Health, Social Care and Sport Committee [Draft]

Meeting date: Tuesday, June 4, 2024

Official Report 820KB pdf

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Social Care (Self-directed Support) (Scotland) Act 2013 (Post-legislative Scrutiny)

Item 3 is an evidence session with organisations that are currently funded to deliver activities that are detailed in the Scottish Government’s “Self-Directed Support Improvement Plan 2023-27”, as part of phase 2 of our post-legislative scrutiny of the Social Care (Self-Directed Support) (Scotland) Act 2013.

I welcome to the committee Kaylie Allen, director of funds at Inspiring Scotland; Dr Jane Kellock, project lead and consultant, self-directed support team at Social Work Scotland; Pauline Lunn, director of In Control Scotland; and Donald Macleod, chief executive of Self Directed Support Scotland. We move straight to questions from Tess White.

Thank you, convener. Hello, panel members. I have two questions. I will put the first question to Dr Jane Kellock and then Donald Macleod. Given the changes since the 2013 act was introduced, particularly the integration of health and social care and the proposed national care service, do you think that the act requires amendment?

I do not know that I would say that the legislation requires amendment. What we have heard from our members and from people who we have consulted over the past while is that the self-directed support legislation is good legislation. People want it to be in place. It is the implementation that is the issue.

I would say the same. We conducted some research in 2020 of people’s experience of self-directed support. The overwhelming sense was that, where it works, it works well, and that there is nothing wrong with the legislation. It is about the implementation, the local variation and the lack of data and accountability. What people are proposing is more investment in the infrastructure.

Before I go on to my second question, I note that some areas or regions would say that they do implement self-directed support, while some scarcely implement it. Do you have any views on that, Dr Kellock?

Yes. There is huge variation across Scotland in the implementation of self-directed support. It is a complex area to implement well, and it is a complex area to implement across all the populations that should have access to self-directed support.

I think that I have mentioned before that we feel that the implementation of self-directed support somewhat stalled at the point when the Public Bodies (Joint Working) (Scotland) Act 2014 came into play, because there simply was not enough developmental or implementation resource at the local level to be able to do everything well. We tended to see self-directed support being implemented reasonably well for adults with physical disabilities and sometimes reasonably well for children with disabilities and people with learning disabilities.

However, there are lots of populations that, in general, do not get good access to self-directed support. That includes people with mental health problems, people with social care needs that are perhaps outwith the regular populations that you would think of—homeless people, say, or people who have substance use issues—and the older population. There tends to be a more transactional service delivery to the older population and those with dementia. There are a lot of populations that do not have access.

There are a number of important factors in the lack of success in some local areas. There are no effective legal mechanisms for individuals who are seeking social care support to be able to challenge decisions. That is generally done through the local authority complaints process, which is opaque and quite general. There is a lack of data to inform improvement. There is so much local interpretation of legislation. Social workers vary in how well informed they are, and SDS is not routinely on the curriculum for social work students.

On national consistency, as Dr Kellock pointed out, there is a lack of availability of all four SDS options across the board in some areas, particularly rural areas. That is creating pressure points in the system, which is overloading another part of the system. Perhaps we will come on to that later. It is creating pressure currently, particularly when it comes to option 1.

My second question is whether panel members think that amendments to the National Care Service (Scotland) Bill or the Public Bodies (Joint Working) (Scotland) Act 2014 are required to ensure the successful implementation of self-directed support. Has the SDS collaboration discussed that? Who would like to go first on that question?

11:00  

I am happy to go first. I am not sure whether this requires an amendment specifically, but there has been a lack of self-directed support altogether in the development of the legislation, or at least there has in the conversations that we have been part of. Many members of the national collaboration have taken part in the development of the NCS: some of us are on the expert legislative group and some have been on the advisory group or in other co-production spaces. It feels as if we regularly have to remind the policy writers that—with few exceptions—self-directed support is the cornerstone delivery vehicle for all social care. Although it would not be a change to the legislation, there should be a reinforcement that that is the national policy for social care.

One concern that I have heard, and one reason why the committee is doing this study, is that we need to understand why self-directed support has not been implemented. We want to look at the areas where it has and has not been implemented.

Kaylie Allen, do you have any comment on what Pauline Lunn just said?

Independent support has a role. There has been some discussion about where advocacy would fit into the NCS. I represent Inspiring Scotland and the support in the right direction organisations that provide independent support. We want to champion the importance of independent support and the range of activity to help people access their rights through self-directed support.

You can have policy and legislation, but people need support to access that properly and they need that throughout their social care journey, from pre-assessment, through having the social care assessment and on to managing their social care budget. That support is on-going.

We would have expected to see more prominence of the importance of independent support and of how advocacy is part of that. The support works best when it is preventative and when people get access right from the beginning of their social care journey, which can mean discussing what their social care needs are before they have an assessment.

Dr Kellock, the first theme for our questions is the collaboration between areas. What are your thoughts about collaboration gaps?

I think there is a huge collaboration gap. When the legislation was first enacted, local authorities had recourse to statutory guidance and a little bit of practice guidance, but the transformative nature of the legislation was, and still is, misunderstood. We see that in the plans for the national care service, where the expression “SDS” represents a huge number of different aspects and elements.

