(184) whole system reform (september 2011)

Whole SystemReform by Dr Simon Duﬀy, e Centre for Welfare Reform, Sheﬃeld, 20th September 2011

The Centre for Welfare• Independent research & development network• Founded upon belief in human equality and diversity• A community of 60 Fellows• Innovators who created person centred planning, individual budgets, self-directed support, support planning etc...• 200+ publications at www.centreforwelfarereform.org working to democratise the welfare

4 thoughts1. We should change our objective - public systems of support should aim at citizenship2. We should change our perspective - real change starts with the person, not with services3. We should change our services - personalisation puts people ﬁrst4. We should change the welfare system - fairness & entitlement instead of powerful paternalism

The welfare state is good

The welfare state is good it’s just designed wrong

Plenty of services...

But people trapped in

Poverty comes in many

People with complex needs• Mental illness - undermining hope and resilience• Isolation & fractured relationships - institutionalised abuse and hate crime• Segregation & prejudice - limited opportunities to contribute and make new friends• Limited support to develop - poor incentives and low expectations• Powerlessness - money locked in services and decisions put in other’s hands

1. Citizenship is achievableIn practice citizenship means...

1. being in control2. with direction3. enough money4. your own home5. enough help, and6. being active in communityemployment is a critical thread

Citizenshipmeans• Being equal - same rights, same worth• Being unique - diﬀerent is good• Being needed - bringing your own gis• Having needs - giving meaning to others

Citizenshipmeans• Being equal - same rights, same worth• Being unique - diﬀerent is good• Being needed - bringing your own gis• Having needs - giving meaning to others living together with mutual respect

RealWealth..

2. People have the capacityRealWealth..

Good help means

Good help means★ inspiring - hope and recovery★ empowering - individuals & families★ strengthening - personal development★ connecting - to community★ building - safer networks not something you can do to people

3. Services can be redesigned

3. Services can be redesigned1. Personalised Support - high quality community support for people with complex needs2. Personalised Transition - educating and preparing kids with severe impairments for active citizenship3. WomenCentre - working in partnership with women with complex needs

Personalised Supportﬂexible & creative support

the old care management system

it’s really hard to

it’s really hard to• empower people - without entitlements

it’s really hard to• empower people - without entitlements• strengthen capacity - focusing only on needs

it’s really hard to• empower people - without entitlements• strengthen capacity - focusing only on needs• connect to community - inside segregated services

it’s really hard to• empower people - without entitlements• strengthen capacity - focusing only on needs• connect to community - inside segregated services• build safe networks - without family, friends and love

replace care management

replace care managementwith self‐directed support

this means we can

this means we can1. empower people - tell people their budget

this means we can1. empower people - tell people their budget2. strengthen capacity - focus on personal outcomes

this means we can1. empower people - tell people their budget2. strengthen capacity - focus on personal outcomes3. access community - use funding ﬂexibly

this means we can1. empower people - tell people their budget2. strengthen capacity - focus on personal outcomes3. access community - use funding ﬂexibly4. build safer networks - work with family & friends

Personalised Transition control: health,education & support

Jonathan’s health needs are complex.In the 3 years beforeleaving school Jonathan spent 150 days in hospital - respondingto problems with breathing. In the 3 years since leaving hospitalhe has spent only 2 nights in hospital - for elective dentaltreatments.Jonathan’s family have overseen the development of apersonalised package of support for Jonathan with flexibility,employment and learning - but not learning in college - butlearning on the job. Over the last 3 years, Jonathan has acquiredtwo City & Guilds Qualifications and is now learning newindependent living skills. Over the last 3 years, the individualbudget system has enabled Jonathan and his family to makesignificant efficiencies in the costs of his care and support andsave the NHS:•Over £100,000 in hospital stays•Over £300,000 in residential care costs

A couple of weeks ago in Sheﬃeld, I met a wonderful womancalled Katrina. Shes got three disabled sons. e oldest isJonathan, a charming, warm hearted young man of 19. He cantwalk or talk clearly, or feed himself alone. Hes had a breathingtube in his neck since he was a toddler. Under a scheme the newLiberal Democrat council in Sheﬃeld is extending, Jonathansjust got his own individual budget and care plan.Now hes doing work with a local charity, attending a musicgroup, has his own personal assistant - a child whose potentialseemed so limited. Finally as a young man, engaged in life in away he and his mother never thought possible. Katrina told mewith the biggest smile Ive ever seen, she said: Weve gone fromhaving nothing to having everything. I wish every childs needswould be taken this seriously. (Nick Clegg, 17 September 2008).

