Carers express concerns over new policy of ‘self-directed care’

Care providers from the public, private and voluntary sectors have all expressed “anxiety” about a “seismic shift” in the provision of care for vulnerable people, MSPs have heard.

New legislation could allow disabled people to buy their own alternatives to council-run social care.

However, Holyrood’s Health Committee this week heard concerns raised by some nurses as well as private and voluntary care providers who may need to deliver thousands of individually tailored care packages.

Three local authorities – Glasgow, Dumfries & Galloway and Highland – have been testing the new “self-directed support” (SDS) agenda. Their work has formed the basis of the Social Care (Self-directed Support) (Scotland) Bill which is currently receiving parliamentary scrutiny.

The Bill will place a duty on local authorities to offer disabled people the option of cash to arrange their own private care or to have it allocated to a provider of their choice, as an alternative to council-run care.

However, committee member Dr Richard Simpson said he has heard “murmuring” of concern from charity and private providers.

He said: “It’s nothing more than one or two emails, but I did get some emails from Church of Scotland, who was one of the groups that mentioned that they had some concerns about the process and how it would affect them going forward. Clearly there’s going to be a big adjustment from the third (charity) sector as well as the local authorities.”

Glasgow’s assistant director of social care David Williams said SDS has seemed like an “alien” concept to some.

He said: “The use of the word ‘murmuring’ about some complaints was very diplomatic. I think there’s been, it’s fair to say, quite a significant level of anxiety expressed over the course of the last year and half in Glasgow, particularly from the provider sector and around about. I think that’s just about the scale of the change that we have implemented, or endeavour to implement, in Glasgow.”

John Alexander, director of social work at Dumfries & Galloway, said the new agenda represents “a seismic shift in how we do business”.

He said: “There’s no doubt that the seismic shift does pose a number of challenges to providers. If I can just simplify it, rather than facing one commissioner, which is the local authority, and having to work very closely in partnership with that one commissioner, they’re potentially facing hundreds and maybe, in city situations, thousands of commissioners, namely the men and women themselves who have control over their direct payment and individual budget. And how on earth do you manage that process?”

However, he added: “The organisations and the market, whether they’re third sector or independent sector, are already living to a degree in an uncertain environment. So, I don’t think this is necessarily a seismic shift from security to insecurity, it’s about saying maybe we move a little bit into insecurity in the sense that ‘we don’t have one place, one door to knock on to have that conversation, and we will need to be more flexible’.”

Janet Spence, programme manager at Highland Health and Social Care Partnership, also spoke of “a lot of anxiety on the part of health staff, particularly nurses, about SDS”.

She said: “I think that’s largely because of a lack of knowledge, so we were very keen to get in there at grassroots level and start talking to staff about SDS, what it was and what it wasn’t. The huge shift needed in mindset and culture, I don’t think it’s unfair to say that a lot of health staff, community-based nurses, hospital-based nurses, are quite protective people who are keen to be seen to be doing things for people, are quite risk averse.

“So, managing risk is something that is quite difficult for them to get to grips with. We have, over the last few months, begun a dialogue with health staff. I think it’s just a very different way of thinking for them.”

Committee member Drew Smith also raised concerns about “abuse” of the system by home carers and others. He said: “If you’re filling in a questionnaire, and your home carer or someone else is maybe assisting you to do that, and they say: ‘If you tick that option then I’ll come and provide the service for you, but I’ll do that outside the local authority, and I’ll do it on my own and I’ll be a private provider for you’. There seems to be a whole range of opportunities for abuse there.”

However, Mr Williams replied: “We shouldn’t lose sight of the role of the care manager here, which remains central in terms of the assuring of adult protection, and ensuring that people’s rights and responsibilities aren’t over-run by the ability for the home carer to say ‘I’ll do it’. And in terms of the delivery of any plan, certainly within Glasgow, the outcome-based support plan has to be signed off by a resource screening group, so it’s not something that can be organised through back-handed wheeler dealing.”

Despite initial misgivings by providers, the project leader of the SDS test sites evaluation team Dr Julie Ridley said the feedback from disabled people who are now directing their own care has been “overwhelmingly positive”.

She said: “We looked at 10 case studies in each of the local authority test sites, and the evidence from looking at people’s experiences of assessment, the kinds of packages that they got, and how they felt about the support that they were getting, were overwhelmingly positive.”

She added: “In terms of choice, control and flexibility, people’s experience would support that.”