We have recently refreshed the self-directed support standards. There are 12 foundational standards and more than 50 core components, which are the elements that we believe are essential to good self-directed support. That in itself says that a really complex infrastructure is needed for self-directed support to work well. When there is a lack of understanding within national policy of the level of detail of self-directed support, you get lip service being paid to it, without enough detail.

We would like to see the self-directed support standards and the core components being written in detail into all relevant policies across Scotland, so that we can see how different policy areas would pick up on different aspects of self-directed support to make that a reality within the national care service.

Kaylie Allen also spoke about budget.

I am interested in the improvement plan, which has been updated for 2023 to 2027. I would like to hear your thoughts about how that update is different to previous plans. Does it allow people to have more choice about and control of the plans for their care?

The improvement plan was co-designed to a certain extent, and it reflects a lot of the core areas for improvement that are common across the collaboration of stakeholders that are involved in self-directed support. It is an iterative journey. I do not think that one improvement plan over four years can make all the changes that are necessary. I also note that it is not particularly well funded. We are working within an envelope of the funding that is available and not the funding that we think is necessary in order to really make it happen. I think that all the organisations that are represented on the panel are working with less available grant funding than we had in previous years. We are feeling the pinch and we are having to prioritise what we pay attention to.

We are now more knowledgeable about what implementation takes, and the implementation gap. In the stakeholder collaboration, we have done a lot of work on taking a learning approach to developments and implementation. We are probably on the front foot there. We are turning our attention to the right things because we understand what the implementation gap is. However, it is a huge area, and the more we explore and understand what the problem is, the vaster the gap that we see becomes. There is a lot to be done at both national and local level to make SDS work.

The data in Public Health Scotland’s dashboard is really helpful. We can look at the data for all of Scotland or break it down by age group, choice of option or local authority. It shows that people up to the age of 18 have predominantly chosen option 1, which is direct payment, and that most people over 18 have chosen the option that involves help from the local authority or a combination. I found all that data interesting when I was analysing it.

I learned previously that people do not really equate self-directed support with what the local authority gives them. They say, “The local authority is doing this for me,” rather than, “This was my choice.” Should we in some way enhance people’s knowledge about what the self-directed support options 1, 2, 3 and 4 are so that people know that they are making a personal choice even if they have chosen the local authority option?

On your first point, there is a danger in assuming that the data that we see on the options that people are using reflects the options that people have chosen. They are not always the same thing. We know that the availability of services is incredibly limited, the pressures that local authorities and support providers are under is intense and eligibility criteria are higher than ever before, which results in people sometimes not having the support that they would choose.

The fact that we have that data does not necessarily mean that there have been active choices. I think that we all agree that that is one of the big data gaps. It is not just about recording who is using what; it is also about the extent to which there have been active choices and what people might have chosen otherwise.

That applies in particular to option 3, whereby the local authority arranges support on the person’s behalf. In Control Scotland published some research on that last year, which I hope you have seen. If not, I will provide it after this session. We looked at examples of good practice or emerging good practice in relation to option 3, because you are absolutely right that the principles and values of self-directed support apply to all four options and not just the ones whereby people are in control of the budget. We learned that there is still some misunderstanding, even in local authorities, of the fact that option 3 is still self-directed support and people who have chosen that option should still have flexibility and freedom to have a little bit of choice and control in what their support looks like.

Our learning has been that the services that are involved in that are often the highest-volume services, such as care at home and older people’s services. However, there are some brilliant examples where local authorities have promoted flexibility, choice and control in those really high-volume services. They are in the research that I mentioned, if you want to have a wee look at some of them.

In each of your organisations, there are budgetary constraints. You have mentioned that already. Would any of you be happy to tell us about a good example of work that your organisation is doing to achieve the revised plan outcomes?

I think that we are all doing the right work, because we now understand better what it will take to deliver on self-directed support.

On the project side, Social Work Scotland has seven workstreams on different themes and areas. I will highlight a couple of those.

I mentioned that we have revised the self-directed support standards. We did that in a very co-productive way, with a whole range of stakeholders across supported people. We looked through different lenses to see who got access to self-directed support and who did not. We also looked through a geographical lens at the challenges in different geographies in Scotland.

All of that helped us to revise the standards and make them more accessible and understandable, and to bring them up to date for post-pandemic Scotland. We have those standards now, and we are about to go out with them on roadshows over the summer to develop an approach with local authorities, looking at how they might bring those standards to life in their own areas—because, ultimately, that is what we want. We are working at an intermediary level, if you like, between national policy and local practice. We want to drive good practice and consistency locally.

We are also testing out an approach to self-evaluation and improvement, which will be of use to social work and social care leadership in local authority areas. So far, that has been tested by three local authorities, and we will roll it out to a further three to five in the coming year as a second iteration. That is very much based on taking a learning approach—looking qualitatively at people’s experience.

To go back to what Pauline Lunn said, you cannot tell how people have found the experience of the self-direction of their social care just by looking at the options. You have to delve in and understand what their experience has been like.

Those are two examples of big areas of work that we are engaged in.

