Describing Self-Directed Support

A paper by West Sussex County Council that makes the case for precise use of language when talking about Self- Directed Support.

WEST SUSSEX INDIVIDUAL BUDGETS PILOT

Discussion paper: Describing Self-Directed Support Services

Abbreviations:AS = Adults’ Services

C(C)M = Care (Commissioning) Manager

DP = Direct Payments

FS = Financial Services

IB = Individual Budget(s)

ILA = Independent Living Association

ILF = Independent Living Fund

LA = Local Authority

PA = Personal Assistant

RAS = Resource Allocation System

SDS = Self-Directed Support

SW = Social Worker

WSCC = West Sussex County Council

1. Background and summary

This paper argues for clear and accurate language in explaining and discussing the W Sussex approach to SDS, for two reasons:

  • In the context of SDS, the catch-all use of the term ‘brokerage’ is unsatisfactory and should be avoided because:
  • it means different things to different people
  • it departs from the accepted usage in the commercial world
  • it implies a new or different set of professional skills
  • There are many different activities that can go towards drawing up a plan for a person’s support and putting it into effect. It will serve everybody’s interests if the words we use to describe them are specific and plainly understood

Terms such as ‘Information, Advice, and Guidance’ or ‘Self-Directed Support Services’ might be more useful alternatives to ’brokerage’ if a general term is needed.

2. The sea change in social care

The UK tradition in care services emerges from over three centuries of the Poor Law, nineteenth century institutionalism, and the post-war social welfare reforms. These have all assumed that the state, as principal provider, should determine what shall be considered a ‘need’ demanding a response, and what that response should be. The relationship has been one of giver and receiver, with an associated power imbalance that has reinforced social disadvantage..

More recently, we have seen two decades of a civil rights struggle within the disability movement, and a political drive for public services that support social inclusion. This means dispensing with services that congregate and segregate people, and with prescriptive responses to ‘need’ based on mechanistic task-and-time assessments.

The vision now is of a new relationship between the state, through Local Authorities, and people who require social services. This is characterised by the right of all citizens, including those for whom the LA has a specific duty of care, to determine for themselves how they wish to live. The resources available for social care are no longer to be dispensed and controlled solely by official prescription, but according to the priorities and choices of people concerned..

3. The SDS journey

Current initiatives such as the IB pilot and ‘In Control’ project lay out a pathway from a person’s first contact with Adults’ Services through to achieving the outcomes that meet their needs. Each step requires judgements, decisions, and choices, and we believe these should be within the person’s own control as far as possible, and as far as they wish them to be.

Briefly, the stages along the way after the initial contact are these:

  • Assessment, drawing on the person’s own responses to a straightforward questionnaire about the difficulties they are living with.
  • Funding streams, exploring a range of possible sources of money
  • Resource Allocation, using a system (the ‘RAS’)that indicates the amount of money that will be available, based on the person’s level of need
  • Agreeing Outcomes, to set down ‘markers’ for the results the person wants to achieve
  • Support Planning, when the person (using whatever help and advice they require) makes their own proposals as to how the money will be used to reach the outcomes
  • Implementation, putting the plan into action
  • Review, tosee whether the support plan has effectively delivered the outcomes in a way that both the client and the LA believe is satisfactory

4 Achieving Self-Direction

The SDS approach offers people four significant opportunities:

  • to describe the nature and severity of their impairment or difficulty
  • to define the outcomes they want to achieve
  • to propose how money shall be used to reach the outcomes
  • to exercise choice and control over what the money buys

People will vary in their desire or capacity to take up these opportunities. The LA’s task is to see that people are aware of the choices open to them, and have access to sources of good-quality information and assistance at each stage. Some will no doubt continue to look to the LA’s own staff for this help, but it will also be necessary to make sure that it is available from independent, non-partisan, sources that people are free to choose.

