Self-directed Support The Unpacking of Assessments SCOVI Conference 24th June 2014 Suzanne Abbate

Welcome! Provide an overview of the Act and brief historical context. Confirm the principles and values of the Social Care (Self-directed Support) (Scotland) Act 2013 (“The SDS)Act”. Help to demystify some aspects of self-directed support assessment Consider some of the implications of the duties of Act for practitioners internal support services partners users of services By the end of this session participants will have: Increased awareness of SDS values, ethos and principles Increased awareness of the key duties in the SDS Act An increased awareness of the implications of the key duties for their role/professional group

What is Self-directed Support? An exciting and innovative approach to assessment and support planning that encourages collaboration and partnership with people. Changes how we all do things and what we so to ensure people have more say in how formal support is designed and have control over how it is delivered. Supported by new statutory duties, values and principles. An opportunity for authorities, and those delegated to undertake SDS responsibilities to develop creative and more person centred systems and practices. It is also an opportunity for partnership working between key agencies for example education, NHS primary care. It is a way of engaging with people and their communities that will involve long term change –potentially in systems, processes and workforce deployment- one of the aspects of today’s session that people may need to reflect on with other colleague on own locality. Its also recognised this is first key step on longer journey of change –over years not months.

The Vision The lives of people who require support are enriched through greater independence, control, and choice that leads to improved or sustained health and well being, and the best outcomes possible. “Self-directed support should become the mainstream approach to the delivery of personal support. Building on the success of direct payments, every person eligible for statutory services should be able to make a genuinely informed choice and have a clear and transparent allocation of resources allowing them to decide how best to meet their needs. The choice should be available to all but imposed on no-one. “ Self-Directed support: A National Strategy, 2010)

Legislative and policy background 1968- Social Work (Scotland) Act   ‘Deficit’ model The state will provide (and decide…) 1990- NHS and Community Care Act (implemented 1993) 1995- Children (Scotland) Act 1995- Carers (Recognition and Services) Act 1996- Human Rights Act 1996- Community Care (Direct Payments) Act 1999- Modernising Social Work -White Paper 2001-Changing Lives 21st Century review of Social Work 2002 -Community Care and Health (Scotland) Act 2010-Equality Act 2011- Christie Commission “ nothing about us, without us, is for us” This shows just a sample of the policies , legislation and change that have influenced and changed relationship between public and public service over last 40 years. Some of this has been in response to where it was perceived we could do better and in response to demands for change More accountability and scrutiny More gatekeeping Social work decision making considered to be too slow and bureaucratic-1999 White Paper A sense for workforce and public alike of prove rather than improve? For people and for practitioners a loss of confidence, a sense of fitting people to services not services to people. Skills and expertise not effectively used To “do” for and not with . The Independent Living Movement started in the 1970s People wanted to be in control of their own care and support Services weren’t fulfilling what was important to people People wanted choice

Influences: Independent living The Independent Living Movement started in the 1970s People wanted to be in control of their own care and support Services weren’t fulfilling what was important to people People wanted choice

Definition of Independent Living The 14 rights: Full access to environment Full access to transport Technical aids and equipment Accessible and adapted housing Personal assistance Inclusive education and training Independent Living means living independently with the right support. Here is the definition from Independent Living in Scotland (ILiS): “Independent living means all disabled people having the same freedom, choice, dignity and control as other citizens at home, a work and in the community. It does not necessarily mean living by yourself or fending for yourself. It means rights to practical assistance and support to participate in society and live an ordinary life.”

The 14 rights (cont’d) An income, including access to benefits for those unable to work Equal opportunities for employment Accessible information Advocacy and self-advocacy Counselling, including peer counselling Accessible and inclusive healthcare Communication, appropriate communication support Civic participation This has wider implications for society , this is not just a responsibility for social work services in local authorities but does give context.

Co-production To do “with not for” Values/ Assets Goal focussed. Person and/ or carer as partner A move to strength based and person led approaches That recognise and value the resources and the expertise that people bring.

Discussion Think for a few minutes about what choice and control mean to you in how you live your life then In pairs; share some of the themes where choice and control influence (and help)you in your day to day routines.“ You have 5 minutes

The Self- Directed Support Values and Principles (for assessment, arranging support, for carers and supported people Values Principles Fairness Freedom Safety Independence Respect Involvement Collaboration Informed Choice Participation Dignity These also apply when guiding people to non formal or non funded support , for example own resources, resilience and own support networks Should be seen an guiding an approach, a new way of doing things.

