Introduction to Self directed support


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Historical overview of the development of self-directed support, its value and the challenges ahead.

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Introduction to Self directed support

  1. 1. Self-Directed SupportDr Simon Duffy ■ The Centre for Welfare Reform■ 17th June 2013 ■ Centre de la GabrielleAn Introduction to an InternationalInnovation
  2. 2. 1. The background to self-directed support2. The idea of citizenship3. How self-directed support works4. Evidence and examples5. Problems and opportunities
  3. 3. Our dark history
  4. 4. At the end of the nineteenth andthe for most of the twentiethcentury it was common for peopleto think that people withintellectual disabilities weredifferent - they were not citizens.
  5. 5. The powerful eugenic movementwhich spread across Europe,America and the British Empire ledeventually to the murder of over250,000 people with disabilities inNazi Germany.
  6. 6. The process of de-humanisation hadseven steps:
  7. 7. The factors that weakened people’sgrasp on their shared humanity:1. Mass morality2. Rootlessness3. State power
  8. 8. The factors that allowed people todestroy the victims:1. Rightlessness2. Poverty3. Segregation
  9. 9. After World War II the focus has changed.Human rights, the demand for independenceand the welfare state have helped changesociety.But there is still a long way to go.
  10. 10. Big institutions have slowly closed acrossEurope. But often they have been replacedwith other kinds of institutions.
  11. 11. There is not just one kind of institutionwe bring the institution with us
  12. 12. This shows spending in one part of Englandafter the institutions were closed:
  13. 13. Often English de-instutitionalisationwas institutions without the park
  14. 14. Discovering citizenship
  15. 15. If you have been doing thingswrong for a long time it is importantto think carefully and to beconfident that you know what to donow.
  16. 16. What is wrong with institutions1.Devalued lives - self-expression and personal developmentthreaten institutional thinking2.No freedom or control - it is very hard to be heard when youhave no authority3.Impoverishment - economic power is nullified4.Sheltered, but homeless - a home is more than a roof - vital tocontrol privacy and security5.‘Care’ not support - ‘care’ already assumes the passivity andlower value of the person ‘in care’.6.Disconnected- it is other citizens who report abuse and it isstructures of power within institutions that make that harder7.Loveless - the shift to focusing on abuse not crime is a symptomof institutional thinking
  17. 17. 1.Direction - Its risky if my life lacks meaning and value2.Freedom - Its risky if I cannot direct my life, communicate orbe listened to.3.Money - Its risky if I lack money or if I cannot control my ownmoney.4.Home - Its risky if I cannot control who I live with, my homeand my privacy.5.Help - Its risky if I’ve no one to help me and if I cannot controlwho helps me.6.Life - Its risky if I am not a valued member of my community.7.Love - Its risky to have no friends or family.Why citizenship is better
  18. 18. Citizenship is the right goal
  19. 19. Being a citizen is better than being‘normal’it brings us together as equalsbut also as unique free individualsEqual and different
  20. 20. Citizenship isalso verypractical. Wecan use the ideaof citizenship tothink about howto helpsomeone.
  21. 21. Citizenship ispossible foreveryoneit just mighttake someextra thought
  22. 22. Patrick’s Story
  23. 23. Tailor everything to theindividual...
  24. 24. Reforming the system
  25. 25. The system gave people giftsnot rights, not citizenship
  26. 26. The old system - services first
  27. 27. The new system - people first
  28. 28. These ideas are being developedand tested throughout the world.
  29. 29. Quality always goes upCosts can go up, down or stay thesameDemand increasesCitizenship can increase alot
  30. 30. It is not about increasing choiceIt is not about markets andconsumerismIt is about life, community andcitizenship
  31. 31. Progress and innovation
  32. 32. This kind of system change is verycomplexIt changes everything
  33. 33. It is important that people get theright support to help makedecisions
  34. 34. Different people might control thebudget
  35. 35. Its important money can be spentflexibly
  36. 36. The change in England came fromcommunities firstInnovation is possible in mostexisting systems
  37. 37. Early successes includedShifting towards entitlements - not giftsGetting people truly flexible budgetsFocusing on outcomes - not servicesAvoiding the trap of ‘brokerage’Process of collective innovation
  38. 38. It is important to let innovationsdevelop properlyRushing innovations will lead tofalse change
  39. 39. Government spent £0.5 billion onimplementation:•more processes - not less•more specialist IT - in an open source world•more ‘consultants’•more middle-management•over-complication rather than simplification•burdening people and professionals•attention going upwards
  40. 40. Problems and challenges
  41. 41. Today individualised funding is thenorm in Denmark, Norway andSweden. England and Scotland willhave moved everyone over to self-directed support in the next 5 years.Australia is developing a newnational system. Many US andCanadian states and New Zealanduse SDS in some form.
  42. 42. But there are fears.
  43. 43. Will budgets be protected in toughtimes?
  44. 44. The UK Response to ‘Austerity’
  45. 45. Will budgets be allowed to beflexible?
  46. 46. Will money be allowed to go intocommunities or just kept forservices?
  47. 47. Can this be extended to health oreducation?
  48. 48. Self-directed support is still changingand developing - it is not yetunderpinned by proper rights tosupport or rights to control support.But its an important innovation thatrespects people’s citizenship.