We support the improvement plan with some of the tools for the job, such as the information systems. We recently launched the national SDS online handbook, which should be a one-stop shop for anybody who is trying to access information on SDS. It is based on the success of the personal assistant online handbooks and the personal assistant employer handbooks.

When it comes to the option 1 arrangements, I chair the personal assistant programme board. We have been working to improve awareness of the personal assistant role and parity between that component of the workforce and the rest of the social care workforce. We look at improving data, the awareness of the role, the recruitment infrastructure and the training infrastructure. We have developed a training framework with modules that focus on PA wellbeing and on direct payments. We are working with Social Work Scotland on a national direct payment agreement. One of the inconsistencies across the local authorities is that there are 32 different ways of applying a national direct payment agreement.

We also have a group that works on peer support networks. We are trying to make that part of the infrastructure as robust as possible.

I am happy to comment on our work. What we at In Control Scotland do that is a little bit different is that we run national and local programmes, all of which are founded on co-production. All of our work involves disabled people, unpaid carers, support providers and local authority staff working collaboratively to solve problems.

On a national level, we do that through a programme called working together for change, through which we bring together folk on a development journey. The interesting thing about that—this is probably true for all of our work—is that you do not see real change at the end of any particular programme; it comes over time. For example, a senior leader from a local authority came on our working together for change programme three years ago, and it inspired him to change the way that he was writing the strategy for self-directed support in his local authority. That then changed the way that he was working to develop worker autonomy practices, and different approaches to eligibility criteria were developed. All those things came as a result of a bit of work that happened three years ago.

Change can sometimes be hard to measure at the time, but it can happen over time. When you are working in a systems change environment, that is the nature of the beast.

11:15  

I can talk about the support in the right direction programme, which contributes to outcome 1 of the improvement plan. The programme provides practical support for supported people and carers to exercise choice and control. It is a Scottish Government-funded programme for which we are the strategic delivery partners. We have 33 projects, with a presence in every local authority. Those projects involve local community anchor organisations, carers centres, disabled people’s organisations, centres for inclusive living and some SDS forums. The programme employs approximately 70 staff across the country who provide practical support for people as they go through their journey.

Our role is to collect information about what people are doing in relation to advocacy, brokerage and providing support around option 1 and what being a PA employer means. We collect information on all the work that goes on to help people through the assessment process and to think about creative options for their budgets and about what personal outcomes mean. Those 70 funded staff provide a lot of practical support, and we gather information on that, so we will be able to collect data on the point at which people come for independent support and who is not getting independent support—with the best will in the world, there will be a lot of people whom the 70 staff are not going to be able to reach.

The programme involves providing people with information about what the process actually means. We gather information on whether people are feeling more confident to manage their budgets, whether they feel that they have had a choice and have some control over their social care plan and on what support they need to put that in place.

To go back to Emma Harper’s point about the options, those organisations get a lot of information about what is happening locally, what the available options are, and what people understand about their options. Do they even know what option 1 is? They might be on it, but do they know that it is option 1? We gather a lot of information about people’s experience on the ground and feed it into the collaboration and to the Scottish Government.

The organisations often work with people when things are not going well. People will get a referral to an organisation, which can support them to feel better about their care, or get the things put in place that need to be put in place for them to feel that they are more in control of their care. However, as I said, ultimately, it works much better when the organisations support people before there is a problem and use things such as peer support to enable people to speak to others who have been through the process. That allows people to understand what it is like. It can inspire them about the different creative options that there might be and allow them to think about other community supports that they might be able to access.

Our real drive is to raise awareness of the importance of independent support, which is needed for people to be able to access social care, and to gather as much learning as possible to feed that back into the plan.

Thank you.

I will come to Sandesh Gulhane in a minute, but I first want to pick up on one point. You might well not be able to answer this question because you are not local authority representatives. However, I have heard a couple of times from panel members about gaps in staff knowledge or understanding of SDS. Do you know of any work that local authorities are doing to address that, or would that be better put to the Convention of Scottish Local Authorities?

I think that you would be well advised to put those questions to COSLA and to senior leaders, who I know are coming to give evidence at a future meeting. However, we work with a community of practice of local authority SDS leads and others who are involved in the local implementation of self-directed support and, in our experience, staff understanding—social work and social work practitioner understanding—of self-directed support is not particularly good.

The availability of training for social workers and social work practitioners is not particularly good. I suppose that that speaks more to the enabling context that sits around self-directed support than it does to self-directed support itself. For example, there is no protected time for social workers to learn, so they tend to get training in areas such as child protection and adult protection on the job. At the moment, the training that is afforded to them for self-directed support is very poor. We are doing a piece of research to look at the availability of training, and I will be able to speak about that at some point during the summer when we get evidence from that.

Our understanding is that the training is fairly poor and that the understanding of self-directed support across the social work profession is not good. The model of practice that adult social care works under is care management, and we know that that is not the right practice model if we want to support people to have choice and control. It is necessary to have more of a relationship-based practice model, and sometimes we do not have that at the moment. Especially when people’s needs are critical, things such as eligibility criteria force practice down to a level where there is no meaningful choice to be had. If your needs are critical, you just need support to be put in place.

