Self-directed support marks a new dawn for social care

P8 self-directed support music web

From 1 April, Scottish people have the legal right to control their own social care budget, a move that impacts on clients and care staff alike

Susan Smith's photo

28th March 2014 by Susan Smith 0 Comments

Cameron McKendrick enjoys archery with support from a personal assistant

Cameron McKendrick enjoys archery with support from a personal assistant

Like most teenagers his age, 18-year-old Cameron McKendrick enjoys sport, going to the pub and playing pool with his friends. For Cameron, however, taking part in these everyday activities is not straightforward as he needs the help of a personal assistant to get out and about.

From the beginning of April this year when the Self-Directed Support (SDS) Scotland Act kicks in, Cameron has a legal right to manage the money that the state spends on his support. This means that Cameron can employ someone to go swimming with him, accompany him to the pub and do all the things that he wants to do, rather than what other people think would be good for him.

Working with Enable Scotland, Cameron has already begun this journey and has set up a team of people in line with his new rights.

The new law provides people who receive support with four options. They can choose a direct payment, where they are given the money to employ their own staff, they can allocate a provider or person to help manage an individual service fund, they can get their local council to organise their support or they can opt for a mixture of all three options.

Recruiting and retaining a high-quality, motivated workforce is crucial to delivering the best outcomes for people who receive support services - Theresa Shearer

Like other adults with a learning disability, Cameron chose the second option, which provides him with control but without a lot of the responsibility that goes with becoming an employer himself.

Through Enable Scotland, Cameron employed Kayleigh, with whom he goes rifle-shooting on a Monday, and who has helped him employ a whole team of people to support him live life to the full.

“I write on forms what activities I would like to do and talk to Kayleigh or Kieron from Enable Scotland,” explains Cameron. "I have interviewed new people for jobs then told Kayleigh which people I want on my team.

“I am looking for people who are good at swimming, good at cycling, good at fishing and enjoy eating out and helping me at Teen Ranch.”

Enable Scotland is fully behind SDS and has spent the last five years revolutionising the way it works in order to embrace personalised care.

While the sector as a whole is also generally supportive, not all organisations are as prepared as Enable. Fears that some local authorities are using SDS as an opportunity to drive down funding for social care with, for example, low direct payment levels has led to anxiety within third sector providers, some of whom have responded by cutting salaries and terms and conditions for staff.

Theresa Shearer, chief operating officer, Enable Scotland

Theresa Shearer, chief operating officer, Enable Scotland

 Enable, however, believes that SDS is in fact an opportunity to improve standards of employment.

“Recruiting and retaining a high-quality, motivated workforce is crucial to delivering the best outcomes for people who receive support services and enhancing terms and conditions of support staff is a key driver for Enable Scotland,” explains Theresa Shearer, chief operating officer at Enable.

As part of its recent transformation, the organisation has adopted a uniformed personal assistant role for frontline staff, which is tailored around the needs of the person they support.

This means that personal assistants will work with fewer clients and service users will have a set team of staff to cover sickness and holidays.

So in Cameron’s case, this means he knows all the people that will be supporting him and doesn’t have to get cover from unknown and untrained staff. The team support him to attend Elmwood College in Kirkcaldy from Tuesday to Friday, then on Saturday he has pooled his budget with a friend from school to employ Dawn, who accompanies them to the pub for a game of pool.

Cameron’s dad Duncan was delighted with the recruitment process.

“I would be very worried about directly employing a support team, especially when it comes to things like insurance, staff sickness and holidays,” explains Duncan. "It is good having Enable Scotland to look after everything.The recruitment process for Cameron’s team has gone well as it has been done at Cameron’s pace to suit him.

“I like the way Cameron’s team keep in touch, how we work out a plan to do the things he wants.”

What is self-directed support?
Self-Directed Support can be used in many ways. It can give support to a person to live at own home, such as help with having a bath or getting washed and dressed.
Out of the home it could support a young adult to college, to continue in employment or take a job, or to enjoy leisure pursuits more.
Instead of relying on the activities run at a day centre, a personal assistant may be employed to help someone attend local classes, go swimming, or be a volunteer helping others. It could also be used to provide a short break (respite) or for equipment and temporary adaptations.

As a result of transforming the way it works, Enable has also been able to buck the trend that has seen third sector organisations cut terms and conditions as major local authority contracts have been cut. In 2012, the charity committed to paying the then living wage, which was £7.20 an hour. It is currently negotiating new contracts at £7.80 an hour, 15p above the current living wage of £7.65 an hour and £1.49 more than the current national minimum wage.

“A huge concern for our sector should be the increasing number of working people living in poverty,” says Shearer. "Ensuring staff within our organisations are protected from this should be a priority and I am keen to see us working within the sector to reverse this trend.

“We expect enhanced terms and conditions will give employees an increased feeling of value, with personal assistants having a real sense of engagement with the people they support, increased autonomy and job satisfaction.”

The initial cost of introducing the living wage in 2012 added £750,000 to Enable Scotland’s costs and was achieved by taking £1m out of its cost base through a variety of efficiency measures. This has involved focusing attention on front-line services and removing costs not directly related to service delivery.

“We were focusing on changing bureaucratic and outdated levels of management, with a strategic focus on front line delivery,” explains Shearer, who was brought into the charity to oversee the change and is soon to leave for new challenges. "Throughout the organisation’s structures, outwith frontline services, we have sought efficiencies. More power has been devolved to the frontline and a leaner more efficient leadership team now supports the strategic development of the organisation.”

More than half those claiming benefits are in work. The third sector can help by becoming champions for the Scottish living wage - Deborah Dyer

Trade union Unison, which includes many third sector care staff among its membership, said that other voluntary organisations should also be using SDS to focus on improving terms and conditions for staff.

Deborah Dyer regional organiser for Unison said: “The impact of tightening budgets has seen the third sector workforce subjected to cuts in pay and conditions resulting in a race to the bottom. The quality end of the sector refuses to be dragged into this race to the bottom, but the financial pressures are enormous.

“More than half those claiming benefits are in work. The third sector can help by becoming champions for the Scottish living wage.”

Dyer acknowledges that SDS brings challenges for third sector providers in relation to staff development and is calling on the Scottish Government to help by including a mandate to pay the living wage in all public sector contracts in the procurement bill currently going through parliament.

Ultimately, Enable believes that SDS is an opportunity to ensure a better quality of life for those providing care as well as those receiving care.

Ensuring personal assistants have a decent standard of employment will ensure that they are able to provide the best, most professional support to the people like Cameron.

“We have listened to the people who receive support and employees and recognised that change in how we organise our workforce was needed,” concludes Shearer.

“The changes we are making ensure that the people we support are in control of who is part of their team and who is not, team members are trained for the specific requirements of each person and all team members are involved in team life, ensuring they support the person to achieve what they want in life.”

Personlisation is a human right
The Social Care (Self-directed Support) (Scotland) Act 2013 comes into effect on 1 April and has been heralded as a major human rights breakthrough for people with disabilities. Self-directed support (SDS) allows people to choose how their support is provided to them by giving them as much ongoing control as they want over the individual budget spent on their support.
It consists of four options:
Option 1 – take a direct payment and chose what to use it for yourself
Option 2 – allocate your budget to a provider the person chooses
Option 3 – the council can arrange a service for the supported person
Option 4 – the supported person can choose a mix of these options for different types of support.
Currently councils are only required to offer the first option (a direct payment) but from 1 April they will have to offer all of the above options.

Related article

A personal assistant's point of view on self-directed support