Dr Charlotte Pearson, Professor Nick Watson & Dr Sally Witcher
Social care in Scotland yet again finds itself in a time of flux and transition driven in part by the Feeley Review. Feeley called for a human rights based approach to the delivery of care and the establishment of a Scotland wide National Care Service (NCS). The report did not however make any recommendations around changes in Self Directed Support (SDS), which remains the foundation for the delivery of social support. There was though a recognition that there are problems with the implementation of SDS. Over the last 10 years we have tracked the roll out of this policy and this research explored views on the intersection of SDS and the Feeley Review from across the key sectors. Our findings identified 3 main areas of discussion, and these are outlined below.
SDS and the implementation gap
- SDS has led to very little change in social care. Option 3 remains the dominant and default service for users.
- The 3 different sectors involved in social care – local authority, disabled people’s organisations (DPOs) and third sector organisations (TSO) – each have different solutions and aspirations for social care. This has resulted in a disconnect between sectors, with little evidence of co-production.
- For DPOs, the gold standard for the delivery of social care is through Option 1, but this is perceived as being expensive and difficult to implement by many social workers.
- TSOs view Option 2 as the basis for a more flexible system, but many local authorities perceive this as contractually difficult and overly legalistic. Therefore, services have not developed services through this route at scale.
- Option 3 has become the default mode. As social care has shifted to crisis management, it is seen as the quickest and most effective means of providing support and therefore dominates service provision.
Feeley’s approach to addressing the implementation gap has focused on 2 main areas: the incorporation of a human rights-based approach in social care and the development of a National Care Service.
Incorporating a human rights approach in social care
- Most respondents welcomed the adoption of a human rights approach but raised concerns as to how this would be actualised in policy.
- Many struggled to define what it might mean in practice and how it would differ from the principles of SDS and Independent Living. SDS legislation is already underpinned by a rights-based approach
- There is also no discussion of redress if rights are not met.
How will a National Care Service work?
- The introduction of an NCS was welcomed and viewed as ambitious and well intentioned across each of the sectors.
- There were concerns over the prospect of another major reorganisation in social care and how a centralised structure would provide locally provided services.
- Participants were usure how the NCS would fit within recently restructured integrated health and social care services.
- This was a particular concern for the provision of Option 1 – direct payments – within this structure.
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