All sorts of things are hampering and hindering the system at the moment. There is no magic bullet. Our understanding of implementation science tells us that there are multiple factors that need to be in place. The main idea that we work with is the notion that it is the relationship between the supported person and the practitioner—the social worker or the paraprofessional who works with them—that draws out the solutions in respect of what matters for that individual. That relationship-based practice is absolutely at the heart of self-directed support. It is not possible to have choice and control unless you understand what matters to the person.

Thank you. We might go into that in a bit more detail later on.

I declare an interest as a practising NHS GP. This question is for Dr Kellock. We have strategies such as the dementia strategy, we have the Promise and we have the proposal for a national care service. There are times when those policies will rub up against one another. How will we be able to navigate our way through that?

I go back to the point that I made earlier about the need for a nuanced understanding of self-directed support throughout all the related policy areas. Rather than self-directed support simply being mentioned in a policy area, it would be useful for the self-directed support standards, which represent the agreed position across all the stakeholders on what good looks like when it comes to self-directed support, to be looked at carefully by the likes of The Promise Scotland and the national social work agency, and for them to have an understanding of what it will take to implement those standards.

Those elements would help at the policy development level, and they would certainly help with the implementation of any of those policies. We really need to have self-directed support more closely weaving through all those policy areas.

We have a national collaboration—a voluntary collaboration—that involves all the stakeholders across the SDS community, which would be more than willing to be involved in any of those areas. We are there for the asking. That is a punt, I suppose, to get us more involved in the development of other policy areas.

I want to move on to the issue of evaluation of the implementation plan. Jane Kellock, you mentioned that you feel that you are “doing the right work”. How are you monitoring the effectiveness of that work?

There is a range of ways of doing that. We always evaluate the work that we are doing. We all do that across the piece, and that gets fed into the general understanding of how effective our work is. It is difficult to measure such things quantitatively, because we are dealing with issues of fundamental change, implementation and development, both nationally and locally. However, it is possible to look at all this through a learning lens to see what we can understand and learn and how we are putting in place different strategies to meet different needs at a local level. At the moment, we are working with our Scottish Government colleagues on the monitoring and evaluation of the improvement plan and are involved in the co-production of that.

That question was not specifically directed at Jane Kellock, but I thank her for answering first. I will bring in Kaylie Allen and then come to Pauline Lunn.

I guess that we are in a slightly different situation. Because we have organisations that deliver for people, we are able to gather feedback from those people about the difference that their independent support is making to them. We collect both quantitative and qualitative data, and that tells us about the number of people who are getting support; the number of people who have been helped with advocacy or to prepare for assessments; and the number of people who are getting support for their option 1 arrangements and how they are managing as a PA employer or just as an employer. We will also gather information on how people are feeling about that, whether they are feeling less stressed or anxious about their support, or whether they have been able to live more independently as a result of the independent support that they got to enable them to make the most of their social care.

We are working with our 33 funded organisations, and we will be gathering and feeding in data on a quarterly and six-monthly basis. However, it is all about the experience of people and carers, how they use independent support and how that has helped them with their social care.

With the strength of the national collaboration and the relationships that we have together, we have a really good opportunity to learn through this learning-based approach. It is not just about numbers. We might see that we had delivered 100 sessions, but so what? What difference did they make? A hundred people could, in answer to a survey, say that they had really enjoyed the sessions. Again, so what? How do we know that they made a difference?

The real learning comes when folk such as the funded organisations and all the people who actually work on the ground in the national collaboration come together and look at the patterns that they have spotted in all the things that we are learning. We can anticipate the things that we might have to address and see what areas are evolving well enough that we can probably leave them alone. The important thing is to have that iterative, shared and collaborative learning.

Data is meaningful only if we learn from it. We can gather as much data as we like, but the question is: what are we doing with it? For those of us working in self-directed support and thinking about outcomes, the question is always: so what? What does it mean? How do we learn from it? I think that we are now, perhaps, in a position to do that in a way that we might not have been able to do with other plans.

That is a really important point. We MSPs talk about data a lot, but the question is: what do we do with it? You might have the numbers or the facts and figures, but the issue is how you use them to improve lives.

Donald Macleod, did you want to come in?

I do not have a huge amount to add, except to say that taking a human learning systems approach and looking at people’s experience of self-directed support will be a way forward instead of considering systems-based data. The collaboration has been involved in co-producing the improvement plan and the monitoring and evaluation format; given that both involve Government and COSLA, they will be a compromise in some ways, but there will be more of a focus on people’s experience.

Thank you.

This question might be more difficult to answer. An additional £200 million has been added to this year’s budget for adult social care and the national care service. How should that money be allocated to achieve the most effective outcomes? You can see now why I said that it might be more difficult for you to answer.

We have conversations with front-line social workers every day. During our option 3 research, people spoke about feeling like they were on a hamster wheel—that is, constantly in motion but not getting anywhere.

The current models, systems and practices are bureaucratic and unwieldy. These things were put in place to support workers, but they have become burdensome. We have massive scrutiny panels and reports have to be written for those. Those things take time, energy and effort and they are not the reasons why people become social workers. People do not become social workers because they want to fill out forms and present to panels. They become social workers or social care workers because they care about people and want to make their lives better.