Values and principles -their importance Reassurance-The values and principles are already embedded in practice , we know this. Drivers for change -They provide a powerful pathway for a shift in control and for innovation at all levels/ Core and fundamental-give permission for enabling effective partnership and collaboration, different rules , better defined purpose. This is

What this means in practice ? For people For practitioners For local authorities being in control Being a real partner in assessment and support planning. More flexibility and choice Support that fits a person not the service. an opportunity to work in partnership. An approach that shares responsibility. More opportunities to be creative. An opportunity to ‘do what you trained for’ work within the values and principles well embedded in social work and in other public services. A need to revisit current service design A need to revisit current processes (e.g. finance, procurement, commissioning) Consideration of where other duties complement and guide the implementation An opportunity for new internal and external partnerships Commissioning arrangements will need to be tailored to person –unique to individual New partnerships With communities With other people with Education NHS etc Process and decision making will require to be transparent for people and for practitioners

Personal outcomes and goals- a new language for assessment Helps highlight the impact of any support put in place People are motivated by what matters most to them there are infinite ways of achieving outcomes that are both efficient and effective for people and for organisations. If you are isolated you don’t necessarily need day care, there are resources and solutions already in our communities longer term this will help people make more effective use of their own natural supports, and ideally have less dependency on formal services

What matters most to people Choice Having people to rely on Seeing friends and family Treated with dignity and respect Feeling valued Involved in community Feeling safe Having things to do Being in control Fulfilling ambitions Keeping well Based on Udset research from 2000 onwards -what people say is important when dealing with social work and health staff. Helps support good outcomes based assessment and planning The Shannari wellbeing indicators provide simlier thems for when engaging with children young people and their families.

Assessment for Personal Care A. I am able to meet my personal needs and do not require any support in this area B. I am able to meet my personal care needs with occasional (not every day) physical / gestural / verbal support to maintain independence but ensure essential care needs are met C. I need significant (every day) physical / gestural / verbal support from another to meet my personal care needs To have essential personal care needs met D. I need frequent (several times per day) intimate support to meet my personal care needs To have essential personal care needs met E. I need constant intimate support to meet my personal care needs I do not require help to meet my personal care needs. I can attend to my needs by myself. I don’t regularly need support with things like going to the toilet, washing and dressing and mostly manage by myself.   I occasionally need help with personal care. I need someone to help me once a day. For example, someone to prompt me to take a shower or wear the right clothes. I need support now and then with personal care. I’m OK for a while but need help with personal care every 3 or 4 hours. I often need help with personal care during the day; I need someone to be there to help me every hour or so. I need a lot of support with personal care (with washing and going to the toilet). I need someone else to help me at night - during the night - as well as during the day.

Assessment for Eating and Drinking I don’t generally need help to eat or to drink. I can prepare snacks and hot drinks, but need help to prepare a main meal. I wouldn’t be able to make a snack for myself / or I need someone to help me to eat and drink.   I need lots of help to eat and drink, I need to be fed and given drinks or need to be supported to make sure I have enough to eat or don’t eat too much.

Assessments for Daily living I do not need support in this aspect of my life or I do not have my own tenancy and I am not planning on having my own tenancy B. I need occasional (once a week or less) support to run and maintain my home To maintain my tenancy and manage the day to day tasks involved in running a home C. I need regular (e.g. At least once a week) support to run and maintain my home To maintain my tenancy and manage day to day tasks involved in running a home D. I need frequent (several times per week) support to run and maintain my home To maintain my tenancy and manage the day to day tasks involved in running a home E. I always need significant (every day) support to run and maintain my home I don’t need help with very much around the home  I need help weekly with some things around the home for example, I need some help with shopping, laundry, housework, managing finances, paying bills and general home maintenance  I need help a few times a week with some things around the home : I need help every other day with practical tasks as I can’t currently attend to these.  I need a lot of help every day and with most things around the home: I need lots of help with my shopping, laundry, housework, managing finances, paying bills and general home maintenance.

What do you think about SDS? In pairs/ at your tables take 5 minutes to discuss what you think SDS will mean for people who live with visual impairments or deafblindness.

What’s new? the six duties We must have regard to the general principles stated the Act when carrying out assessment and the provision of support. Power to provide support to carers(of adults) following carers assessment . We have a duty to offer 4 choices to persons assessed as eligible for funded support to how that support is delivered: Option 1 direct payment Option 2 the person directs the available support Option 3 the local authority arranges the support Option 4 a mix of the above. We must take steps to explain the ‘nature and effect’ of each option. We must provide information, assistance and support – to express any views (how to manage the support and where to get help.) We must, as far as is reasonably practicable, promote a range of providers and types of support (commissioning/procurement.) Facilitators Notes: Quick overview, 5 main duties which are new

Group Exercise Identify some of the benefits that this will bring for the people who require support You have 5 minutes Facilitators Notes:

Any questions, comments or observations?

