Self-Directed Support update (SDS) Update

SDS Thematic Review
East Lothian Health and Social Care Partnership (ELHSCP) was one of six Scottish health and social care partnerships to take part in a Care Inspection Thematic Review of the Implementation of SDS in Scotland. The Care Inspectorate visited East Lothian during September last year and worked with service-users, carers and staff to establish how well SDS was being implemented in the county. They had some very positive insights to share. They thought that the way that we supported people to experience positive personal outcomes through the implementation of self-directed support was good in East Lothian. Here’s what the inspectors had to say.

‘Good conversations and positive outcomes were clear strengths of our inspection findings in East Lothian. Staff…were confident that they were supporting people to achieve positive outcomes…many supported people and unpaid carers were clear that they were experiencing flexibility, choice and control in their care and support and that this was making a difference to their lives’.

They also noted that staff felt confident, competent and motivated to practice in an outcome-focused and person-led way. They rated us as good, saying:

‘The majority of social work staff we met…felt autonomous, confident and supported. There were appropriate arrangements in place to express views, share, discuss and reflect on practice issues at events, workshops and individual support levels with managers.’

Another area that impressed the inspectors was the way we had effectively communicated and engaged with our stakeholders and promoted more flexible commissioning strategies. They also liked the way that we empowered and supported staff to develop and exercise appropriate skills and knowledge, and they felt that leadership was good too.

They added:

‘The self-directed support vision, values and culture were generally well established across the partnership…Overall, the partnership was collaborative, innovative and had designed and embedded numerous new ways of working all based around efficiencies, market stimulation and self-directed support principles’.

East Lothian carer quoted by Care Inspectorate

SDS Action Plan
We re currently working on an action plan action plan to deliver the recommendations from the thematic review. In November, we will be holding an event for managers to work on the mapping process.

SDS Prepayment Card

SDS prepayment card
In January 2019, we introduced the SDS prepayment card. We put the amount agreed for the service-user’s four-weekly Direct Payment on to it every four weeks. It works like a debit card and has an online user account—just like an online bank account—and each card is PIN-protected.

With more people using Direct Payments, we need to put better, more efficient monitoring in place. The payment card will mean that no one will have to make quarterly submissions any more(and people will be able to check their balance online at any time). There will no longer be any need for people to open special bank accounts for Direct Payments, so it will be much quicker to set Direct Payments up. We think this system will be an added incentive for people thinking about or currently using SDS, as it will make finances much easier for service-users to control.

SDS Uptake

Mental Health and Service Misuse Change Board Update

Key objectives:

  • Achieving a range of improvements of access, ongoing support and recovery for people experiencing difficulty and/ or distress related to mental ill- health or substance misuse issues

Update: Workforce scoping underway to identify training needs/resource required to begin to row out trauma-informed practice to Health and Social Care, Children’s Services, Primary Care, Housing and Community Development. 

Suicide Prevention Training will be delivered alongside given the complimentary nature of the input 

  • Addressing the health inequalities experienced by people with substance misuse needs, and those with poor mental health, particularly those with severe and enduring conditions

Update: Health Needs Assessment for East Lothian very recently completed by Public Health to inform our planning of the needs of the population in relation to substance misuse and sexual health needs

  • Collaboration with community justice to support those with poor mental health and/or substance misuse needs

Update: Following two public engagement events, the MH Reference Group is currently prioritising actions for year 1 of the action plan which will be reported to the January 2020 Reference Group, and subsequent Change Board. There are also drug rehab organizations that can help.

  • Improved access to a range of treatment and supports locally, i.e. in East Lothian and within the area partnerships across East Lothian

Update: Development of a service specification and development of an enhanced Grade 4 rehabilitation and recovery housing care and treatment support service, increasing access to this aspect of care for East Lothian by 50%.

Primary Care Change Board Update

Key objectives are:

  • Same day Triage and advice/consultation in support of Inveresk, The Harbours and Tranent practices, bringing a total of 52000 patients into the care model

Update: HIVE practices are in consultation over concerns about capacity in CWIC. This may delay rollout

  • Physio Practitioner and Primary Care OT led services available by self-referral/care navigation from all East Lothian GP practices, available same day to all East Lothian residents

Update: We have recruited five additional Primary Care (mental health) Occupational Therapists, who are now in post

  • Treatment Room nurse led services available by self-referral/care navigation from all East Lothian GP practices, available same day to all East Lothian residents

Update: Work on treatment-room nurse-led services is recruitment dependent

  • Paramedic and Nurse Practitioner led home visiting services in support of East Lothian GP Practices

Update: An ELHVIS pilot is in progress and further expansion likely to follow in 2020 dependent upon evaluation

  • Level 3 Pharmacotherapy Service for all East Lothian practices as specified in 2018 GP Contract

Update: There is a variable level of Pharmacotherapy support, with not all practices yet receiving support. Staff turnover and recruitment shortfalls relevant

  • Links worker service for all East Lothian practices as specified in 2018 GP Contract, by April 2020

Update: Pilot still running in four practices in west of county. Engagement with potential service providers and with service users including GP practices, in progress October 19. Service specification and tendering process to follow.


