Highland Council to consult on Self-Directed Support

7th April 2015

Families and carers of children and young people who are eligible for Self-Directed Support are to be consulted on the continuing use of direct payments for services in the Highlands.

Self-Directed Support is available for children and young people who have been assessed as requiring care or support. Plans for Self-Directed Support may include:
· A direct payment.

· Working with a care provider to manage the child or young person's budget.

· Arranging care or support for the child or young person.

· A combination of the above options.


The Highland Council is responsible for administering Self-Directed Support for children and young people in Highland.

The Council has commissioned the Highland Children's Forum (a registered charity) to carry out a consultation on Self-Directed Support. The consultation aims to establish the long-term demand for direct payments and to seek families' and carers' views on options for the re-allocation of social care funds to free up resources currently committed to existing services.

Proposed options were presented to the Council's Education, Children and Adult Services Committee in February 2015.

Bill Alexander, Highland Council's Director of Care and Learning said: "The Council is seeking equity in the use of Self-Directed Support resources. While the financial decisions are complex, we are keen to take account of the views of the users of these services. We will try to find out what level of understanding families have of the SDS options and benefits available to them. People will have the opportunity to prioritise the options, and to come up with other ideas."

He added: "In the second stage of the consultation, people who access an SDS budget will be asked about their experience of the process. Those who do not have a budget will be asked about any barriers that are preventing them from doing so."

Highland Children’s Forum will consult children, young people and their families using a variety of different methods and will target urban, rural areas in Highland.

Further information on dates and locations of focus groups will be made available in due course.

The options were set out in the council papers in February and are reproduced below -

The Highland Council Agenda
Item
16.
Education, Children and Adult Services Committee
11 February 2015
Report No ECAS 31/15
Self-Directed Support
Report by Director of Care and Learning

Summary
Implementation of Self Directed Support requires that we free up resource by re-shaping
services at the same time as reducing the overall spend. The current spend on services for
children with disabilities remains in excess of budget, due to the factors outlined in this and
previous reports. This report outlines the various options and their likely impact on service
provision, and proposals to consult on options for change.

1. Reasons for increasing costs
1.1 The increasing number and complexity of children and young people identified with
Additional Support Needs (ASN) across Scotland prompted the Doran Review.
The interim findings confirmed the increasing complexity partly due to better
recording but also to better survival rates for premature babies and childhood
illness, more children living in the community due to enhanced technology and
medical support, and due to the increase in SEBN, autism and other health issues.
1.2 The research also confirmed the increasing expectations of families and
communities that they will be provided with the appropriate level of support to care
for such children at home and that they will be provided with education locally.
1.3 This includes children who have experienced very pre-term births and have
significant medical, physical, sensory and cognitive needs. Although small in
number, this group requires a significant level of support to meet their health,
education and care needs.
1.4 This pattern has been noted in Highland, and reported to Committee in May 2014,
following the work undertaken by the ASN Review Group to study prevalence rates
to support the process of identifying need for future planning of services.
1.5 The statistics used to predict the numbers of children and young people considered
to have significant levels of support in school (levels 3 and 4) reflects the need for
significant levels support outwith school. Up until May 2013, mainstream schools
had recorded 1710 pupils with level 3 and 4 needs. Adding to this, there are
approximately 150 level 4 pupils in special schools, which brings this figure to1860.
1.6 The number of children and young people with disabilities currently provided with a
support package by the disability teams, is around 600. A profiling of caseloads
over the last 3 years is currently underway in order to forecast future need

2. Impact on disability budgets
2.1 The main budgets involved in providing care and support services to children with
disabilities and their families are:
 The Family Team budgets, previously Children with Disability Teams, including
support work budgets
 The residential respite resources
 The Positive Partners scheme of family based respite
 The home based respite budget used to spot purchase from Carr Gomm and
Cross Roads Care
 The Direct Payment budget.

2.2 All of these budgets are under significant pressure due to the level of demand.
2.3 Care at Home also continues to be required, and current and future need has been
projected. Discussions continue with NHS Highland regarding an adjustment to
current financial arrangements to provide the necessary home care component of
Direct Payments
2.4 An additional si
gnificant factor is the small number of children with very complex
needs living in challenging circumstances, e.g. when more than one child in the
family is affected, in a single parent household, when a parent has physical and/or
mental health issues. The care packages for such children are very large in order
to sustain them at home. Most of these children have SDS packages which include
both Direct Payment and residential respite.

3. Options and implications of releasing budget by re-shaping services
3.1 All the reports to Committee to date have outlined the need for budget
reconfiguration in order to release budget for the implementation of SDS as
families assessed as having eligibility begin to opt for Personal Budgets.

3.2 This has not been achieved to date, except on a marginal basis, mainly because
the bulk of resource is tied up in residential respite and support work where staff
posts are the main cost.

3.3 There are no easy solutions for moving resource, and the main purpose of this
report is to outline potential options in moving forward with the redesign of services.

3.4 There is no established pattern in Highland on which to base the re-design. Whilst
we have arrangements in place for families to choose a Direct Payment, many
continue to use a mixture of Direct Payment and traditional council services.
Indeed many others, whilst wishing to have more control over service provision,
also don’t want to manage the budget for this, and so work in partnership with the
council services.