11:30  

However, every portion of the sector has been facing the worst challenges with regard to recruitment and retention that most of us have ever seen. My personal priority—I think that my organisation would agree—is investment in the social care and social work workforces. Many of the system’s problems will automatically become easier to deal with if there are more people to do the work. However, at the same time, complementary to that, we need to think about reducing bureaucracy—we need to think about the things that people could be not doing as well as what they could be doing.

I definitely agree with that. I would draw the distinction between the volume of people that we need—we need more workers, they need to be better paid and we need to attract people into the sector—and the systems issue. At the moment, the practice model is not right. The systems that sit behind social workers and social work practitioners and local authorities are cumbersome and difficult to navigate, so improvements are definitely needed in order that we have a practice model that is well placed to support the fundamental principle of self-directed support, which is choice and control.

I will refer back to the independent review of adult care in Scotland, in which Derek Feeley advocated a national care service that was delivered with the full involvement of the independent living movement—the disabled people’s independent living movement in Scotland. That part of the infrastructure is chronically underfunded and underresourced as people struggle to deal with their own lives and to get choice and control for themselves.

During the pandemic, disabled people felt that their lives were becoming deprioritised. The proposed disability equality strategy has not been delivered, and we have not had an immediate priorities plan for disabled people. More investment is needed in the infrastructure and the organisations that support disabled people.

Kaylie Allen has spoken about the independent support organisations. With regard to those organisations but especially the people’s collectives that are governed and delivered by disabled people themselves, such as the centres for inclusive living, we found that it was extremely difficult to deliver the Covid payment to front-line workers—personal assistants—because those organisations do not have the capacity. Therefore, more investment is needed in that, and more investment and credibility need to be given to independent living.

I want to build on the questions that the convener asked about training and awareness in local authorities. A lot of best practice guidance has been written over the past 10 years. What are the panel’s thoughts on the quality of the guidance, and on how it is or is not being used in local authorities? There is a lot of nodding going on. I will pick Donald Macleod first, if that is okay.

That is fine. We were all involved in the review of the SDS practice guidance. It is great stuff and it is good that it was reviewed. It is very thorough. It is the nuts and bolts of daily delivery, but it does not improve delivery in and of itself—it is just a nuts and bolts manual on how to do things.

With regard to investment in the training infrastructure and the gaps that you have heard about in the knowledge and awareness of local authority front-line workers, a lot of the independence support organisations provide some of that training and awareness for local authority staff. We are currently delivering a national brokerage framework with a Scottish Qualifications Authority accredited award, which a lot of local authority staff are taking part in. More investment is needed in that. As I said, the statutory guidance itself is a good piece of work, but it is just a nuts-and-bolts manual.

We have done a lot of work over the past few years to review and refresh all the bits of guidance in the self-directed support library, which is an online resource. We have reviewed that, brought it up to date, aligned all the material with the standards and recently developed new practitioner guidance that sits alongside the more general SDS handbook. We launched that, and we are monitoring how accessible it is for social work practitioners on the front line.

The community brokerage training for self-directed support is second to none. It is a fantastic training resource, and we would love to see that being used more. I heard recently from social work colleagues that they cannot afford at local authority level to pay for that training, nor can they afford to free up their staff to undertake the training. We have to understand that it is not just about the quality of the resource that is available; it is about what we would call the installation of it. How does it land? Can people use it in a meaningful way on a day-to-day basis? That is where we are finding most of the difficulty.

Over the summer, we will be exploring in depth with three local authorities how easy or otherwise it will be for them to use the self-directed support standards and to bring those standards to life. We will get an immense amount of information and data from that process, and we will really understand what is going on at a local level that would militate against the standards being fully brought into play.

There is more to be understood. It is a very complex system. Yes, there are resources and training, but there are many other enabling or disabling factors in respect of people being able to use it.

I will talk about the independent support organisations. The guidance is there, and those organisations know it well—they know it inside out. They often support social workers by pointing to bits of the guidance and saying, “This is where it is.” They have reported pockets of good practice in which independent support is alongside social work and the former can show them what the guidance means practically, give examples, show how the guidance could make things easier, show what a good conversation looks like and talk about other ways that they have been able to make the guidance come to life. There is a very close relationship and alignment between social work and independent support.

The point about how the guidance is used and how it can be embedded is important. National consistency always comes up in relation to self-directed support. Which of the activities in the improvement plan will or will not help to address national consistency, and should or could any aspects of SDS be standardised nationally?

On the second part of your question, we have uncovered something around definitions. At the very beginning of somebody’s journey, when they stick up their hand and say, “I need some help,” the information on self-directed support that they are presented with sits separately on a local authority’s website to the rest of social care, so we have already othered it as something different and more complicated.

People who have heard me speak before will know that I am fond of saying that we need to stop talking about self-directed support, because it is just business as usual; it is just the way that we do social care. By giving it a name and putting it on a different bit of the website, we make things seem more complicated than they actually are. In our learning, particularly the bits of research that we have done recently on options 2 and 3, there are differences in the language that is used to describe the options, which can be problematic—the differences can be subtle but powerful.