Key objectives are to:

  • Ensure that NHS are sell informed of support available to carers and how to refer carers for services

Update: COEL has continued to provide Think carer training to NHS staff over the course of the year completing sessions with clinical support staff, OTs, managers and Hospital to Home services.  A further session is planned for Jan 2020.  These are being conducted alongside Jess Kearslake from VOCAL.  COEL has now completed their move to the East Lothian Community Hospital and hopes that this will raise their profile among NHS staff to make referrals for their services more likely.  Discussions are taking place with John Gibson and Gordon Gray around including COEL within staff induction into the hospital  

  • Provide ELHSCP with an assessment of how well minority ethnic groups and those with protected characteristics are included within our services, policies and strategies

Update: The MECOPP audit steering group has met again in November.  The audit is underway and MECOPP hope to have a draft completed by end Dec.  Training sessions on outcomes workshops will be planned for 2020.  Dates to be confirmed. 

  • Develop a longer-term plan for carer funding through a formal procurement process to provide greater security for our carer organisations  and meet procurement and legal requirements

Update: The procurement working group comprising of staff from Childrens Wellbeing, MELDAP, The One Partnership Fund and Adult Wellbeing is continuing to outline plans for procurement of carer services.  Engagement is ongoing with carers.  Surveymonkey questionnaires have been sent to adult carers, both hard copies via COEL’s newsletter and an online survey available through the consultation hub.  There have been delays with engagement with young carers due to challenges working with ELYC.  Members of the working group recommended that schools and guidance teachers be involved in completing the survey with young carers known to them.  ELYC are also to complete focus groups with young carers in November.  Feedback from the engagement will inform the service specification.   Current carer services have also been mapped against the outcomes within the carers’ strategy – as a result it has been noted that much of the current funding is focused on awareness raising, information and advice and identification of carers.  While this is appropriate at this stage as we try to raise awareness of carers and carer issues, the group are keen that procurement look at improving provision of services to carers (outcomes 4 – 8 of the strategy), that is, breaks from caring, supporting carers to have a life outside of their caring role.  

  • Brief staff on changes to replacement care and respite charging

Update: Replacement care briefings have taken place over October to assessment staff in Adult Wellbeing.  Staff now understand the approach ELHSCP are taking to charging for breaks from caring and replacement care.  Support plans are beginning to filter through for carers to access free breaks from caring/replacement care.  Work is still ongoing with MOSAIC team around changing how this support is logged on the system.  Performance reports may have to be amended to reflect the changes and need to be planned to ensure they capture the data correctly

  • Ensure that carers have access to counselling support through their local carers’ organisations

Update: Carers of East Lothian was provided with funding this year to set up a counselling post within their service.  The counselling coordinator has been recruited and will provide both direct counselling as well as co-ordinate counselling students to provide a service to carers.  COEL has now confirmed the service will start once they have moved to the new hospital with carers being offered six sessions.  Recruitment of student counsellors will happen once the service is more established.

Adults with Complex Needs Change Board Update

Its key objectives are to:

  • Transform the model of care for community-based day supports and services for adults with complex needs

Update: Work on the transformation programme for people with complex needs is ongoing and the Change Board had endorsed a set of final recommendations supported by the Reference and Engagement Group

  • Deliver the Learning Disability Action Plan

Update: Work on the transformation programme for people with complex needs is ongoing and the Change Board had endorsed a set of final recommendations supported by the Reference and Engagement Group

  • Increase capacity for independent living for adults with complex needs

Update: ELHSCP has secured a development in Elder Street, Tranent to increase capacity for independent living for people with complex needs.

  • Oversee policy, planning and processes for young people into adult ELHSCP services

Update: Work will begin once strategic support has been secured from planning and performance

  • Deliver shared capacity through the Shared Lives Business Plan

Update: The board has produced a Shared Lives Business Plan, which is now being looked at by the IJB’s Chief Finance Officer Claire Flanagan and Alison Macdonald

  • Deliver the Fairer Scotland Business Plan

Update: Work is ongoing with the Lothian-wide Sensory Impairment Group and current contracts for specialist provision are under review.

Change Board Updates

There are six strategic planning change boards in our strategic planning structure:

Stakeholders are actively involved in the reference groups that support these boards. The Change Boards themselves feed into the Strategic Planning Group which in turn reports to the Integration Joint Board (IJB).