Self-Directed Support (SDS) was introduced by the Scottish Parliament in 2013 with the goal of allowing service users to choose their specific support provisions while giving them as much or as little direct control over their individual social care support budget as they want. This paper analyses five years of data and lived experience on SDS in Scotland to shine a light on the effects of risk attitudes among key state actors on conceptions of social care market stewardship.
SDS presents service users with four options, including (1) direct payments to service users, (2) budgets managed by councils (or third parties) under service user instruction, (3) conventional council-managed budgets and council service provision, and, finally, (4) a combination of all three options. For options 2, 3 and 4, state actors play a dual role in empowering service users to make independent choices. At the same time, they also act as market stewards (Carey et al., 2017), managing provider options through their own service offering, commissioned services, and ‘curated’ services provided by third parties.
Based on qualitative and quantitative data from recent public audit reports (e.g. Audit Scotland, 2014 and 2017; The Alliance, 2017), as well as our own qualitative data from focus groups and in-depth interviews, the paper focuses in particular on state actors’ attitudes towards risk and how these affect not just service user choices but also how they shape the social care support markets within individual Scottish councils. While some recent work has started to link risk attitudes to the success of public service innovation (Brown and Osborne, 2013; Flemig et al., 2016), risk remains undertheorised when it comes to its effects within social care market stewardship.
Based on our multi-method data analysis, we propose three key lessons from SDS in Scotland with wider applicability to other personalised budget innovations, as well as a first conceptual model that links risk and market stewardship approaches.
References:
Carey, G., Dickinson, H., Malbon, E., and Reeders, D. (2017) The Vexed Question of Market Stewardship in the Public Sector: Examining Equity and the Social Contract through the Australian National Disability Insurance Scheme. Social Policy & Administration, doi: 10.1111/spol.12321.
Audit Scotland. (2014) Self-Directed Support. Available online at URL: http://www.audit-scotland.gov.uk/docs/central/2014/nr_140612_self_directed_support.pdf
Audit Scotland (2017) Self-Directed Support: Progress Report. Available online at URL: http://www.audit-scotland.gov.uk/report/self-directed-support-2017-progress-report
Health and Social Care Alliance (the ALLIANCE) (2017) Personal Experiences of Self-Directed Support. Research Report. Available online at URL: http://www.alliance-scotland.org.uk/news-and-events/news/2017/05/self-directed-support-is-falling-short-of-disabled-peoples-ambitions/#.Wfclm2e7KM8
Brown, L. and Osborne, S.P. (2013) Risk and innovation: Towards a framework for risk governance in public services. Public Management Review 15 (2), 186-208.
Flemig, S., Osborne, S.P. and Kinder, T. (2016) Risky Business - Reconceptualizing Risk and Innovation in Public Services. Public Money & Management 36 (6), 425-432.