3.5 The legislation allows the possibility of a wider group of children and their
parents/carers seeking to use Direct Payments to access services, including for
those are not currently using council services, thus increasing the call on budgets.
This should be managed by shifting resources from council services, but in
Highland many families continue to be dependent on these services, and there is
no current established change in this pattern of usage.
3.6 Officers are therefore seeking to initiate a consultation process in order to establish
views on the future pattern of delivery. Options have been developed as a basis for
consultation, but it may be that other options emerge from the consultation
process. The options developed to date are outlined in the following sections of this
report. Through consultation it is hoped that new types of services may be
identified which could better meet the needs of families.

4. Gate-keep residential provision and reduce as funds are moved to SDS

4.1 Highland Council has very well established residential respite provision, at The
Orchard, Thor House and Staffin Respite Centre. To date, few families have opted
to reduce the use of these resources. The options for freeing up resource, which
require a reduction in the level of staffing include:
4.2 Option 1:
 Contract provision to the ‘core’ group of children with complex heath needs and
significant disability.
 Restrict provision to residential respite and cease all other activities such as day
care, after school support, group work, and outreach.
4.3 Option 2:
Amend the Resource Allocation System (RAS) to reflect the true cost of residential
respite provision, instead of the subsidised amount utilised to date in order to
cushion the implications on residential provision. (This would require review of all
SDS Support Packages approved using the subsidised rate.)
5. Reshape support work services using all available budgets to obtain better
value for money.

5.1 Option 3:
The Support Work Review, reported separately to this Committee, will result in
additional funding for Self-Directed Support. At the same time, the pre-existing
staffed support work requires to be re-shaped to avoid the risk of double spend.
Essentially, this means continuing the move away from support worker posts into
more flexible budgets.

6. Review the maximum level of the Resource Allocation System (RAS)
6.1 The work undertaken to date to develop an equitable Resource Allocation System
was based on an exercise costing 60 current packages and, utilising a financial
formula, allocating points along a sliding scale. This resulted in five levels for the
RAS, ranging from under £2,000 to a top level of £20,000. This work was based on
current spend not on current budget.
6.2 Option 4:

Reducing the value of the whole RAS by an agreed amount, for example £5,000
with a top level of £15,000 and change the allocation of pounds to points. This
would bring it more in line with budget.

7. Limit the total package available for SDS and prioritise children with highest needs

7.1 Currently there are a number of SDS packages which are well over the £20,000
limit. These are exceptional cases of high need and the packages are thought to
reduce the risk of the greater expenditure of accommodating a child or funding an
out of authority placement.

7.2 Option 5:
The maximum level for the additional resource could be set at a reduced level.
8. Consultation: April - June 2015

8.1 We have reached this point in our implementation of SDS, where it has been
essential to set out the implications of this transformational change in service
provision. These issues are currently facing every Local Authority in Scotland.
8.2 For Highland, each of the options holds its own challenges. More work is required
regarding the potential resource that may be released by each option, but given the
nature of the likely implications for children and families, it is imperative that the
options are consulted on with these stakeholders.

8.3 Such a consultation requires a pan Highland approach in order to maintain equity.
Whilst the Development Officer Disability could facilitate the process, it would
benefit from the involvement of an independent agency. Discussions are taking
place with the Highland Children’s Forum regarding this.

8.4 It would also be of value to consult with the range of professionals providing other
kinds of intervention with the children and families most affected.
8.5 Staff who are likely to be affected by future changes in provision will require to be
supported throughout this process.

9. Implications
9.1 Resources: Regarding the implementation of SDS, Audit Scotland state that
Councils should ‘take action to lessen the risks of overspending, which might mean
that they are unable to provide support for everyone who needs it’. It also stated
that Councils need to have plans ‘for how and when to stop spending on existing
services if too few people choose to use them, and plans to develop and invest in
new forms of support for people with social care needs’.

9.2 Legal: Highland Council has committed to implementation of the new legislation
from April 2014. The implementation of Self-Directed Support is intended to be
transformational in its implications.

9.3 Risk: There is a risk in pre-empting any established changed pattern of need and
demand, by unnecessarily reducing some council services. There is also however,
a risk in continuing to provide the same level of services, whilst offering greater
opportunities for families to access Direct Payments.
9.4 Equalities: There is a risk that SDS may be a favoured option for those groups of
children and families who are able to use it, but that there will as a consequence be
less choice and poorer access to services for other groups, as traditional services
are downsized.
9.5 There are no climate change/carbon clever, rural or Gaelic implications arising from
this report.

10. Recommendation
10.1 Members are asked to agree a consultation on service and financial options for
those people who currently use Self-Directed Support packages, or who may
require and choose one in the future.
Designation: Director of Care and Learning
Date: 2 February 2015
Author: Marlyn Campbell, Development Officer Disability

Background Papers:
1. The report Meeting the needs of Scotland's children and young people with complex additional
support needs: The Scottish Government's response to the Doran Review sets out the Scottish
Government's action in response to the recommendations.
2. Full report of the Additional Support for Learning Review
http://www.highland.gov.uk/learninghere/supportforlearners/
3. Accounts Commission - Auditor General prepared by Audit Scotland. June 14
Self-directed support