Dr Simon Duffy gave this talk in June 2017 to the staff of Community Links and on behalf of DD Network. Simon explores the historical and philosophical background to recent innovations in self-directed support and citizenship. He argues that we should not be looking for a perfect model, but instead should work together to build on best-practice and challenge injustice. Simon also explained why Citizen Network had been formed to advance citizenship for all.

1. Evolving
Practice in
Self-direction

2. 1. The wider context is important
2. Citizenship, not choice, is the goal
3. It’s not budgets, it’s entitlements
4. Flexible support, not brokerage, is critical
5. Collaboration and innovation, not purism

3. 1. Context

4. The welfare state was
created to tackle real
problems, but
sometimes created
new problems…

6. • The growth in the economic cost of
health and social services is an
international problem.
• More expensive, more centralised
and more institutional services grow
in cost, but do not become more
efficient.
• Greater value lies in supporting
citizenship, families and local
communities, but investment in this
is reducing.
• How can we move resources
upstream to solve problems earlier
and more efficiently?
An international challenge
€
£$

8. • Personal budgets offer one
powerful way of moving
resources out of the wrong
services and back to citizens
and local communities.
• Personal budgets are flexible
and they let people be creative
and use resources in their
local community.
• Personal budgets help
community organisations to
get funding from people -
outside the procurement
systems that often leads to
centralisation.

12. Self-directed support has been growing for 50 years

13. • Personal budgets are not the solution for
every problem
• The need for self-directed support may
reduce in fairer and more inclusive
communities
• Some services are better organised by
collective or professional decision-making
• Yet - a powerful and still evolving innovation

14. 2. Citizenship

15. Value of self-direction is
• not about consumer
choice
• not just about meeting
needs
• not just human rights
• about meaning & love

16. Agency for citizens means control and cooperation
consumerism is a minimal form of agency

18. 1. Finding our sense of purpose
2. Having the freedom to pursue it
3. Having enough money to be free
4. Having a home where we belong
5. Getting help from other people
6. Making life in community
7. Finding, sharing and giving love
Citizenship = different and equal

19. Human flourishing
requires a sense of
meaning and love

21. • Self-direction is about meaning, the human
spirit and love
• The success of any system or innovation
should be tested by those realities
• If our work is not fulfilling for ourselves then
we are not doing the right work

25. 3. Entitlements

26. People take control and so can become full
citizens playing and active part in community life

27. If budgets can be used flexibly then people use money differently and
connect to community

28. Location N Change
England - 6 Sites Phase I Report 60 -18.0%
England - 17 Sites Phase II Report 128 -9.0%
England - 13 Sites IBSEN Report 203 -6.0%
England - Northamptonshire 17 -18.7%
England - City of London 10 -30.0%
England - Worcestershire 73 -17.0%
England - Southwark 85 -29.8%
Scotland - Glasgow 12 -44.0%
USA - Denver - Disabled Children - -34.0%
USA - Florida - Disabled Children - -30.0%

30. 4 strategies to ensure efficiency
1. Transform how existing funding is
used - don’t spend new money
while leaving the old system in
place.
2. Make sure there is funding in place
to make rights real - delegate
money to local areas as much as
possible.
3. Don’t restrict too much who can
provide support or help people
manage their budgets - keep the
system open.
4. Make sure people can use money
flexibly, so that they can build on
what is already good in their life.

31. • Transparency and clear rights convert
resources into meaningful entitlements
• Entitlements enable the agency of the citizen
• Eroding entitlements is to weaken the
effective citizenship of the person

32. 4. Support

33. We’ve not paid
enough attention to
personalised support

42. • Too often independent
brokerage is treated as an
inevitable requirement of any
system of self-directed
support
• This underestimates what
people and families can do
• It underestimates the positive
role social workers can play
• and the positive role of good
personalised support.

44. • Relationships matter, including relationships
with professionals
• Social workers, support providers and others
need to join the journey towards self-direction
• Let’s avoid adding to the complexity of the
system - where we can.

45. 5. Innovation

47. Find these people:
1. Pig-headed pioneer - find a way of doing it
2. Divisive communicator - inspire others to join in
3. Disruptive engineer - make it easier in practice
4. Political activist - hassle and smooch the system
5. Irritating prophet - look ahead for the next wave
And somehow work together!

48. • The system fights back - that’s why it’s taken
50 years just to get to here
• Competition isn’t helping drive forward
innovation
• It’s time to refocus on the goal and work
together

50. The old ‘transition’ pathway - dominated by systems…

52. • Hope - there is a
meaningful and
positive place for you
in the world
• Partnership - we are
partners with the
person and their family
- we are not alone
• Leadership - we can
generate purposeful
action by seeing our
actions in a wider
context

54. Katrina’s son Jonathan has complex health
needs. He has a tracheostomy and needs to
take a breathing unit with him at all times. He
suffers from severe epilepsy, which requires
rectal medication for treatment. He has severe
curvature of the spine, is double-jointed and
has hypotonia. His health assessment
described him as having severe learning
disabilities, severe behavioural problems,
global development delays and no speech. He
also has bilateral deafness and eczema. In the
last 3 years before leaving school Jonathan
spent 150 days in hospital with breathing
problems.
After leaving school Jonathan had support that
was recruited and controlled by his mum, and
funded by an integrated personal budget.
There were no more stays in hospital; he had a
job where he was valued and earned several
qualifications; his life changed for the better.

56. www.cforwr.org
@citizen_network
@CforWR
@simonjduffy
fb.me/centreforwelfarereform
fb.me/citizennetwork
e simon@centreforwelfarereform.org
www.citizen-network.org