This paper suggests that the types of assistance that will be needed will include:

  • Advocacy

Drawn from legal usage, this means helping someone state their case or to represent their point of view in a negotiation, where the advocate is personally independent of the interests at stake but taking the part of the client. This may be especially relevant at the Self-Assessment stage, or in describing the person’s own vision for their future

  • Information-giving (or ‘Signposting’)
    This is simply arming someone with the facts that they need in order to make their own spending decisions. This is most helpful to people who want to be as self-sufficient as possible.
  • Researching what is available

An extension of Information-giving with an element of guidance. Helping someone find out what is available in the market-place and the community generally, and to think about the assistance they need and about making use of the amenities in the community.

  • Informal support

Many people will benefit from the help of family or friends to help them plan their arrangements. In most cases, this will be available at no cost to the client or the LA, although sometimes these supporters will need backup or technical advice and information It may often be helpful if a Carer’s Assessment can be undertaken to identify how much can reasonably be done by informal supporters, and where they might need their own guidance or practical help.

  • Technical advice-giving

Providing technical information and guidance, but with an indication of a favoured route and of the consequences of taking it or departing from it. For example, the ILA’s DP Support Workers can advise on the obligations surrounding employment of PAs. Similarly, OTs could help with decisions about equipment or environmental adaptations.

  • Financial administration

Providing some or all of the practical assistance in running a budget as it concerns holding an account, paying bills, keeping records. It may or may not include a Payroll service where the client opts to use their budget to employ PAs.

  • Management

Help with actually writing the support plan, and with problem solving, making changes, and contingency planning

  • Brokerage
    As in the commercial world (such as insurance or shipping), this is the function of drawing on specific skills and knowledge of the market place to turn the client’s money into the particular form of service that is required. In social care, it is the function carried out by case management specialists with, for example, disabled people who need complex care arrangements funded by insurance or compensation payouts.

4. Principles

Using the SDS approach, the LA is no longer the sole provider, arranger, or governor of the support people will use, but it retains a duty of care: that of seeing that assessed needs are met. If it is not itself directing the activity that meets the needs, it must ensure that the person has the means to do so. Otherwise it would be setting people up to fail.

This implies some basic principles:

  • The LA should see that a range of services is available, both from within its own ranks and in local communities, to meet the demand for all the types of information and guidance described above. This has implications for its training, operational management, and commissioning functions.
  • The LA has an interest in assuring the quality of the information, advice, and support services available to people. This applies both to those it provides itself and those to which it refers people for whom it has recognised a duty of care. This has implications for the LA’s performance management and contracting functions..
  • The sources of advice and guidance that someone may use at any stage of the SDS journey should be independent of a commercial interest in the person’s choices and decisions. The financial aspects of the provision both of advice and of other services should be absolutely transparent.

4. Recommendations on use of Language

(i)That the term ‘brokerage’ is not used in a general sense to describe the broad range of different functions that may apply within the SDS context.

(ii)Describing any and all supportive activity as ‘brokerage’ is unhelpful because it is unspecific and open to confusing or conflicting interpretations. It also implies that it is a novel class of activity which may engender a new professional domain, possibly replacing Social Work. This is unrealistic and unnecessary, because the actual activities can be carried out by existing bodies, or by adapting them to new types of work. Also, there is no prospect of general funding for an extensive new ‘service brokerage’ profession.

(iii)That accurate and specific language should be used to refer to the many different stages encompassed by Self Directed Support. In order to make sound decisions about what guidance to seek, and from whom, it will help the LA’s staff as well as those using services to identify precisely what is required at a particular point on the SDS pathway.

(iv)That the term ‘brokerage’ is only used in those specific circumstances that may apply.

(v)That consideration is given to a more inclusive expression such as simply ‘Information, Advice, and Guidance‘ (often abbreviated as ‘IAG’) , ‘Individual support options’ or Self Directed Support Services’. The latter conveys the context, and is broad enough to encompass a number of distinct and identifiable activities that could be described in a simple leaflet.

(vi)The LA supports people to be able to act on their own judgements about how they will use the available money to meet their own needs.

(vii)In forming those judgements, people may want to draw on information and guidance from a range of competent sources, and the LA should help them to do so.

Barry Ruffell

Direct Payments Liaison and Individual Budgets Development Officer

15/10/2006

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