Self-directed Support and the Impact on Self Management
Colin Young, Senior Policy and Outcomes Officer at the Health and Social Care Alliance Scotland, summarises his report “Personal Experiences of Self-directed Support“and the findings which show the impact this can have on self management.
The ALLIANCE recently published its latest report, ‘Personal Experiences of Self-directed Support’, exploring the impact of SDS on the lives of people who require social care in Scotland. It comes just over three years since SDS became law in Scotland and half-way through the country’s 10-year strategy. The report finds that while there have been positive effects of giving people more choice and control over their support, the process of getting SDS and managing budgets can restrict people from achieving their outcomes.
Self-directed support has predominantly been implemented through social work services throughout Scotland. This has meant there has been a more focussed effort on personalising the social care elements of people’s support and outcomes. However, the ALLIANCE has recognised the role SDS could play in improving people’s control over their health outcomes since the introduction of the SDS strategy. That is why the study ‘Personal Experiences of SDS’ gave participants the opportunity to discuss the impact of SDS on their ability to manage their conditions.
Though not explicitly referenced within the research, self management does feature as an aspect of people’s social care experiences and demonstrates the possibility that Self-directed Support could be integral to empowering people to manage their long term conditions. Within the online survey, which asked participants to discuss how they use their SDS to meet their outcomes, 10% of respondents signalled that they used their self-directed support for health care.
While acknowledging the small proportion of participants who discussed SDS in relation to their health, there were two narratives coming through in the research. The first discussed SDS more favourably in terms of its positive effect on participants’ ability to engage in health and fitness activities. Speaking directly to this point, one participant stated that having SDS “Help to manage health conditions, go to hospital appointments, participate in exercise to help my health”, which demonstrates the use of a personal budget to facilitate the maintaining of positive health outcomes.
In a more holistic sense, SDS was also described as a way of ensuring the safety and overall wellbeing of people who require support to follow medical regimes in order to stay well. An example of this came from a carer of an elderly parent, who stated that their SDS budget “will be used for a personal assistant to keep my mum safe at all times and aid her with all aspects of the care she requires e.g. personal care, medication prompt, toileting, safety within the home.”
It must also be recognised that there were comments made which suggest that the process and reality of having SDS can have negative effects on people’s health. With the application and assessment often taking up to a year or longer, as the research found, and the eligibility criteria being set at the local level (meaning the picture can look very different across the country), a participant described the toll the process took on her; “…I feel as long as I attend to my father then they won’t give my father the SDS, yet my own health is at risk”. At the same time, another participant discusses the impact of being an employer when in receipt of SDS; “Being an employer was affecting my mental health so a decision was made with my social worker to choose a voluntary sector provider”. This experience well demonstrates the benefits of having a review process integral to a person-centred approach to SDS. However, it is important to understand that SDS cannot be implemented in isolation or viewed independently to a person’s overall wellbeing.
I believe the main lesson to be taken from this blog, and the wider report, is that if SDS is collaboratively designed with people who require social care and it empowers them to be in control of their overall wellbeing, then people could be able to self manage in a way the meets their health and social care outcomes. I hope this research helps to stimulate further conversations about the ways in which self management can support people through their social care experiences. We intend to publish a series of focussed briefings on the key issues for certain demographics, which will be available on the ALLIANCE website when published.