SDS Implementation

Whilst there has been progress in the implementation of SDS (Audit Scotland, 2017), the radical transformation in social care promised by the legislation has yet to be seen (Pearson et al, 2018). As discussed below, there are a number of reasons for this.

Progress in implementation

It is difficult to accurately ascertain the extent to which SDS has been

implemented in social care throughout Scotland (Scottish Government, 2019a;

Audit Scotland, 2017). This is related to inconsistent or unreliable social care data at the national level, and local variation in SDS implementation practices and processes (Scottish Government, 2018a, 2019a; Audit Scotland, 2017). In their 2017 progress review, Audit Scotland noted the need for more reliable data – particularly in relation to measuring uptake of the different options chosen (Audit Scotland, 2017). In response to Audit Scotland’s report, the Scottish Government acknowledged the difficulties in determining ‘the extent to which self-directed support has been fully embedded in practice across the country’, and commissioned research which would ‘contribute to improved understanding of the impact and effectiveness of self-directed support at a national level’

(Scottish Government, 2019a: 3).

The published report from the Scottish Government study acknowledges unresolved challenges in undertaking a full evaluation of SDS implementation and notes that ‘measures of uptake of the different options in a local authority is not a suitable proxy for genuine implementation of self-directed support and fidelity to its principles’ (Scottish Government, 2019b: 27). Further highlighting the complexity in determining the national picture in relation to

implementation, Self Directed Support Scotland (2018) note that national data reporting is based on whether people had ‘choice’, yet the meaning of ‘choice’

is not clear.

Although the most recent published national data on SDS shows an

implementation rate of 70% in 2016-17 (Scottish Government, 2018a), this is accompanied by several caveats in relation to data collection and calculation methods which advise caution over the reliability of this figure. In reporting the SDS implementation rate, the Scottish Government note that:

‘The key criterion for inclusion [in the calculation] is that the client was given a choice – an individual should only be included [in this data] if they have undergone an assessment during which the available SDS options were explained.

Scottish Government (2018a: 4)

Notwithstanding the difficulties noted above in relation to data collection, it would seem that SDS has yet to become the ‘mainstream approach’ to social care envisioned by the national strategy in 2010. Recent evidence suggests that, in practice, ‘little has changed in the type of services people are receiving’ as the majority of people are still receiving traditional services under option 3 (Pearson et al, 2018: 663). Large variations in implementation rates between local authorities and between different user groups (Audit Scotland, 2017) further illustrate that SDS is not yet the ‘mainstream approach’ to social care;

for example, the implementation rate for Glasgow is reportedly less than 40%

(Scottish Government, 2018a).

The limited progress to date has been attributed to a combination of related but external factors, most notably: the integration of health and social care;

constrained public sector budgets; and social care workforce shortages (Scottish Government, 2019a; Audit Scotland, 2017). Prior to the implementation of the Act in 2014, a review of barriers and facilitators to self-directed support found that factors affecting uptake included: availability of information; clarity over the legal position (of direct payments); perceptions of risk; and perceptions of cost effectiveness (Scottish Government, 2011c). The legislation and regulatory guidance attempted to address some of these issues, however the lack of research evidence on the impact and effectiveness of self-directed support for users and their families, or best practice in implementation, may also have impacted upon progress.

Are more people experiencing choice and control and improved outcomes?

Within the context of the limited progress in the extent of implementation noted above, there have been some small studies which have attempted to ascertain the impact on the lives of people who have experienced SDS. For example, a pilot study of SDS users carried out by Self Directed Support Scotland in 2016 reported that, although there was little understanding and awareness of SDS and the different options, most respondents felt they had choice and control over their support (SDSS, 2016). However, this was a small, quantitative study which was not intended to produce statistically significant data.

In the same year, Learning Disability Alliance Scotland carried out a national survey of people with learning disabilities, half of whom had gone through the SDS process and half of whom had not (LDAS, 2016a). The survey results

suggested that there had been some progress in relation to people feeling they had control over their care as those who had gone through the SDS process were more likely to report that their views were included in the care plan, and that they had enough information to make choices. However, the survey responses to questions about outcomes showed little difference between the two groups.

