Self-directed Support Implementation Des McCart National Lead on SDS and Commissioning JIT is a strategic improvement partnership between the Scottish Government , NHS Scotland, CoSLA, the Third Sector, the Independent Sector and the Housing Sector

Social Care (Self-directed Support) (Scotland) Act 2013 “Individuals will have greater choice and control over the services they use through self-directed support for social care and person-centred healthcare.” It gives people 4 options in terms of how their social care is delivered. Option 1 – they take a direct payment, and arrange their own support, either by employing their own Personal Assistants to deliver their care or buying care services from a care agency. Option 2 – they decide who they want to deliver their care and their local council arranges the support Option 3 – after talking to them, their council decides and arranges their support Option 4 – they use a combination of 2 or more of the other options to arrange their care and support

SDS Strategic policy objectives 2015-16 Main objective: Engaged informed empowered individuals and carers who exercise choice and control Supported by: Appropriate services, systems and processes that support personal outcomes Skilled and valued workforce which works with others to empowered and support with a focus on prevention Responsive commissioning that supports choice and control

The national picture so far: building the capacity of local authorities, support and information organisation’s and providers as well as raising awareness to the people of Scotland, their families and carers More and more positive examples of how SDS is being used to improve individuals lives are being highlighted in the form of case studies - these are being shared nationally Local authorities are at different stages of implementation – the government are working closely with them to keep them appraised of priorities and to support them to come up with solutions to barriers

Health and wellbeing outcomes Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer Outcome 2: People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Outcome 3: People who use health and social care services have positive experiences of those services, and have their dignity respected Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services Outcome 5: Health and social care services contribute to reducing health inequalities Outcome 6: People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being Outcome 7: People using health and social care services are safe from harm Outcome 8: People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide Outcome 9: Resources are used effectively and efficiently in the provision of health and social care services

Outcomes Based Approach The aim of an outcome based approach is to: "...shift the focus from activities to results, from how a programme operates to the good it accomplishes.“ Margaret Plantz, Martha Greenway & Michael Hendricks (1999) Outcome Measurement: Showing Results in the Non-profit Sector. United Way of America Online Resource Library Outcome Based Commissioning is about pushing the level of conversation between commissioners and providers up the scale – from processes and outputs to outcomes. Not the detail of how services or interventions operate but what they want to achieve. Too often conversations between commissioners and providers start at the wrong end and commissioners meddle in operational detail. There are many techniques to support outcome based decision making, including techniques developed from the work of Mark Friedman and his work on Results Base Accountability, known as Outcomes Based Accountability in the UK. You may have heard the term `turning the curve’ which comes from this work. Many local areas have begun to use this methodology as a way of ensuring that their commissioning processes focus on ends, rather than means…….and use data to inform practice and decision making. More information about this approach is given in the OBA handout. Note that there are other techniques to support outcome based commissioning, but OBA is widely used for strategic planning based on outcomes.

Things people like about an Outcomes Approach Based on the person’s desires, not service led. Holistic approach. Fits with person centred approaches; puts the individual at the centre. Empowers service users and promotes self advocacy. Emphasises evidence based practice. Focuses on needs and seeks positive interventions to provide better outcomes. It facilitates a co-productive approach using person’s assets as well as services or support. ASK; what do people DO NOT like about outcome based approach? Hard to measure – can be time consuming The more aggregated the personal outcome measures – the less meaningful they become Dichotomy between importance to individual and meeting national standards and other drivers