Personalisation in Scotland

Scotland’s government is pledging to make self-directed support central to social care. Jeremy Dunning investigates what this will mean

Scotland has historically lagged behind its southern neighbour in rolling out personalisation in adult care, and has far lower direct payment rates than England. In part, this reflects the political impetus provided by the UK government to further personalised care in England, culminating in the three-year Putting People First programme launched in 2008 and backed by £520m in development funding.

However, last month the Scottish government put out to consultation its own strategy for self-directed support. Its ambition – echoing policy in England – is to make self-directed support “the mainstream mechanism for the delivery of social care”.

Theresa Shearer, of user-run learning disability charity Enable Scotland, says it is time the agenda on self-directed support is pushed forward with more vigour. “Our members are very keen for that mainstream roll-out,” she says.

Among the strategy’s 26 recommendations are that the Scottish government consults by this spring on the need for new legislation on self-directed support in order to address existing barriers to increasing direct payments uptake.

How it works in practice will depend on the 32 local authorities. Currently there are significant differences in uptake of direct payments between areas. For instance, Edinburgh accounted for one-eighth of packages in 2008-9, followed by Fife and Glasgow.

Bill Scott, policy officer at Inclusion Scotland, a coalition of disability organisations, says some councils have wanted to retain control over the services offered to users, while others may have told people about self-directed support as an option while trying to dissuade the clients from taking it up.

As in England, the strategy promotes the use of individual budgets – known as personal budgets in England – under which users are allocated a sum of money to meet their assessed needs which they can take as a direct payment or leave to the council or a third party to administer. This will draw on experience so far.

North Lanarkshire Council started ­piloting individual budgets in 2008, with the charity In Control. A review published last year found individual budgets had “filled in the gaps” by enabling people to spend money on gym membership and other services not funded by the council and improved control and flexibility for users.

The strategy will also be informed by three test sites – in Glasgow, Dumfries and Galloway and Highland – which will be trialling different aspects of self-directed support until January 2011.

The Scottish strategy differs from its English equivalent which sets milestones for councils, though it has set ambitious aspirations for the next five years and beyond.

The Scottish government also believes the strategy can tackle “tighter financial pressures and demographic changes” on the basis that “more of the same”, in terms of traditionally commissioned care, cannot deliver improved outcomes.

Duncan Mackay, head of social work development at North Lanarkshire Council, warns that, in the current economic climate, self-directed support could be perceived as a cost-cutting measure.

But he adds: “What’s positive about the strategy is that the Scottish government has realised the need to take a more broad brush approach to self-directed support than simply one based on increasing the number of direct payments, although that’s an important consideration.

“What the draft strategy does is ­significantly increase the likelihood of more people enjoying the benefits of self-directed support.”

England versus Scotland on personalisation

England

● Number of adults receiving direct payments in 2008-9: 86,000

● Number of adults receiving home care services in September 2008: 340,600

Scotland

● Number of people receiving direct payments from 2008-9: 3,017

● Number of home care clients in March 2009: 68,334

Sources: NHS Information Centre and Scottish government

Milestones and measures

England: Milestones

● By April 2011 at least 30% of eligible users or carers should have a personal budget in each council.

● By December 2010 every council should have at least one user-led organisation contributing to the transformation to personal budgets.

➔ Read more on the Milestones 

Scotland: Measures of success in strategy

● A radical increase in the uptake of self-directed support.

● A sustainable network of independent support organisations for service users.

● Appropriately trained personal assistants and personal assistant employers (service users).

➔ More on the Scottish self-directed support strategy . Consultation closes on 7 May 2010.

CASE STUDY

Glasgow pilot spawns innovation for budget holders

Glasgow Council began its pilot site in May 2008 in the east of the city, focusing on testing individual budgets for people with learning disabilities.

Although there are only 10 packages, 24 more sit in the pipeline. From April the council intends to start serious project planning to boost numbers now that it is satisfied the systems work.

Ultimately, it intends to roll out self-directed support across the city, starting before the project ends in 2011.

Service user group Enable Scotland has been working closely with the council and has found a lot of enthusiasm for self-directed support among its members.

Enable’s Theresa Shearer says the group had sometimes noticed signs of inertia in parts of the council’s bureaucracy but strong support from the top overcame this.

Although it is early days, those members already on individual budgets are doing “innovative” things.

“One wants to be involved in a community but the way day centres are run does not suit her, so she’s looking at setting up a community-based singing group,” Shearer said.

The work involved in starting this pilot area has been enormous. Glasgow spends about £360m on social care each year, purchasing services from about 240 providers.

David Williams, the council’s assistant director of social work, says: “This highlights the sheer scale of the task from moving from council-led provision and commissioning of services to something that’s more self-regulated.”

It required the council to encourage a culture shift among staff and put in place an entire infrastructure for self-directed support, including a resource allocation system to determine the cash value of individual budgets, user-friendly self-assessment policies and governance arrangements to manage risk.

Williams says: “The world is a changing place and our priority has to be about ensuring how Glasgow’s people get the services they need at the time they need.”

The council is also working with systems provider OLM to develop an online portal to offer information about services.

The Glasgow Social Care Providers’ Forum was set up to help providers become more informed about the changes that will take place, including the changing relationships they will have with councils and service users.

Director Charlie Barker says providers recognise that changes have to take place, and many see self-directed support as a chance to provide better care and services, though there are concerns over the financial impact.

But she says: “People say the bottom line is the outcome. But it’s actually about what people require to get a life. What does it matter if it’s also saving money?”

There are wider concerns among users and their families that self-directed support is simply a cost-cutting measure and not a means of empowerment. Clearly more needs to be done to market the concept.

For instance, the council is considering closing three learning disability centres and reinvesting the savings into adult care.

Project leader Margaret Wheatley says: “We want to modernise day service provision for people with learning disabilities. But families will find it tough to trust our motives so we will have to work with them.”

This article is published in the 18 March 2010 edition of Community Care under the headline “The Scottish path to personalisation”