Prior to the national roll-out of SDS, the Scottish Government (2011a) funded three local authorities as test sites from 2009 to 2011. While test site

participants generally reported experiencing increased choice and control, it was not clear whether this was a direct result of having SDS, or if it was related to the additional funding and support provided in the test sites (ibid.).

Findings from Scottish Government funded ‘Independent Support’ projects suggest that information, creativity and flexibility are necessary in order to

achieve outcomes (Evaluation Support Scotland, 2015a). Similarly, a pilot

project undertaken by Glasgow Disability Alliance (GDA) reported that a focus on person-centred support and user-defined outcomes, as well as sufficient

resources, were key factors in achieving the vision associated with SDS (Witcher, 2014).

With the exception of small pilot studies, as in the case above, most of the limited research on SDS to date is from the perspective of professionals as opposed to the individuals and carers who use services (Manthorpe et al, 2015).

Addressing this gap is of critical importance because there are strong indications that disabled people are not experiencing improved outcomes in the current economic climate (Pearson and Ridley, 2017), there are concerns about

adequate resourcing (West, 2012) and there is a potential disconnect between policy discourse and user experience (ibid.: 646). Furthermore, research ‘about’

disabled people has been strongly contested by the Disabled People’s Movement (see chapter four), and the lack of attention to users’ perspectives conflicts with the overarching aspiration of personalisation and its aim to shift power from professionals to service users.

Nonetheless, evidence from the test sites and pilot projects suggests there are lessons to be learned in relation to SDS and improved outcomes. The findings from these projects show that the key to improved outcomes is not choice and control per se; rather, it is the ethos of independent living which underpins SDS policy and is, subsequently, reflected in its values and principles. A focus on person-centred assessments and user-defined outcomes, as well as adequate funding, were identified as vital factors in achieving the aims of SDS (Witcher, 2014). However, support alone is not enough to remove the barriers faced by disabled people in society – such as negative attitudes, inaccessible transport, inequality in education and employment (Witcher, 2014) – and achieve the aspirations set out in the National Strategy.

Resourcing

The discussion above highlights the importance of funding in successful implementation. This is supported by Roulstone and Morgan (2009: 343) who argue that planning and resources are crucial to transforming social care in order to meet the goals of ‘genuine personalisation’. Longstanding issues in relation to the funding of social care are highlighted by West (2012), who notes that there were concerns about the sufficiency of resources for implementing

personalisation policies in England pre-austerity. More broadly in relation to public services, Ferguson and Lavalette (2014: 22) argue that the goal of ‘doing more for less’ pre-exists austerity.

Personalisation policies have a longstanding association with cost savings (Pearson and Ridley, 2017). As discussed in section 3.2, the potential cost savings proposed by BCODP influenced the eventual acceptance of direct payments legislation in the 1990s (ibid.). Within the context of SDS

implementation in Scotland, and notwithstanding the evidence outlined above which shows the importance of sufficient resourcing, policymakers’ concerns about the cost effectiveness of SDS are illustrated in the recent Scottish

Government Implementation study (Scottish Government, 2019a). Acknowledging the challenges in resourcing personalisation policies in England, Slasberg et al (2014/15: 50) propose that policymakers need to recognise the existence of unmet need and, in doing so, make a commitment to closing the current funding gap over time.

The personalisation agenda has emerged at a time when the rights of disabled people are being undermined due to austerity measures, which have targeted welfare benefits and resulted in substantial reductions in local authority social care budgets (Pearson and Ridley, 2017). Instead of extending autonomy for service users, the implementation of SDS in the current economic climate has

resulted in the allocation of individual budgets sufficient to meet only basic needs – ‘critical’ rather than the ‘aspirational’ needs – associated with the policy aims, and the reframing of eligibility criteria which denies social care to some groups (ibid.).

