Challenges and issues in implementing choice, flexibility and control in social care services - an evaluation of self-directed support pilots in Scotland

Abstract

Reform of social care emphasises delivery of personalised and flexible support, whereby individuals have greater choice and control over the way their needs are met. In 2009, Scottish Government selected three local authorities to trial targeted activities as part of its investment to promote self directed support (SDS) in Scotland. They commissioned an evaluation which assessed the process and impact of the test sites during 2009-2012 focusing on uptake, activities to promote and increase awareness of SDS, the impact on service users, carers and staff, and assessing the extent of system wide change. This presentation focuses on the evaluative study, which used mixed methods – qualitative interviews; internet survey; monitoring information; documentary analysis; and individual case studies. Methods were designed in partnership with local project managers and other stakeholders.

Local authorities face a number of challenges in implementing SDS and achieving transformational change. The study established that access increased and those accessing SDS packages were positive about the choice and flexibility offered, though this was linked to greater levels of support and funding available during the pilots. The test sites took longer than anticipated to get established – recruiting staff, raising awareness, training and setting up SDS systems, and providing support.

Despite obvious progress, all three local authorities faced remaining and significant challenges in implementing SDS. For example, ensuring communications about SDS were transparent and up-to date; managing the impact of financial and capacity constraints which might compromise choice and control; and, whilst designated SDS/personalisation teams were highly valued, they were described as over-stretched. The pace of implementation was a significant factor influencing perceptions of the success of implementation, and high numbers of SDS packages per se were not always considered to be positive when this compromised quality of involvement and co-production in assessment and support planning.