Who can be offered the 4 options? The offer of the 4 options can be given to anyone who is eligible for social care funded support. This is only available after a full outcomes focussed assessment has been completed AND after alternative supports have been explored (natural supports, universals services, re-enablement support

Are there exceptions? Local authority have discretionary powers to not offer option 1 and 4 in these circumstances: People in Residential Care (Option 1) Person whose safety is at risk (Option 1 or 4) Facilitator note: We are awaiting the regulations (laid before parliament in 16th of January) which will clarify the residential care issue. NCHC is being rolled over for 1 more year to allow preparation for proposed move to local commissioning .

When will it start? The Act commenced in April 2014 The duties will apply from April to people new to the system People already receiving services or who are “in the systems” must be offered the four options when their package is reviewed

How SDS fits with other legislation The SDS Act does not replace any of our existing duties. The SDS Act aims to complement and support other legislation. There may at times be conflict between duties within other legislation that will require to be negotiated. Protective duties will remain paramount. SDS Act resonates strongly with Human Rights and Equalities legislation. Statutory Guidance is available aims to support implementation and inform practice. Facilitators Notes The act does not replace existing duties, such as duty to safeguard and promote the welfare of children and adults, duty to provide assessment of needs, for adults, carers and young people. The new act should complement and support other legislation and links with others key act such as Social Work (Scot) Act 1968 and the Children's (Scotland) Act 1995 which is the two main pieces of legislations that governs practice within Social Work Our duty to safeguard and protect adults and children at risk remains key to the social work task, SDS support does not diminish this, in fact the principles of involvement and collaboration etc. could and should support positive risk enablement, the key to SDS is adopting a relationship based approach to engaging with individuals and there families which can provide good ways of identifying and responding to risk.

Social Care (Self-directed Support) (Scotland) Act 2013 Mental Health Care & Treatment Act 2003 Adults with Incapacity Scotland Act 2000 Human Rights Act 1998 Social Work Scotland Act 1968 Children Scotland Act 1995 Adult Support & Protection Act 2007 Domestic Abuse Scotland Act 2011 Equalities Act 2010 Direct Payment Act 1996 Welfare Reform Act 2012 Children’s Hearings Act 2011 NHS & Community Care (Scotland) Act 1990 Community Care & Health Act Scotland 2002 Social Care (Self-directed Support) (Scotland) Act 2013 Patients Rights Scotland Act 2011 Disability Discrimination Act 1995 Housing Scotland Act 2010 National Assistance Act 1948 A simple visual representation of the many (not exhaustive) Acts that shape and inform our policies, procedures and practice Prizes for identifying any missing ones !!! This slides really aim to emphasis that we are surrounded be legislation that helps guide our practice, but also influences our lives as citizens often we as citizens we are not aware of all the powers and duties associated with the acts but frontline practitioners need to have a sound understanding of how these affect there role. Clear policies and guidance both nationally and locally assist staff. SDS is just another piece of the jigsaw aimed to support better outcomes for people who require support. Public Service Reform Scotland 2010 Regulation of Care Scotland Act 2001 Protection of Vulnerable Groups Scotland Act 2007 Chronically Sick and Disabled Person’s Act 1972 Data Protection Act 1998 Education Scotland Additional Support for Learning Act 2009 Local Government in Scotland Act 2003 Freedom of Information Scotland Act 2002

In Summary The majority of legal powers and duties will fall to local authorities. Where a health board is discharging social care duties on a delegated basis the duties in the Act apply. Duties and legally binding and cannot be ignored. Self directed support, is intended to support, promote and protect human rights. Support should be delivered in a way that supports choice and control. Cultural and system change will be required to support successful implementation. It is complicated but legislation, statutory and best practice guidance is there inform practice.

Useful links  Statutory Guidance & Regulations ‘The Social Care (Self-Directed Support) (Scotland) Act 2013’ – Scottish Government http://www.scotland.gov.uk/Publications/2013/11/3923 Current eligibility for adults in Scotland http://www.scotland.gov.uk/topics/health/suphttp://www.careandhealthlaw.com/Public/LawDatabaseCasesDesc.aspx?IndexType=2&Id=171port-social-care/support/older.people/free-personal nursing-care/guidance Self-Directed Support Scotland http://www.sdsscotland.org.uk/ A Guide to Receiving Direct Payments (Scotland) NHS http://www.sehd.scot.nhs.uk/publications/grdps/grdps-01.htm   Disability Rights UK www.disabilityrightsuk.org Belinda Schwehr – Legal judgments for England that can support SDS delivery in Scotland http://www.careandhealthlaw.com/Public/LawDatabaseCasesDesc.aspx?IndexType=2&Id=171

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