| More choice more control: are you ready for self-directed support? |
 |
 |
 |
| Tuesday, 17 January 2012 |
In the third of her series looking at issues surrounding mental health and recovery, Emma Razi explores the Scottish Government's proposed 10-year strategy and legislation on self-directed support. More than 100,000 people in Scotland receive social care and support. Traditionally local authorities select and ‘bulk-buy’ the support needed by the population. This means that people have very little choice and control over the services they receive. More recently there has been a cultural shift around the delivery of care and support in Scotland. People in need of support are increasingly viewed as citizens with rights and responsibilities; who should lead the decision-making concerning the care they receive. This is a welcome change for many reading this article – as choice and control are key drivers of personal recovery. The Scottish Government has responded to this shift by publishing their draft 10-year strategy on Self-Directed Support (2010). The Government has also consulted on proposals for a new Bill to make the necessary legislative changes to promote the strategy and pursue its agenda. Self-Directed Support (SDS) is when people arrange some or all of their (or their child's) support, instead of receiving services arranged by the local authority. The aim of SDS is to allow more flexibility, choice and control over individual’s support. SDS can be accessed via a direct payment, which is made to the individual, in place of receiving traditional council services. This payment can be used to pay for anything that responds to their assessed needs including: support at home, support in education or employment, accessing leisure facilities, equipment and adaptations or for housing support services. SDS can also be purchased using a personal budget – this is money that the local authority uses to pay for services selected by the service user.  The Bill proposes to introduce the language and terminology of SDS into statute and provide a clear and consistent framework for it into law. In addition the Bill proposes to move everyone in receipt of support and care to direct payments and allow people to opt out if they feel it is not the right solution for them. It also proposes to widen the eligibility of direct payments to carers.  Overall, the response to the Bill has been positive. It is hard to argue with legislation that promises flexible support and care, chosen and controlled by the individual. It has the potential to be a powerful driver for recovery and person centred approaches. However, throughout the consultation process some challenges were highlighted. Glasgow Association for Mental Health (GAMH) held a Service User Forum to gather views on the proposed legislation. A number of services users were concerned about the variability of their health and how they might access extra support during a crisis, one asked: “the support needs of mental health service users fluctuate over time, can the level of support be increased rapidly under SDS when the service user is in crisis and unable to request additional help due to the nature of their condition?” Government statistics show that people with mental health problems account for the fewest recipients of direct payments where it is currently available. According to the Government’s analysis of consultation feedback, a number of respondents felt that this is because SDS and direct payments may be unsuitable for people with mental health problems. Several respondents emphasised that extra support is necessary for individuals with a variable condition who choose to direct their own support. The Bill proposes that everyone requiring support and care receives direct payments unless they ‘opt out’ and return to receiving care arranged by their local authority. Many respondents to the draft Bill were in favour of this as it will remove barriers that currently mean SDS is only really available to those who know their rights. There is no doubt that this is a positive step – but there is some concern over whether service users have access to enough information and guidance; allowing them to make an informed choice about their care. One GAMH Service User states “this [opt-out proposal] is empowering, but people have to make informed decisions.” In addition, a number of GAMH Service Users were concerned about how people will manage the added responsibility of managing their own budget. For example “it is not easy for people to take on the responsibility of being an employer and manager; you might have a relapse and need help. At that time you would not be in control.”  Nigel Henderson, Chief Executive of Penumbra states: “Some people may not want the added responsibility of directly managing their own finances and budget, but that shouldn’t mean that people miss out on the opportunity for more choice and control over the support they receive.” In many situations, the added responsibility involved in managing direct payments and SDS will be lightened by the help of unpaid carers. There are 657,000 unpaid carers in Scotland. The draft Bill proposes that authorities should have the power to make direct payments to carers. A GAMH Service User believes this is: “an excellent idea because carers are so stressed and undervalued.” Another adds that “direct payment for carers would be a good idea and beneficial to both carer and individual.” The SDS model challenges the notion that the state knows best and puts the power into the hands of those needing care and support. But how does it ensure people are well-informed about their rights, responsibilities and choices? Tell us what you think about SDS and how it might affect you below. Comments (0)
 Write comment
|
Show/Hide comments
Show/Hide comment form
See our Submit Your Thoughts pages for details on how to submit a story to us or you can contact us.
 |
 |