WomenCentre a creative andpositive community

• Real Total Place innovation• Slashed re-oﬀending rates - to less than 5%• Success in protecting women and children from abuse• Signiﬁcant improvements in mental health• Modest funding - but now cut by 41%

built on hope & trust

For employment providers• Build on personal capacity• Stimulate local solutions• Challenge faulty tax-beneﬁt system• Help shi power back to local communities• Resist the temptation to just play the system

Localism anyone?

4. Systems can be fairer

4. Systems can be fairer1.Current tax-beneﬁt system is unfair and very complex2.Current ‘reforms’ target cuts on disabled people3.ere is a fairer alternative

Some things to keep in1. e poor can be very poor indeed - the poorest must live on £2,780 per year - compared to mean household income of £50,000 per year (<6%).2. e poor pay marginal taxes of around 100% on their earnings and they pay more tax as a percentage of their income than any other group (!!)3. Poor lose income if they live together - 25% tax on IS and have no incentive to save or invest.4. e UK is the third most unequal society aer USA and Portugal

One cheer - there is agrowing recognition thatthe tax-benefit system is1. e recognition that the poor are over-taxed2. at the benefit system is unfair and unduly complex3. at the benefit system is stigmatising4. at the tax and benefit systems should be integrated

137 differentways...to give peoplenot verymuch...•linked or not•means-tested or not•tax credits or beneﬁts•disability related or not•employment- seeking or not

Citizens Advice acknowledges that the £1.5 billion cost offraud in the benefit system must be recovered, but we are veryconcerned at the government’s persistent tendency to roll fraudand error figures together. Errors account for the remaining£3.7 billion of the £5.2 billion figure quoted...In the meantime, the £5 billion cost to government throughfraud and error is dwarfed by the £17 billion of benefits andtax credits that remain un-claimed every year, because peopledon’t know they are entitled to claim, or because the system istoo complicated. e danger of making benefits more difficultto claim is that people in real need will not receive the moneythey need to pay their rent, keep their families warm, or feedtheir children. Teresa Perchard , Director of Social Policy at Citizens Advice

Government defrauds thepoor at more than 11 times the rate at which the poor defraud the government

1.5 million people with the most significant disabilities will lose: • £4.6 billion in social care support • £4 billion in disability living allowance • Termination of ILF • Cuts to Supporting People • Many further cuts in housing support and other benefitsServices perceived as universal are protected: pensions,NHS and schools - services that are perceived asmarginal are cut: social care, disability benefits,community spending...

1.5 million people with the most significant disabilities will lose: • £4.6 billion in social care support • £4 billion in disability living allowance • Termination of ILF • Cuts to Supporting People • Many further cuts in housing support and other benefitsServices perceived as universal are protected: pensions,NHS and schools - services that are perceived asmarginal are cut: social care, disability benefits,community spending... BUT they may not get away with it www.campaignforasociety.org

An alternative• Growth has undermined older systems of security (the land, the Church, the family or the ﬁrm).• Growth will never provider suﬃcient income to keep the poorest from unacceptable poverty• As a community it is our role to make sure we safeguard everyone from poverty

An alternative• Growth has undermined older systems of security (the land, the Church, the family or the ﬁrm).• Growth will never provider suﬃcient income to keep the poorest from unacceptable poverty• As a community it is our role to make sure we safeguard everyone from poverty premise - poverty can be limited by our social

Family Security System: • Universal income security • Fair taxes for all • Focus on women & family structuresUnderpinned by respect for human rights,constitutional reform and transparentsystems for deﬁning entitlements andtaxes.

Thoughts for government• Start focusing not on beneﬁt caps - but underlying security and key principles• Create a transparent process for deﬁning underlying securities• Create legal rights - to realise human rights - and checks and balances to make rights real• Make the system of income security universal

The Centre for Welfare ReformThe Quadrant, 99 Parkway Avenue,Parkway Business ParkSheffield, S9 4WGT +44 114 251 1790 | M +447729 7729 41admin@centreforwelfarereform.orgGet a free subscription at:© Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org

(184) whole system reform (september 2011)

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