Emerging Themes in Self-Directed Support


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Talk given to Ministry of Health, Education and Social Development officials in Wellington, new Zealand in August 2013. International progress on self-directed support remains slow, but important themes are emerging about what helps in system redesign and what is not helpful.

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Emerging Themes in Self-Directed Support

  1. 1. International developments in self-directed support Dr Simon Duffy ■ The Centre for Welfare Reform ■ 12th August 2013 ■ Wellington Emerging themes
  2. 2. 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.
  3. 3. • 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
  4. 4. • always improves outcomes • always increases demand • sometimes reduces costs • system design is critical 40 plus years of self-directed support
  5. 5. Positive Negative Rapid policy and large scale change Breakthroughs in flexibility and awareness of entitlement System was financially sustainable Avoided undue reliance on brokerage Development of complex RAS, eroding trust Support planning industry Increasing levels of bureaucracy Failure to engage providers effectively System now abused to help with 33% cut in care recent changes in England
  6. 6. 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
  7. 7. Being a citizen is better than being ‘normal’ it lets us be equal and different
  8. 8. Citizenship for all is practical, but requires social change
  9. 9. There is not just one kind of institution we bring the institution with us
  10. 10. Rights
  11. 11. the government money fallacy... ...money can’t always be theirs
  12. 12. “It’s my life, my human rights”
  13. 13. 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
  14. 14. Control
  15. 15. It’s not about doing everything for yourself
  16. 16. Is the system even-handed towards all the control options? Is changing the point of control an appropriate safeguard? system design issues
  17. 17. Clarity
  18. 18. 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
  19. 19. Flexibility
  20. 20. 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
  21. 21. Ease of Use
  22. 22. 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.
  23. 23. Community brokerage... not another profession
  24. 24. 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 system design issues
  25. 25. Community
  26. 26. O’Brien’s five basic tasks of support
  27. 27. The changing role of advocacy and development agencies
  28. 28. We haven’t begun to tap the power of peer support
  29. 29. 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
  30. 30. Sustainability
  31. 31. Positive change can happen at any levels, but requires the creation of opportunities for innovation
  32. 32. Innovation is complex, evolving and requires different strategies at different stages.
  33. 33. 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?
  34. 34. If you found these slides interesting you might like to read...
  35. 35. Lots of free resources on all these topics and more: @simonjduffy and @cforwr - follow www.centreforwelfarereform.org.uk - subscribe like The Centre for Welfare Reform on Facebook