I will give examples from our research on how option 3 was described by three local authorities. You can “choose” to let the local authority arrange support, “ask” for support to be arranged on your behalf or “wish” for support to be arranged by the local authority. Those three words are quite different, so there is the opportunity for inconsistency from the very beginning. I can wish to win the lottery, which does not mean that I will, but me actively choosing that is a different strength of word.

From the very beginning there are issues around the shared understanding and definitions of what self-directed support is and could be. There was some improvement when the statutory guidance was updated, because the definition of option 2 is a bit less woolly than it was before, but as soon as you are at the front door there can be inconsistencies that arise from the language and the way that we describe things.

I am not sure whether it could be standardised in the way that something more procedural might be standardised. Self-directed support is not procedural. We are all involved in work at intermediary level to bring consistent best practice approaches to the fore so that we can encourage and support local authorities to adopt those.

We are involved in the self-evaluation and improvement framework and are trying to get a common approach that can sit across the range of improvement models that local authorities might already be engaged in through their health and social care partnerships. Pauline Lunn was involved in testing a framework in one local authority. We are trying to build frameworks that support people to come together to learn and understand what needs to be done in their local authority, and to do that by using the SDS standards, because that is the most standardised tool in our toolkit at the moment.

We are also bringing together local authorities to engage in their self-improvement journey through a community of practice. We think that that will bring benefits because people will be able to learn from one another. We also host a group of self-directed support leads who are looking at policies and procedures and we are trying to bring them together to do that more systematically, so that they are not developing things separately in their own local authority bubbles.

That is all co-production work. We are trying to work together with people and to benefit from the experience of supported people and carers along the way.

Dr Kellock, I have a number of very direct questions, so it is fair enough if you do not know the answers. How many social workers do we have in Scotland?

That is not something that I can answer. It would be wrong of me to suggest an answer to that. There are thousands of social workers. The Scottish Social Services Council would have the most up-to-date statistics for how many social workers are registered, but I have not seen the most recent statistics.

There are about 6,000 in local authorities and about 10,000 registered. What is the average working life of a social worker in Scotland?

Social Work Scotland did some research just the other year. We found that some social workers were leaving the profession within six years, although it is our understanding that that number is less than it used to be. All sorts of reasons were cited, including terms and conditions and work-life balance. The practice model is also a contributory factor.

On the subject of training and social workers coming into the workforce, do we know how many are being trained each year? Is there any significant increase on what that number was in the past?

I am afraid that I do not have those statistics to hand, but we do know that number. Work is under way to improve social work education and the support for newly qualified social workers. That really valuable work is happening at national level and through universities. Improvements are definitely being made.

There has already been mention that people do not get a particularly high awareness of self-directed support when they are training at university to become social workers. People often come out of courses without much understanding of self-directed support, so they have to learn on the job. There are issues there, for sure.

11:45  

It is safe to say that social workers are not sitting idle; they are very busy doing what they do. Some 40 per cent of social workers reported that their workload was unmanageable; 70 per cent of social workers reported that they could not complete their work in their contracted hours; and 20 per cent of the social work workforce left in 2020, with 40 per cent planning to leave in the next three years. On top of that, rural areas find it hard to recruit and train social workers.

However, everything that I see coming through from the Scottish Government requires social workers. For example, the implementation of the Children (Care and Justice) (Scotland) Bill requires 500 social workers. So, even with more money coming in to be spent, if we do not have the necessary number of social workers and the ones that we have leave after only six or seven years, how can we possibly implement policies successfully?

I would not disagree with any of that; it is a major issue for the social care profession. The social care workforce does not have enough resource and is extremely pressurised at the front line.

There are quite a few paraprofessionals—unqualified people—working in social work teams, too, and we need to address that balance to ensure that we get it right. We also need to ensure that we are training those members of staff in order to enable the delivery of policies such as self-directed support. You are right to say that there are a lot of issues within the social work profession.

That is relevant to what was said earlier about people coming out of university and not being trained highly enough, especially around self-directed support, and the fact that there is no protected time for social workers to do some learning, even though people in every profession need to continue to do professional development.

Training more people is one thing, but we also have to retain them. What can we do to retain social workers and stop them leaving the profession?

One of the big things that came out of the recent research that Social Work Scotland commissioned concerned the case load balance for social workers—that was a huge issue. As the profession has increasingly relied on paraprofessionals to do some of the less complex work, the case loads of qualified social workers have become more complex and larger. Social workers are faced with really complex work that often has to be done at the point of crisis, which causes quite a lot of stress for the worker. Those sorts of issues are relevant to your question.

Workers are leaving the profession earlier, and we have also seen quite a lot of social workers retiring relatively recently without a sufficient workforce coming in to fill the gap. We are definitely seeing newly qualified social workers having to take on more complex cases than they might have done when I was a chief social work officer some years ago, just because of the nature of the work and also the size of the teams.

There are big issues there and, if social workers are leaving after six years, there is no way that you would want to put people through a four-year degree course only to have a career that is six years long. There is not a good work balance for social workers.

On your point about social workers dealing with people in crisis, in my conversations with social workers, they tell me that the fun has gone from their jobs and that, whereas, previously, they were seen as somebody who helps and ensures that people do not get to the point of crisis, all they are doing now is crisis management and they are often seen as the bad person—the person you do not want to come knocking on your door. That is quite a step change for them. How can we make the job what it should be, which is about prevention?

