International developments in self-directed support

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 12th August 2013 ￭ Wellington

Emerging themes

An overview of the international development of self-directed support, the emerging themes and challenges, issues of leadership, rights and sustainability. What has worked well and what hasn’t and why.

• 1990 in London, brokerage, individual funding and service design

• 1996 in Glasgow, new models of service provision and Individual Service Fund

• 1999 in Scotland, working on self-directed support with local government

• 2003 in England, led piloting of self-directed support

• 2009, established The Centre for Welfare Reform, global community for social innovation

• trying to combine practice and theory

Simon Duffy, some background

• always improves outcomes

• always increases demand

• sometimes reduces costs

• system design is critical

40 plus years of self-directed support

Positive Negative

Rapid policy and large scale changeBreakthroughs in flexibility and awareness of entitlementSystem was financially sustainableAvoided undue reliance on brokerage

Development of complex RAS, eroding trustSupport planning industryIncreasing levels of bureaucracyFailure to engage providers effectivelySystem now abused to help with 33% cut in care

recent changes in England

A system of self-directed support is a system of funding for support that helps people to achieve full citizenship. It can have the following qualities:

1.Rights - robust rights that give people effective entitlements

2.Control - person, or someone close to them, controls budget

3.Clarity - systems, rules and budgets are clear

4.Flexibility - budgets can be used in many different ways

5.Ease of Use - it is easy to plan, manage and control assistance

6.Community - person’s contribution to society grows

7.Sustainable - system is affordable, innovative and supported

Being a citizen is better than being ‘normal’

it lets us be equal and different

Citizenship for all is practical, but requires social change

There is not just one kind of institution

we bring the institution with us

RightsRights

the government money fallacy...

...money can’t always be theirs

“It’s my life, my human rights”

Are people’s plans public property?

What are the political realities of the language of entitlement?

Is self-directed support a service or an income adjustment or something else?

system design issues

ControlControl

It’s not about doing everything for yourself

Is the system even-handed towards all the control options?

Is changing the point of control an appropriate safeguard?

system design issues

ClarityClarity

Can we do without a RAS?

Why do we want complex assessment systems?

What do we mean by ‘sufficient’?

Should we means-test love and community?

system design issues

FlexibilityFlexibility

Can people use their money to buy things which are not ‘services’?

Can people use their money flexibly and pool it with their other resources?

Is self-directed support transformational or merely transactional?

system design issues

Ease of UseEase of Use

We don’t know enough about abuse; but we do know institutions increase the risk of it and having relationships

reduces the risk of it.

Community brokerage... not another profession

What purpose is served by complexity?

Can providers evolve to embrace, support and underpin self-directed support?

Do we need a new professionals?

What of social workers and other existing professional groups?

How do you resist the plausible regulation?

system design issues

CommunityCommunity

O’Brien’s five basic tasks of support

The changing role of advocacy and development

agencies

We haven’t begun to tap the power of peer support

How do local communities engage with self-directed support?

Is it helpful to abandon the commissioning model?

What helps people connect, contribute and create new solutions?

system design issues

SustainabilitySustainability

Positive change can happen at any levels, but requires the creation of opportunities for innovation

Innovation is complex, evolving and requires different strategies at different stages.

system design issues

How can you ‘design in’ affordability?

How can system change be both liberating and evolving?

When change is inevitable how do you frame it helpfully?

How can you let everyone to join in?

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