Lost in Translation: An Ethnography of Self-directed Support in Scotland

Self-directed support (SDS) is Scotland’s approach to social care and was enshrined in legislation with the passing of the Social Care (Self-directed Support) (Scotland) Act 2013. This policy is underpinned by a shift towards personalised social care services with the intention that people who require support can exercise as much choice and control as possible over their receipt of social care. With a clear emphasis on co-production and outcome-focussed support, SDS is intended to support people to participate in society whilst also protecting their human rights, including the right to independent living. Although the positive transformative potential of the policy is evident from its overarching principles and values, it is widely acknowledged that SDS is not being delivered as was intended. Within the growing SDS literature, scarce attention has been paid to the daily work of practitioners, who are tasked with translating SDS legislation into everyday practices. Consequently, in order to bridge this gap, this thesis places an emphasis on what practitioners actually do, by exploring how their SDS knowledge is translated through their everyday activities.
An ethnography was undertaken in a Scottish local authority adult team to explore the everyday implementation of SDS. The fieldwork included practice observation, formal and informal interviews, document analysis, and auto-ethnographic reflection, all of which took place between December 2019 and January 2021. The mobile methods captured desk work, meetings, informal interactions, and home visits within fieldnotes, a reflective log, and interview transcripts. The fundamental question being addressed was not whether SDS works, but rather how SDS works. Consequently, the work of practitioners has become the unit of analysis and the central focus of this thesis. The findings were analysed through Freeman and Sturdy’s (2014) embodied-inscribed-enacted knowledge framework, which provides a powerful tool to identify and capture practitioners’ SDS knowledge during policy translation. Practitioners embody SDS knowledge through their emotions, feelings, and embrained information. They inscribe SDS knowledge into documents and artefacts as they construct the policy reality, and enact it through their everyday encounters as they create and recreate a collective SDS world.
The thesis renders the unseen backstage SDS practice visible, providing a window into the black box of social work practice, or what has been described as the ‘the invisible trade’ (Pithouse, 1998). The findings highlight the contested nature of SDS implementation and reveal a concerning gap between social work practice and policy expectations. Practitioners are pulled in different directions due to competing functions in daily work, and the thesis therefore shines a light on the complex position occupied by social workers. Although SDS processes and procedures attempt to standardise work, highly bureaucratic tasks seem to have encroached on their practice, depleting the time available to build relationships with supported people. The evidence suggests that relationship-based practice thus takes a back seat, and high eligibility criteria, thresholds, and procedural demands are placed upon practitioners instead. Workers feel frustrated and constrained by these bureaucratic boundaries imposed through local authority processes and procedures, impacting their sense of professional identity and autonomy.
Amid this global pandemic the importance of social care and SDS delivery has never been more apparent, which is why an overdue but much-needed board discussion regarding a Scottish National Care Service has been sparked. This thesis contributes to the current national conversation regarding the future direction of SDS amid the shifting social care landscape.