I would go so far as to say that it is unethical to expect a workforce to deal with crisis at that level for such a long period. When you are dealing only with people in crisis, you lose some of the skill and ability to think creatively with people, which is really what is needed for self-directed support. You need the time to explore with a supported person what matters to them and how they can have their needs met.

The practice model is not necessarily a quick win, but it is something that we can definitely work on. As part of it, we would not expect a transactional care management approach; instead, it is about moving towards more relationship-based practice. Again, though, it is difficult for workers who do not have the time or who have huge case loads to get through a checklist-type assessment, and very difficult for them to find the time within that to develop relationship-based practice.

This is, therefore, a very complex issue, with lots of different elements. I think that, when it comes to implementation, we have to understand the workforce issues in their entirety and holistically as part of the system, but we definitely have to do something to help improve workforce competency.

Good morning, panel. Thanks for your answers so far.

I want to talk a little bit about the long-term care commission. Last week, Alzheimer Scotland was in Parliament, talking to colleagues. The commission’s report focuses on long-term care; obviously, a feature of that is residential care, but it also encompasses quite well a lot of the themes that we have been talking about such as the real cost of care, how it is paid for, alternative care models and improving commissioning.

The improvement plan does not discuss the underlying issue of funding. We have just been talking about the challenges facing social workers, and I imagine that operating or trying to operate in a human rights-based way in a time of austerity is soul destroying. Obviously, local authorities determine how much of their budget goes into social care, as does, I believe, the NHS, with regard to what goes to integration joint boards. Should—or could—the broader question of the funding of long-term care be addressed by the collaboration?

I am not sure how much of that lies within our sphere of influence. How local authorities disseminate their budgets would not be something that we, as funded partners, would have much sway over. We would certainly have opinions, though.

What we can do is try to influence. For example, a particular interest of mine is commissioning; I used to write tenders for a living, I manage tender teams and I am really interested in reforming commissioning. We can have an influence from that perspective.

We hear worrying stories of local authorities moving to price-only tenders—that is, with the quality component stripped out—and I agree with the part of the long-term care commission report that highlights that an unintended consequence of the underinvestment in community care services is more folk going into residential care. As a result, they do not get access to self-directed support, because it does not apply to residential services; however, such services are significantly more expensive, so it is a false economy.

There are certain parts that we can influence. As for whether the national collaboration should be involved, I am not sure how many organisations comprise the collaboration, but the majority are in the voluntary sector, with people on the ground delivering services.

I suppose that this speaks to the broader enabling context in which self-directed support sits. In order to have that choice and control, we need a better-funded infrastructure around it. However, that infrastructure would support not just self-directed support itself; a balance would be struck across all of the organisations’ duties and responsibilities.

We would certainly want the opportunity to ensure that what we understood by self-directed support implementation, quality and practice was understood better by those in the position to make such decisions. That brings me back to my earlier points about ensuring that a deep understanding of self-directed support is wedded to the policy context.

From what I have heard from colleagues in local authority areas working in self-directed support, it is not necessarily high enough up the agenda, and certainly not in health and social care partnerships. We would therefore welcome more direct visibility of self-directed support to ensure that those who are charged with its implementation at a local level can speak directly to the most senior people within the organisation. Such an approach will allow the local position to be reflected and some understanding to be built around what is required at that level.

In your answers to Emma Harper and just now, you touched on the issue of wider understanding, which I guess is a matter both for the public and for policy makers. What has to change in that respect? I was struck by the phrase “cornerstone delivery vehicle”, which was used, I think, by Pauline Lunn. I think that we see this almost as a separate project or thing, not as that kind of vehicle. I know that it is quite a big question, but what has to change to ensure that we get that visibility?

We deliver a lot of training on self-directed support, have lots of programmes and speak to people about it all day, every day, and one of the things that we tell people—and which often comes as a surprise—is that SDS is not something that you get. Instead, it is a way of working; in fact, it is the only way of working for the vast majority of social care. Because it is a way of working, its values and principles are all about showing flexibility and making sure that there is choice and control in people’s lives.

SDS is not a thing that you get; it is a thing that you do. That connection is not often made, even by local authorities and organisations delivering services, and I think, therefore, that we need to start right at the very beginning. People phone us up all the time and say, “I’m getting support, but I want SDS instead,” and we are like, “Okay, cool—let’s dial it back.” Having to explain that is fundamental to the whole thing. I do not know whether others have a position on it, though.

You do not know about it unless you are in the system. It is the same with social care; people probably do not really understand it until they need it. I think that that is the conversation that needs to be had. It can be quite complicated or quite simple, but it is all about the way in which social care is delivered.

Just to pull the threads together, I come back to the role of the voluntary and community sectors here. They are key players, and they need to be resourced better to help people live independently in their communities. The way in which they work is to ask, “What does this person need, and what can we put around them?”, regardless of whether they are in the system.

I have been thinking about the conversation about prevention, the role of the voluntary sector and the community in supporting people and the language that gets used when explaining self-directed support. It is not something that you are going to retain, unless it is actually and practically where you are at and you need it. We can have better definitions and national consistency in how we talk about self-directed support—and that would be good—but I think that it is all embedded in how we work with people. We say to them, “What matters to you? You have a choice, and here are some options.” That is what the voluntary and community sectors are very good at delivering.

