t Chisholm: Debate on the Social Care (self-directed support) Bill
Malcolm looks at issues surrounding self-directed care
Debate on the Social Care (self-directed support) Bill Malcolm Chisholm (Edinburgh North and Leith) (Lab):
I welcome the bill, which is the first piece of legislation in this policy area since the Community Health and Care (Scotland) Act 2002, which extended the scope of direct payments to all care client groups. Self-directed support, however, is about much more than direct payments. I particularly welcome the new option 2, whereby the supported person decides the support and the local authority arranges it.

Self-directed support requires profound cultural change to make it work properly and action on the postcode care issue, which will require some central direction, as Jackie Baillie outlined.

Culture change is certainly necessary. Not that long ago, the City of Edinburgh Council was preparing to change social care provision for hundreds of disabled people without any consultation with those who were about to lose a trusted carer. That was stopped because of a great campaign against it, but it leads me to agree totally with Professor Frank Clark, who said:

“The situation is a bit like what happened with the integration of health and social care, in that there is no point in getting the structure right unless practitioners on the ground behave differently.” - [Official Report, Health and Sport Committee, 15 May 2012; c 2266.]

That is partly about training, and it is certainly about an understanding of the personalisation agenda in health and social care and a determination to do things with people rather than to them.

Self-directed support has to be about promoting human rights and independent living rather than consumerism and the cost of services. To make it work effectively, however, there has to be investment in independent advice and advocacy to help people access it. Age Concern and the Scottish Association for Mental Health argued for that in their submissions on behalf of their respective client groups.

It is also crucial that people should get the appropriate level of direct payment; a related point is that, where charging is permissible, they should be charged fairly. More central direction is required for that via a framework of standards, and an appeals system is probably necessary to ensure equity.

Bob Doris:

Malcolm Chisholm raises a vexed issue - the expression “postcode lottery” is sometimes used - but does he accept that charging is sometimes directly related to the amount of money that local authorities decide to invest in their social work departments, and that that is a local democratic choice for them? The situation must be monitored nationally, but how much local authorities want to invest in their social work departments should be a real local democratic choice.

Malcolm Chisholm:
That will become quite an issue during discussion of the bill and the forthcoming health and social care legislation. There is always a balance between local decision making and national decision making - I have been having a Twitter conversation with Roseanna Cunningham and others over the weekend about that. My general view is that there needs to be a bit more national direction a framework of standards - because otherwise people will feel that the system is simply not fair.

Charging people very different amounts and assessing them in different ways will be a threat to this excellent bill. That is why we need a framework of standards and an appeal mechanism.

I accept that there are no large sums of extra money available for self-directed support, but it is important to ensure that the policy is not used as a cost-cutting exercise. The principle of equivalence of resource is important in the context of the bill. There are fears about costs - Duncan McNeil talked about COSLA’s view - but we should remember that, in his report, Professor David Bell said that self-directed support costs are similar to the costs of existing commissioned services. The issue to do with bridging costs has been recognised for a long time, and it is interesting that the financial memorandum draws on the direct payments finance project report of 2003 - the situation has become easier since then, because of the move from block to spot contracts. Such issues can be resolved.

Many more issues will be discussed in detail at stage 2; I will touch on two or three matters in the remaining time that I have. There is an issue to do with personal assistants, who were not included in the Regulation of Care (Scotland) Act 2001. Barnardo’s is calling for a register of carers and personal assistants who are eligible to be employed. I am not sure that we need to go that far, but we should certainly ensure that all carers and personal assistants are covered by the protection of vulnerable groups scheme. The Government should consider the SSSC recommendations in that regard, because there needs to be protection for vulnerable people. As SAMH pointed out, many potential employers will be vulnerable.

I agree with what the minister said about the employment of family members. The move in that regard from exceptional to appropriate circumstances is entirely right.

The interplay between the bill and the health and social care integration agenda needs greater clarity. In a sense, it is unfortunate that we are not discussing two bills together. The committee said in paragraph 199 of its report:

“the Committee encourages the Scottish Government to ensure that the principles of self-directed support enshrined in this Bill can be extended to address the health needs of people also in receipt of social care.”

I support that.

I strongly support the inclusion of children and young people in the scope of the bill, but I was interested in Barnardo’s comment that not enough evaluation has been done. It is important that there is full analysis of current projects that involve children. In general, I certainly agree that children and young people should be included in the bill.
September 18th 2012