good practice
Value of self-directed support
.Self-directed support means that individuals lead the process rather than the practitioner.
Gail McCulloch, a senior care manager from Surrey, UK, has been praised for helping a family overcome their problems by using self-directed support. Natalie Valios from Community Care reports.
When the director general for social care is so impressed by a piece of work that he says it is the best example he has seen and he describes the social worker involved as inspirational – you know it is something worth shouting about.
In this case, David Behan was talking about self-directed support in Surrey, and the work of Gail McCulloch, a senior care manager with the county’s adult social care department.
The work in question involves a family comprising Kevin and Ali and their daughters Megan, four, Millie, three, and six-month-old Isla. A few years ago, they were living in another local authority and were referred to social services after Ali was diagnosed with Ehlers-Danlos Syndrome Type 3, a rare connective tissue disease which causes joint instability, pain, loss of mobility, heart problems and fatigue.
Ali was feeling socially isolated, depressed and felt she had lost her status as a mother, as well as having to give up work as a book-keeper. Kevin had to give up work to care for Ali and their three children and was dangerously overweight with high blood pressure, depression, and fatigue. He was also suffering from social isolation.
High stress levels
“Pain was stopping Ali from doing anything” says Kevin, “so I was dealing with everything myself. It was a lot for one person to cope with and stress levels were high.
“Ali was getting down because she couldn’t help, and I was getting down because it felt like a 24-hour job. Megan was 18 months and Millie was six months. I had to stop work because Ali had a few bad falls and it got to the point where somebody needed to be with her all the time.”
Their council offered Ali a direct payment which they used to employ her mum as a personal assistant for 15 hours a week. This lasted until the family moved to Surrey in August 2008 and were referred to its adult social care department.
Self-directed support
McCulloch received the referral and saw the family for the first time in September.
“It was very early days of the self-directed support project in Surrey and I brought the information with me” McCulloch says. “Self-directed support means that individuals lead the process rather than the practitioner.”
The supported assessment questionnaire left by McCulloch helped the family identify where they most needed help. The main thing the family wanted to resolve was Kevin’s health. As Ali puts it: “Nothing runs without Kevin. He gets up for the girls at night and runs everything during the day, so he has to be healthy.”
As Megan has been diagnosed with the same condition, and it is probable that Millie also has it, the girls wake up often during the night because they are in pain from cramps in their joints.
However, time and money wise Kevin couldn’t see how they could address his health issues. “Depression was a big thing,” he says. “I was having to deal with an awful lot. I was tied to the home so that meant I didn’t have time to deal with my weight.”
Solutions
They also wanted Megan and Millie to be less isolated, needed help to run the home, and wanted to have some friends. The solution the couple came up with included gym membership for Kevin, two-and-a-half days a week at nursery for Megan and Millie, and a laptop for Ali so she could e-mail friends, access support groups for her condition, and manage the direct payment accounting.
“The girls love going to nursery and it’s freed up time for Kevin to go to the gym and the weight is coming off,” says Ali.
They have increased Ali’s mother’s weekly hours to 20, and both her parents stay with them regularly so that Kevin and Ali can have some time to themselves. Kevin is on a reduced dose of anti-depressants and is feeling much better. “Self-directed support makes us feel normal and able to do something outside these four walls, which we haven’t been able to do before.”
The couple feel their lives have improved no end through self-directed support. “Before [with a direct payment] it was all based around me rather than the family,” says Ali. “We needed more flexibility than that. We were at home together the whole time, and to see Kevin come back from the gym so happy and have a sense of achievement is really nice. It’s finding solutions to the problems. We didn’t have the means to do it before but now we can and it’s made a big difference to all of us.”
As for McCulloch, self-directed support has meant she can go back to her social work roots: “Being able to be a social worker again has really reminded me what it is all about –enabling people to find the solutions for their lives. It’s been amazing for me to see the solutions Kevin and Ali have come up with.”
And the couple are full of praise for McCulloch. “We know we can tackle anything with her,” says Ali.
What is self-directed support?
It is a new system that aims to enable people to be in control of the support they need to live their life as they choose. The system started with social care and the money in social services, but now also involves health, education, and other funding and services.
Self-directed support works with the use of personal budgets. With a personal budget you know how much money you can spend and what outcomes you are aiming to achieve, and can decide exactly how and when that money is spent. People with personal budgets may choose to use direct payments to manage their budget. However, it should be emphasised that self-directed support is much more than simply having a direct payment to purchase services.
There is more information about self-directed support available from In Control, a social enterprise set up in 2003 to transform the current UK social care system. In Control is a partnership working with different kinds of membership including citizen members, local authority and NHS members. It helps local authorities to deliver self-directed support and has over 120 local authority members.
The government’s Putting People First ‘Concordat’ of December 2007 says that every local authority will need to make personal budgets available to people. For more information visit www.in-control.org.uk or telephone the In Control support line on 01564 821650.
This article was first published in Community Care magazine on 25 June 2009 and is reproduced with permission. www.communitycare.co.uk