Excellence network: self-directed care

Welcome to the Excellence Network, Community Care’s new honours programme which recognises innovative and impressive practice and shares it with the whole of social care. We have been looking for teams that are passionate and committed and have implemented progressive ways of working.

Today we can reveal the teams our judges felt demonstrated real excellence in self-directed care. The four teams have made great strides in brokering new services. Over the next two weeks, we will be covering honoured teams in the categories of early intervention and training and development.

All the learning points from these teams and projects – and from many more – can be accessed through our free good practice database available


The Excellence Network is right to identify self-directed care as one of the categories recognising initiative, team working and professionalism. As Putting People First made clear self-directed support is to become mainstream, and personal budgets will be available for everyone eligible for publicly funded adult social care support.

Entries for this category of the Excellence Network reflected the current state of play in self-directed support. Some clear trends can be highlighted. The greatest developments are in services for people with learning disabilities, and for people with physical disabilities. Much less innovation was apparent -for older people, where there are still frequent assumptions that people will not be able to cope or will not want the hassle of managing personal budgets.

In the mental health field self-directed support has scarcely registered on the horizon and future developments will have to address the problems in balancing choice and control with concerns over risk, public protection and compulsion on the other.

Impetus

A policy impetus is building in children and families services. Individual budgets for families with disabled children are to be piloted by the Department for Children, Schools and Families from this year. Last year’s Treasury review of services for disabled children said individual budgets could give “families and disabled young people real choice and control to design flexible packages of services which respond to their needs”.

Furthermore, it is also clear that these objectives are consistent with the policies for all children and with the outcomes framework addressed in Every Child Matters. Personal budgets for families with disabled children could be just the first step for enhanced personalisation for children needing support. It will be vital for policy learning to be shared between adults’ and children’s services centrally and locally if the scope of individual budgets for children and families is to be maximised and they are to benefit from the emerging evidence of what has already been shown to work.

There are opportunities to extend self-directed support to young people in transition between children’s and adult’s ser-vices, and this is reflected in entries to the Excellence Network. The recent report on In Control includes initiatives about children, young people, their families and carers.

Adulthood

Some of this has been developed by Paradigm (an In Control partner) with the “Dynamite” programme of self-directed futures for young people. This remains small-scale activity – the first seven sites began work in autumn 2005 and 12 local authorities have taken part altogether, with 37 young people using a personal budget. The Dynamite model has been described as offering “a radically different pathway into adulthood than that usually available to disabled young people”. The transition between children’s and adults’ services has often been a problem “of being slotted into services whether or not they fit with a young person’s aspirations”.

The principles of self-directed support that have been developed by In Control are rest on an ideology of citizenship based on the six pillars of self-determination, direction, money, home, support and community life. Support to enable people to live as full citizens and to achieve independent lives is at the heart of these objectives self-directed support is a means to these ends and not an end in itself. While innovative approaches promoted by In Control and other agencies, and by the range of teams represented within the Excellence Network, are important, this goes far beyond merely working with new procedures. As David Towell and John O’Brien have pointed out, the challenge is essentially about establishing “a clear understanding of the moral foundation for social care and to gather support for it”.

Judgements about progress towards improved independence, choice and control for people who use services are made by looking at proxies such as direct payments and personal budgets. Over time the Excellence Network should promote a greater understanding of the transformation agenda and encourage excellence in supporting people – of all ages and capacities – to attain genuine citizenship.