Choice and control exist in social care – just not yet with the people who need it
Eight years ago I began working with ENABLE Scotland as a management consultant, helping to prepare the organisation for the brave new world of Personalisation and Self-Directed Support (SDS).
Around that time, ENABLE Scotland was involved in several innovative SDS pilots, including in North Lanarkshire and Glasgow. I worked with many people who have now designed their own support arrangements, recruited their own teams and, as a result, are living full and happy lives. Alan Starrs was one of these individuals, and is one of the nicest people you could meet.
His smile is infectious; he loves spending time with his friends, and takes a genuine interest in everyone he meets.
And on my first day back in ENABLE Scotland as CEO, I had the pleasure of meeting Alan, as he dropped into my office to say hello.
I was thrilled to hear that Alan had achieved all that he wanted from his support from ENABLE Scotland, and that he was sitting across from me planning his next holiday.
I have witnessed first-hand the impact that the freedom SDS offered had on Alan and many others. For the first time, they were in control, and they weren’t being constrained by the sector’s three Rs – rotas, rules and risk assessments.
Transforming the mind-sets of the people receiving support – to think about what was possible – was the easy part. Transforming the processes and practices surrounding the delivery of that support, was a much more significant challenge.
In 2015 ENABLE Scotland implemented a wholesale transformation of our delivery of traditional services to a personalised model of social care which was built on person-centred recruitment. By the end of 2015 every person that ENABLE Scotland provided support for had the opportunity to recruit their own individual support team.
In essence, our organisation had fundamentally changed to ensure that the principles of personalisation and SDS were truly embedded in our model of social care delivery. We were – and are – ready.
There are countless examples of great practice as a result that I could share with you – including the fact that 78% of our services have received either a grade 5 (Very Good) or grade 6 (Excellent) rating from the Care Inspectorate. Or the visible changes I have seen in people such as Alan as they have developed and grown to become active members of their community – on their terms.
We have also been working as part of the Scottish Government’s SDS Implementation Fund to take forward innovative work in our Fife SDS project, working with individuals, families and social work staff alike to explore how people can be supported to have the control and power to bring about change in their lives, highlight the value of people and communities to help bring about positive change, and to reinforce the need for just enough support to help people move closer to their outcomes.
However, whilst many providers, individuals and commissioners have been committed and fully prepared to taking SDS forward, the realisation of true SDS for every person receiving social care support in Scotland has been fragmented at best. Seven years since the advent of SDS, in far too many areas of Scotland, not enough has changed. It’s still a postcode lottery, and that’s not good enough.
This week’s progress report from Audit Scotland recognises the tremendously positive impact that SDS can have if effectively realised, but is also stark reminder of how far we are from realising the true ambitions of the 2013 Act. Unsurprising perhaps, given the current challenges facing the social care sector in Scotland. But I wonder how can this improve without further systemic change?
The Audit Scotland report finds that current commissioning structures impose restrictive terms, constraining providers and the people they support and stifling the innovation and freedom required to deliver true choice and control for every individual. Audit Scotland find that a significant minority of social work staff, whilst positive about the principles of SDS, lack understanding, confidence and autonomy to make decisions with people about their support.
These issues are exacerbated by the ongoing recruitment and retention challenges facing the sector – a repercussion of the pay and conditions available to frontline staff and, ultimately, an additional barrier to nationally realising the life-changing support SDS can bring. As recognised by Audit Scotland, ongoing work to deliver better reward via the Living Wage rate for all hours worked at the frontline of social care delivery is a significant part of the journey to full realisation of personalised support from excellent quality staff.
The challenge presented by the Audit Scotland report to public bodies, Scottish Government and providers alike is this – we do have choice and control. The choice and control to commission differently, to upskill staff, to pay social care staff a real Living Wage rate, to choose wisely about where to best direct the public funding resource we do have to ensure that it delivers personalised support and dignity for all of our most vulnerable citizens who need it.
We welcome the clear recommendations published by Audit Scotland today, but acknowledge that, with £70 million already invested by the Scottish Government over the last seven years – it’s not all about the money.
Transformational culture shift across the sector is what’s required.
The leadership and culture challenge presented by today’s report to leaders across the social care sector is now to make the difficult choices to think differently about how to ensure that control really does lie with the individual – and not within social care providers and public bodies.