"I would never have believed..."

Learnings from our Self Directed Support (Option 2) pilot

The introduction of the Social Care (Self- Directed Support) (Scotland) Act in 2013 has provided a framework for a brave new world in which to work and live. 

For the first time, legislation has enshrined the notion that people who require support should have choice and control over their support, and that the systems set up to provide that support should be as flexible and responsive as possible.

Individual Service Funds are at the heart of the practical application of Self Directed Support.

Shortly before the introduction of the Act, Thistle Foundation and City of Edinburgh Council agreed to collaborate on a pilot of ISFs, an approach to the practical application of Option 2 that was (and still is) far out of the comfort zone of many providers and local authorities.

The pilot tested whether personalised support could be designed and delivered differently by a creative approach to planning and use of funds and whether this approach led to better outcomes for the people involved – as intended by the Act.

This approach lies in stark contrast to a traditional hours-based approach. 

With a shared understanding of the leap of faith required to bring about the wholesale change to the traditional approach to health and social care provision, Thistle and CEC embarked on the pilot by identifying a small number of people that were already supported by Thistle and exploring the notion of ISFs with them.

Of the seven participants identified, one dropped out because she felt the process was not for her and another dropped out because the process was more complex than anticipated. The remaining five participants experienced significant and positive change in their lives. Three of their stories are included in this report as they each demonstrate the diverse ways possible of using an ISF budget.

Creative use of the ISFs included a range of purchases, relationships and activities not normally seen in conventional support packages. These included the purchase of sound-proofing for someone’s house, a shared-care arrangement with a parent and the funding of a person’s involvement in social groups in order to grow their social networks.

Participants achieved a wide range of outcomes, including increased self-confidence, improved health and wellbeing, reduced professional support, improved relationships, increased autonomy and greater self-advocacy.

Health and Social Care Practitioners also benefited from an approach that was more outcomes focused: they experienced more multidisciplinary collaborative working which enabled more frequent, consistent and better informed shared decision making and risk taking with the families and people involved in the pilot.

As well as delivering personal outcomes, the ISF pilot generated significant learning for both the City of Edinburgh Council and Thistle Foundation. The need for close collaboration and solution-focussed conversations between partners was fundamentally important, as was the need to develop a reasonable and straightforward process and framework for deciding how personalised budgets can be spent. The approach to monitoring this expenditure, and the need to factor in indirect costs such as administration, were also highlighted as vital.

It is clear that user choice and involvement are key: the pilot showed that, along with great opportunities, there were great challenges for all concerned in overcoming fear, anxiety and distrust of such a new and different approach to the provision of care and support.

Providers and Commissioners must find a way of working that is flexible enough to be both achievable and workable for those that need support and those that help provide it. It must have the ability to be both widely applied and individually tailored.

There are many opportunities to progress the rollout of SDS and the approach tested in this pilot is just one. While it is an approach that accepts that the structures and processes already in place in traditional health and social care systems do not make for an easy adjustment in the short term, it is one that balances the need for such structures and processes with the opportunities for change that now exist for supported people.

The hard work of supporting people to have better, more informed choices and to have control and flexibility in the way they use the resources available to them through Self Directed Support on a larger scale is just beginning, but this report demonstrates the significant positive changes that can happen when we work together to do this

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