SELF directed support is a simple idea which has wide support from policy makers, age and disability charities, health and social care agencies and from those who it is supposed to give control over their own care.
That is in principle. In practice, user groups and disability advocates are increasingly frustrated by the reality on the ground. Critics claim an idea which was supposed to transform the provision of social care has become complicated by cuts, staff shortages and inertia in the public sector.
The old model of social care was unsatisfactory. If you needed care – perhaps because you were elderly, or had a mental health problem, or you were a parent receiving help to care for a disabled child – it used to be that you would ask your council for help and they would tell you what you could get, and who would provide it.
The aim of SDS is to give people control over their own services, so they can choose to use resources as they wish. Rather than being offered a place in council daycare, a family of a disabled child might take those resources and give them to a charity to take their son or daughter for arts activities. Someone with dementia might use their resources to employ a personal assistant to go on day trip to the beach.
As a report by Alzheimer’s Scotland, Scottish Care and In Control Scotland pointed out earlier this month, SDS is the law. Under the Self-Directed Support Act, which came into force in April 2014, every local authority social work department should offer everyone eligible for social care a range of choices over how they receive their support.
The Government maintains that although only 27 per cent of social care clients are using SDS, around half of those who are eligible to make a choice do so. Even so, tens of thousands of people are not getting to choose , in breach of the law, three years after that law was implemented.
And there are wide variations in how much choice is on offer around the country. Councils have attempted to simplify SDS by offering several options - ranging from giving care users direct payments and complete control of what they are spent on, or limiting the choice to a list of approved agencies and charities, to having the council keep the resources and choosing and arranging appropriate support.
It has been said anecdotally that many councils and health boards do not mention SDS to older people and these figures seem to confirm it. SDS take up is much lower among older people and of those who do, 86 per cent opt for the type of SDS which gives them least control.
There are question marks over how genuine the control is in these case and this calls into question whether even the 50,000 people receiving SDS are genuinely choosing to have someone else exercise choice on their behalf.
While bad timing has seen the policy unfortunately associated with cuts, it continues to have wide support. But while SDS has changed the policy on paper, many supporters feel there needs to be an accompanying change in mindset for that policy to work.
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