuring that people’s needs are met by looking at the outcomes achieved.
  • People can do their own planning, using different kinds of support, and professionals could move to the background.

Many local authorities started to implement parts of this new system of Self-Directed Support. In Control helped to share this good practice and it encouraged others authorities to do the same. The idea, borrowed from the world of computers, was that we could design a new ‘Open Source Operating System for Social Care’. In other words, without looking up to government, we could all work on designing, sharing and implementing a better system.

What went wrong?

Many individuals and families now get more control, more flexibility and can live better lives. Some people even control funding from the NHS and education. Some local leaders have really tried to build a better social care system. It is not all doom and gloom.

However there are some very real problems. Some areas implemented these ideas very well, others have implemented them badly and in a few areas things seem to be going backwards.

Here are just some of the problems that people are facing in reality:

  • People are being put through new RAS assessments which are being used to cut budgets unfairly, but which then take months to challenge.
  • The Resource Allocation System (RAS) is often a monstrously complex set of forms and the process for agreeing the budget is mysterious and long-winded.
  • Social workers and citizens have to fill in more forms, questionnaires, plans, agreements than they did before – bureaucracy has blossomed.
  • People are not expected to plan for themselves, instead care managers or other professionals carry on writing Support Plans just as they did Care Plans.
  • People are still told they cannot use their budgets creatively or as they see fit – instead they are being limited to social care services.
  • The budget still has to be managed in a separate account, with auditing and clawbacks.
  • At the heart of all these problems is the big unanswered question – whose money is this?

The money should belong to disabled people and their families. If people are entitled to it then it should become their money – that’s what an entitlement means. However, most people in the system still seem to think that the money belongs to the government and so professionals should be able to control it. This is a deep legal, political and cultural problem and it cannot be solved simply by bending the current rules.

The strength of In Control’s approach was that it was able to help bring about important changes without the support of central government; however it did not succeed in bringing about the legal changes that would have been necessary to embed these new approaches. It is for this reason that organisations like the Campaign for a Fair Society are demanding a new system, with a real recognition of the human rights of disabled people.

Where are we today?

Personalisation should be about shifting power and control of money to disabled people, so this means we must talk about funding. The government’s cuts to local government funding will lead to an annual reduction in social care spending of about £6 billion by 2015 – nearly a third of the current spend. It is also cutting benefits by £18 billion. This is the most direct attack on the rights of disabled people since the creation of the welfare state.

We must not accept this. If we cannot fight for the rights of disabled people now – all disabled people, all who are under attack – then when will we fight for those rights. It is not good enough to pretend that merely tweaking the current system with some extra consultancy or training course will solve the problem. Much more profound changes are necessary.

If we are to make further progress then four strategies seem important:

  • Carry on – There is still much to do and there are lots of ways of making things simpler, easier to implement and much less bureaucratic. The Centre for Welfare Reform has published many practical proposals for doing things better and there are many local areas still trying to do it right.
  • Challenge – Disabled people and families should have high expectation. Some of the bad practices that people are slipping into are illegal and illogical and so should be challenged.
  • Connect – Don’t try and do everything on your own – work with other disabled people, other professionals, other families – create your own circles of peer support. Strength comes through working together.
  • Campaign – Governments listen to people who make a fuss – so join the Campaign for a Fair Society – get involved. Now is not the time to quietly acquiesce.

Author: Simon Duffy