Exploring the Reality of Self-Directed Support


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Simon Duffy explores the lessons that can be drawn from the UK experience of self-directed support. He outlines the key features of a good system for people, families and professionals in Perth, WA.

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Exploring the Reality of Self-Directed Support

  1. 1. Exploring the reality of self-directed support Dr Simon Duffy ■ The Centre for Welfare Reform ■ 1st October 2013 ■ Perth, WA building a better system together
  2. 2. Features of a good system (what to expect, demand, lobby for or build together). Examples of self-directed support in practice (ideas, stories, models). How to be strong and supportive of each other (people, families, providers and government).
  3. 3. Beginnings
  4. 4. • 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
  5. 5. There is not just one kind of institution we bring the institution with us
  6. 6. Often English de-instutitionalisation was institutions without the park
  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. • always improves outcomes • always increases demand • sometimes reduces costs • system design is critical 40 plus years of self-directed support
  10. 10. Positive Negative Rapid policy and large scale change (700,000 now have budgets). Breakthroughs in flexibility and awareness of entitlement System is financially sustainable Avoided undue reliance on professional brokerage Development of complex assessment and RAS, eroding trust Support planning industry Levels of bureaucracy now increasing Failure to engage providers effectively System now abused to help with 33% cut in care recent changes in England
  11. 11. 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
  12. 12. Questions?
  13. 13. Rights
  14. 14. the government money fallacy... ...money can’t always be theirs
  15. 15. “It’s my life, my human rights”
  16. 16. Can we turn human rights into real entitlements? What shouldn’t be cashed out? Are people’s plans public property? Is there an alternative to the language of entitlement? Is self-directed support a service or an income adjustment or something else? Questions
  17. 17. Control
  18. 18. 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.
  19. 19. It’s not about doing everything for yourself
  20. 20. Is the system even-handed towards all the control options? Is changing the point of control an appropriate safeguard? Can people really be trusted? Questions
  21. 21. Clarity
  22. 22. Can we do without a RAS? Why do we want complex assessment systems? What do we mean by ‘sufficient’ ‘reasonable’ ‘necessary’ ? Necessary for what? Should we means-test love and community? Questions
  23. 23. Flexibility
  24. 24. 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? Questions
  25. 25. Ease of Use
  26. 26. Community brokerage... not another profession
  27. 27. 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? Questions
  28. 28. Community
  29. 29. O’Brien’s five basic tasks of support
  30. 30. The changing role of advocacy and development agencies
  31. 31. We haven’t begun to tap the power of peer support
  32. 32. 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? Questions
  33. 33. Sustainable
  34. 34. Positive change can happen at any levels, but requires the creation of opportunities for innovation
  35. 35. Innovation is complex, evolving and requires different strategies at different stages.
  36. 36. 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? Questions
  37. 37. Next Steps
  38. 38. As Western Australia develops a system of self-directed support what would I want to contribute?
  39. 39. Peer support - providing information, learning from others organisationalpolicies tobackinnovationandcreativity Making sure there is real control and flexibility in how we deliver services - across whole organisation. Make the block funding flexible. An online forum for people, families and providers. Plus regular face-to-face events (computers don’t work for everyone) Engage differently - use ‘entitlement’ - challenge more People and families - being part of the dialogue of development - make an input Quality audits - show how people’s outcomes is the best response to ‘quality’ Aparityaudit-peopleonoldsystem Certificated programmes available to understand all of your disability rights, including funding Decentrali sed approach to service provision Work with bell curve - how to support innovation and the people who are stuck accept failures Providers use infrastructure to support peer support Push for more innovation & change watchoutforcuts a system that is pro-community inclusion and accessibility amplify voices for rights: people & parents MH and elder equity in NDIS breaking down the age discriminations public register for support for financial advice, planning etc. construct the entitlement argument How will I contribute?