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Markets, Money and Power: Perspectives on Self Directed Support

Written by Colin Murray on 18 June 2012

Thursday June 28^th, Lifecare, Cheyne St. Edinburgh

Now that personalisation of care services has been around for a few years, at least in design and planning, Scottish government has published its Bill for the implementation of Self Directed Support. Overall the intention seems to be to achieve better value, more responsive, integrated services, improved outcomes and an enhanced role for individuals in the care received ie more choice and control for people in the support or other services they elect to use. For voluntary sector providers the challenges come thick and fast in this new world, with sustainability high on the list.

The Self Directed Support Bill offers four options for individuals assessed to qualify for support in this form:

1) direct payment

2) person chooses their support which is then arranged by the local authority on their behalf

3) the local authority selects and arranges support on a person’s behalf

4) a mix of the above for different aspects of a person’s overall support

The same basic principle applies to all these options: an individual will make choices concerning their care and support, on the forms of support they require and who the provider will be. Whatever choice is made power resides with the individual holding a budget.

With money going directly to people using services to spend as they see fit providers are thrust into a market scenario, competing as one among many to attract individual buyers.

Further, for voluntary sector providers currently working to CEC contracts the likelihood is that over time the scale of contracted services will diminish, as the local authority seeks to fund SDS in part at least by reducing contract volumes and values. The extent to which this happens and the pace at which it takes place has significant implications for voluntary sector providers, especially smaller, locally based agencies (where, unlike large national agencies there may not currently exist the capacity to compete in a market place for business).

A myriad of questions and issues emerge in relation to SDS and this EVOC and TSSG Thinkspace event offers a first opportunity to uncover some of the rhetoric, explore the issues that matter to providers and service users and begin to identify ways forward which maintain levels and quality of voluntary sector provision. The morning presentations will present views from Government, local authority, voluntary agency and service users with question and answer sessions, to be followed by an afternoon of discussion to identify concerns and outline means to address the key challenges. As a starter for ten here are some questions the event may cover (bear in mind this is not an exhaustive list and groups will decide on their priorities for discussion):

How can agencies enter a market effectively?

Is there are role for brokerage, and how is it provided without adding another layer of professional interests?

Who conducts assessments and how can disputes be resolved (bearing in mind human rights legislation)?

Will SDS improve access to services for marginalised individuals and groups and how?

In light of personal budgets what steps are required to ensure the development of preventative services and community capacity?

How do personal outcomes and strategic priorities relate to each other?

Are there ways in which collective approaches to purchasing might enhance outcomes for individuals?

How are fluctuating needs especially those with high cost implications met?

How can voluntary agency sustainability be maintained?

What constitutes care and support, or, who will determine appropriate spend and by what criteria are those decisions arrived at?

How, without any statutory requirement, will the NHS approach SDS as we move towards integrated health and social care arrangements?

Evidently such questions cannot be resolved in the course of a day and a report will be produced from the event, which will continue the debates and inform discussions with the local authority over system design and implementation. No-one yet knows how SDS will be implemented and at times there appear to be differences of views and perceptions within institutions. It is hoped that at the very least we shall obtain greater clarity on how many individuals are likely to participate in SDS over the short, medium and long terms, and some indication of the measures and approaches available to agencies to respond to this set of changes.

You can find an Event Invitation on our website.

You may find the following links of interest. Items 8 and 9 go to committee next week and give a good indication of current play at CEC.

http://www.edinburgh.gov.uk/meetings/meeting/2721/health_social_care_and_housing_committee

· Item No 8 – Whole System Approach to the Personalisation of Health and Social Care (Reports, PDF, 1.09 MB)