Forgive me if I go over some things that we have already discussed, but it is not always the budget that restricts choices. This is also about models of care. We will all have examples from our constituency work of someone who, having been assessed by an allied health professional or social worker as requiring a level of support to live their life, will then be told that that support is not available. It is not all about money; in fact, in the committee’s inquiry into rural healthcare, we found that sometimes the issue was availability of service.

It is not all about money, no, and I think that you were right to talk about the practice model, as that is really important.

Perhaps I can look at this very simplistically through a care management lens, if what you are asking about is care management. What is seen as success in a care management process is paid-for care at the end of the day. You carry out an assessment that tells you what level of care is required; you cost that up; and that is your success factor at the end of the day. In a relationship-based practice model, success looks like what matters to the person. That could mean enhancing their natural, family and community supports, which goes back to the question about early help and prevention, early intervention and having those supports available locally.

One of the things that we addressed, which we heard quite a lot about when we reviewed the SDS standards, was the need to protect natural supports for people. At the point of crisis, what was being made available was sometimes something that got in the way of the person’s natural supports and rendered those supports difficult to deliver.

12:00  

By natural supports, do you mean someone’s network—their family and friends and so on?

Yes, their network, their family and their community supports—things that matter to them in the community. The best self-directed support that we have seen builds on and values those as core to the person’s sense of wellbeing. It is not all about money. We need more resources in the system but, if we had a different way of practising, we would make best use of what we already have in the system and what people already have themselves.

May I have one brief final question? I am testing the convener’s patience a little bit.

Obviously, speaking simplistically, the challenge in moving to prevention from patching things up—if we think about hospitals and investment in community care—is the process of moving money away from fixing stuff to the relationship and preventative stuff. Is that a similar situation? I am trying to understand what the blocker is in moving from, “Here’s what you need and here’s how we’re going to give you it,” to the relationship that we are talking about.

Maybe the question is about understanding what unmet need looks like. The assumption that you can move money from the acute end of the system upstream is predicated on there not being unmet need that comes in and uses all that resource.

It is being predicated on that.

Yes. It is difficult to predict.

On the impact of funding on future service design, local authorities have, on average, had a 10 per cent cut over the past decade. Around 80 per cent of local authority funding is central Government grant and 20 per cent is raised through council tax and local charges. In Glasgow, the percentage of funding that is spent on education and social care has risen from 60-odd per cent to over 70 per cent. Clearly, the council’s focus has been pared down to two big areas of policy delivery, which puts subsequent pressure on delivery.

How do we break the cycle of annual budgets that are under increasing pressure, which is being ratcheted up, for health and social care partnerships and integration joint boards, which we then see being backed up into the NHS? I am trying to figure out how we break this prison of accountancy, if you like, and build the case for cost avoidance. We just heard about people presenting at A and E departments with late-stage cancer. Those are obvious business cases that show that, if we deal with something earlier, we will avoid a lot of costs to the public in the longer term and have better outcomes for people. What are your insights into how we better design that model for the future?

That might be above our pay grade. However, I am sure that we have some opinions on that. It is very complex. I used to be involved in systems to tackle health inequality, in the days when there was funding in the system. Sometimes, it is about knowing what is the right thing to unblock systems. You need to have a really good understanding of whole-system dynamics. That is where we look towards implementation science, which is a much wider field of understanding about complex social policy and health policy, rather than thinking, “Oh, yes, there is a simple solution to this. We do this bit over here.” It is about the unintended consequences and understanding how to mitigate those.

Our approach is to start small, test small and test in different environments so that you can understand what is happening out there. One thing that have we picked up in our recent engagement with people is the arbitrary decisions that are made to help to protect local authority budgets or prioritise how local authority budgets are being spent. Rules will come into effect that say, “We’ll only do this,” or, “We’ll only do that,” or, “We’ll only spend it here.” Those rules seem to make sense if you are looking from a financial perspective but, when those rules are applied to real-life instances, all sorts of strange things happen and there are all sorts of unintended and really unwanted consequences.

What we have been hearing about people’s natural supports being interfered with comes from those sorts of decisions and rules being put in place to try to control spend and manage within budgets. A whole-system approach is about understanding that, if you put a rule in somewhere, it will do something further down the line and impact on the rest of the system.

We need to think things through well, not rush to make decisions. We need to think on a whole-system basis to understand what good implementation looks like, not just what, in this case, good self-directed support looks like. We need to work in a co-productive learning way with the whole range of stakeholders. That is quite difficult to do. Through the national collaboration and the work that we do—at the level that we do the work—we would say that we have gained a huge amount from working collaboratively with people who use services. That has to play out across Scotland in order to get the kind of systems at that macro level that we need.

I thank the witnesses for their evidence.

Next week, the committee will continue phase 2 of its post-legislative scrutiny of the Social Care (Self-directed Support) (Scotland) Act 2013 with an evidence session with integration joint boards.

That concludes the public part of our meeting.

12:07 Meeting continued in private until 12:25.