What does good support look like?

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Self-directed support (NDIS or My Way) has the potential to revolutionise support to people with disabilities. But service providers must also adapt, learn and innovate. These slides were shared at an event for over 90 service providers in Perth, WA - with the support of WADSC and NDS.

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What does good support look like?

  1. 1. What Good Support Looks Like Dr Simon Duffy ■ The Centre for Welfare Reform ■ 8th October 2013 ■ for NDS and DSC, Perth, WA reflections for service providers
  2. 2. 1. Background
  3. 3. “It’s my life, my human rights”
  4. 4. • 1990 in London: brokerage, individual funding, person-centred planning and supported living • 1996 in Glasgow: new models of service provision and Individual Service Funds • 1999 in Scotland: self- directed support with local government • 2003 in England: piloting of self-directed support via In Control • 2009, established The Centre for Welfare Reform, global community for social innovation Simon Duffy, some background
  5. 5. We still have much still to learn
  6. 6. Things to remember 1. The goal is citizenship 2. Support will need to change 3. Services will need to change 4. NGOs can play a leading role, if...
  7. 7. After the big institutions were closed People were not free People were not included
  8. 8. Citizenship is the right goal
  9. 9. 2. SDS/NDIA/MW...
  10. 10. Professional Gift Model • Help is received as a gift for which I must be grateful - difficult to change or challenge • Help defined by someone else and delivered as a fixed service. • Help is inherently incompetent it takes control away from me • Blame moving up and down systems of hierarchical control • Community cut off from awareness of its own proper role.
  11. 11. Citizenship Model of Support Challenge: a new paradigm - but one that has to be developed from within the old system itself. • Individual in control • Life led in community • Clear entitlement to funding • Support agreed with professionals
  12. 12. • it improves outcomes • it increases demand • it can reduce costs • design details matter 40 years plus of self-directed support tells us
  13. 13. Self-directed support is a system to enable citizenship. Ideally it has 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
  14. 14. Self-directed support in England involved multiple changes to the existing system.
  15. 15. Change how money works
  16. 16. Its the person’s money
  17. 17. Phase One Report 2006
  18. 18. Phase Two Report 2008
  19. 19. Place N Change 6 Sites Phase I Report 60 -18% 17 Sites Phase II Report 128 -9% 13 Sites IBSEN Report 203 -6% Northants 17 -18.7% City of London 10 -30% Worcestershire 73 -17%
  20. 20. In the UK in the best places... • Citizens and families are trusted more. • Citizens and families are stronger and more in control. • People’s lives are much better. • People use services less, community more & have more friends. • Money is citizen’s and can be used flexibly. • People drive the design and delivery of their support. • No new support systems of‘brokers’- instead better use of community and professionals. • It costs much less than the old system.
  21. 21. Mistakes and failures • Pseudo-scientific assessment tools (RAS Versions 3, 4 & 5) • Failure to build-in‘time limits’ • Support plan treated as a contract • Not enough focus on peer support • System was not easy for professionals and people • System tries to‘make’people be creative • ‘Person-centred planning’ industry • On-going means-testing income & social capital • No clear legal right to entitlement for support
  22. 22. The UK experience is paradoxical Commissioners invest in institutional services, despite associated risks, regulators regulate institutional services and observe on-going failure, but letting citizens take control is seen as risky. There has been rapid growth in individualised funding, but services have changed slowly Service providers led developments in individual funding, but are mistrusted by commissioners. Systems have taken steps to invest more trust in citizens, but shown less trust in civil society.
  23. 23. 3. Innovation process
  24. 24. Government’s don’t innovate - but they can support innovation (or not).
  25. 25. Development of self-directed support is a complex and evolving innovation that requires change at 3 levels
  26. 26. 4. The challenge
  27. 27. Can we build a respectful partnership with people and a new balance of power?
  28. 28. 5. Personalising everything
  29. 29. What I am most proud of
  30. 30. You can use Individual Service Funds to have your budget managed for you
  31. 31. 6. Supporting families
  32. 32. 7. Staff as people
  33. 33. 8. Peer support
  34. 34. We haven’t begun to tap the power of peer support
  35. 35. 9. Safety
  36. 36. 10. Support with life
  37. 37. For the 3 years before 150 days in hospital - responding to problems with breathing. In the 3 years after leaving hospital he has spent only 2 nights in hospital - for elective dental treatments. Personalised learning - on the job - 2 City & Guilds Qualifications. Saving NHS, LA & Education •Over £100,000 in hospital stays •Over £300,000 in residential care costs •Over £100,000 of funding contributed by the LSC Jonathan’s story
  38. 38. Schools can lead the way...
  39. 39. 11. Community assistance
  40. 40. community brokerage
  41. 41. rethinking advocacy
  42. 42. 12. The bond of trust
  43. 43. Women’s organisations... understand personalisation
  44. 44. 13. Community change
  45. 45. the government money fallacy... ...money can’t always be theirs
  46. 46. 14. Commissioning...
  47. 47. 15. End thoughts
  48. 48. 1. Ask providers to lead the process of change and deliver efficiencies 2. Build in peer support at every step. 3. Treat the money as if it already was people’s money. 4. Innovate and seek to foster innovation. 5. Work together, learn, share and change.
  49. 49. Intework is going to remember that it is always the client’s money Interchange is going to build more peer supports St Jude’s will be focusing on more individual community-based supports. Therapy Focus we are committed to peer supports, individualising and innovating. GIFSA will encourage choice and control, remembering its the client’s money.
  50. 50. For more information: Web: www.centreforwelfarereform.org Twitter: @CforWR and @simonjduffy Blog: www.simonduffy.info Facebook: centreforwelfarereform Campaign: www.campaignforafairsociety.org © Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org
  51. 51. For more information go to www.centreforwelfarereform.org These slides are © Simon Duffy 2013 ■ Publisher is The Centre for Welfare Reform ■ Slides can be distributed subject to conditions set out at www.centreforwelfarereform.org ■

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