Whilst IRISS (2012) caution against conflating SDS and austerity, the policy context inevitably affects local authority implementation and therefore user experiences. In some local authorities in Scotland, SDS has been used as a means of achieving cost savings (Pearson and Ridley, 2017). Importantly in relation to this thesis, there is a body of evidence that Glasgow City Council adopted this approach in learning disability services (Main, 2014: 34; LDAS, 2016a: 2; SCSWIS 2011: 9). As one of the three test sites, Glasgow City Council approved the roll out of SDS in learning disability services in 2010, announcing that SDS would result in £10m of savings during 2012/13 (Main, 2014). Presenting SDS as the fair way to allocate scarce resources, one of the ways in which cost savings have been achieved is through the closure of day centres for people with learning disabilities (Main, 2014).

As discussed in chapter two, resources previously directed towards collective provision have been redirected to individual budgets (Hall, 2011). The

combination of personalisation policies and austerity has led to the contentious closure of day services for people with learning disabilities as segregated, specialist provision has been replaced by individual care packages (Power and Bartlett, 2015). Whilst this policy shift presents opportunities for alternative places of care to emerge, the loss of collective spaces risks increased isolation for people with learning disabilities (Power, 2014). The shift in resources from collective provision to individual budgets, and the lack of alternative provision, has resulted in fewer options for people with learning disabilities. For many people with learning disabilities in Glasgow, the implementation of SDS has been experienced as offering them ‘less choice, less money and less say’ (Main, 2014:

34).

Austerity

The implementation of SDS in Scotland is taking place at the same time as public spending cuts and welfare reform associated with austerity. In April 2014, when the SDS Act came into effect, local authorities in Scotland were also dealing with substantial budget cuts (Pearson and Ridley, 2017). As noted above, both the Scottish Government and Audit Scotland acknowledge that constrained public sector budgets have contributed towards SDS implementation taking longer than expected (Scottish Government, 2019a; Audit Scotland, 2017).

Public spending cuts have been presented as an essential government response to the challenging global economic climate (Levitas, 2012); however, this is highly contested. Clarke and Newman (2012: 303) propose that the UK government has reacted to the global economic crisis with cuts 'deeper and harder than most EU countries', and have presented this as a righteous and necessary response to the problem of 'Britain's broken society' (ibid.: 310).

Describing these actions as an ‘assault on welfare’, Ferguson and Lavalette (2014: 5) argue that the global financial crisis made it possible for the UK government to make structural changes which would have been met with resistance at any other time. Thus, the global financial crisis has undergone an ideological transformation through political discourse, being reframed as a crisis of the welfare state, blamed on the Eurozone, the recklessness of previous governments, and welfare dependency (Clarke and Newman, 2012). The reframing of the problem of, and solution to, the global financial crisis has enabled the cost of the financial crisis to be shifted on to ‘the shoulders of the working class’ (Ferguson and Lavalette, 2014: 5).

The 'age of austerity' has resulted in radical cuts to the UK welfare state, with the greatest impact felt by the most disadvantaged groups in society (Ginsburg et al, 2012). Disabled people are particularly vulnerable to cuts because this

group is disproportionately reliant on health, social care, housing and transport services, and are more likely to live in poverty or be on benefits because of low rates of employment and high costs of living with impairment (Demos, 2010;

EHRC, 2010). Spending cuts have a cumulative effect on the lives of disabled people, with the potential loss of benefits resulting in additional demand for social care services at a time when local authority care budgets have been cut, eligibility criteria has been increased, and charges for care services have also increased (The Hardest Hit, 2012; Morris, 2011).

There is some evidence to suggest that cuts to local authority budgets have resulted in individual social care budgets being set at a level which just meets basic needs – particularly for people who need personal care in their own homes (Pile, 2014). Pile argues that service cuts and closures, and ‘management

pressure to trim care packages’, are being carried out under the guise of

personalisation (Pile, 2014: 55). Furthermore, the effects of reduced social care budgets are being exacerbated due to cuts in community services – such as libraries and leisure centres (Pearson et al, 2018; Ferguson, 2012). Whilst both the national strategy and the SDS Act are underpinned by commitments to human rights and independent living, there is evidence to suggest that this has been compromised by the timing of SDS implementation and the impact of austerity (Pearson and Ridley, 2017).