The document discusses efficiency and welfare reform. It argues that efficiency is a political concept rather than just a technical one, and that definitions of efficiency often treat public services as obvious goods that need to be delivered at the lowest cost. It also notes that efficiency reforms often negatively impact the most needy. The document advocates for a personalization approach based on capabilities and equal citizenship rather than a limited focus only on money. It provides examples of how personalization can achieve social justice and citizenship through approaches like individual budgets and personalized transition planning.

1. Efficiency & Welfare Reform
Glasgow, November 2010
© Simon Duffy. Rights Reserved. The author must be cited if images or slides are used

2. Whose efficiency in the
‘age’ of austerity
• Efficiency is political, not just technical
• Power encourages definitions which treat public
services as ‘obvious goods’ that need to be
delivered at the lowest cost.
• Tax payer is promised ‘efficiency’
• but ‘mainstream services’ are protected
• Negative impact often focuses on the most needy

3. Personalisation & Social Justice
• Personalisation was inspired by visions and values
outside mainstream political theory
• Provides a capabilities approach that takes us
beyond a limited focus on money - real wealth
• Provides a non-meritocratic and inclusive vision of
social change - equal citizenship
• Offers principle of equity - sufficient for citizenship

6. To achieve citizenship takes real

7. The goal should be to support

8. Personalisation is a set of
approaches for achieving

9. 3 examples of personalisation
• Individual (or personal) budgets
• Personalised transition
• WomenCentre model

18. Costs vs Needs
(ranked by cost)
70 £60,000
60
£50,000
50
£40,000
40
Needs
£30,000
30
£20,000
20
£10,000
10
0 £0
1 11 21 31 41 51 61 71 81 91
People
Needs Cost

19. Net Percentage Improvement
Health & well-being 42%
Time with people 52%
Quality of life 75%
Community life 62%
Choice & control 71%
Safe & secure 28%
Personal dignity 59%
Economic well-being 31%
0% 20% 40% 60% 80%

20. Place Number 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%

23. 90
Hertfordshire
Cambridgeshire
Worcestershire
67.5
45
22.5
0
Person Provider User Trust
NB Split budgets are counted against both control mechanisms

24. Wholly controlled by person
Split with LA
Wholly controlled by LA
19%
40%
41%
Cambridgeshire data on
shared usage - total number
63

25. Explanatory hypotheses
Data suggests we can exclude some
hypotheses, therefore we can currently
assume:
• NOT because of lots of professional brokerage - there was
very little and where most money was invested in brokerage
progress was slowest
• NOT because of comprehensive assessments - there were
none
• NOT because everybody used direct payments or employed
their own staff - although c.50% did
• NOT because people had to unduly rely upon family and
friends - this remained largely unchanged, but was better
integrated with paid support

26. Possible explanatory hypotheses
•The ability to integrate paid support more carefully
with unpaid support increases efficiency and allows
people to focus paid support where it is really
required.
•The ability to use funding flexibly allows people to
identify more creative, individual and appropriate
support at the right price
•Needs-led approach avoids the definition of need by
available service and the inherent upward ratcheting
up of costs.
•Expensive, crisis-led solutions can be avoided if
people are equipped with information early enough
to enable meaningful planning

30. Taxation
The right money... ...to the right person
Resource Allocation
Targeted
System (RAS)
Accountability
• The right money
Wider Market
Supported Decision-
Making
Community
• To the right person
Family Support Creativity • Maximum choice and
flexibility
Added
Value • Minimum burdens and
waste
• Clear entitlements
Increased Stronger E!ective
High
Economic Families & Welfare
Satisfaction
Productivity Communities Reform

31. • DON’T stop people from knowing their
budget or eroding their sense of
entitlement
• DON’T let your RAS be driven by ‘care
planning’
• DON’T make planning difficult or obscure
• DON’T limit support options for planning
• DON’T limit control options
• DON’T limit how people can use their
money
IE - We could unintentionally undermine the development of the market either by
creating barriers to entry or weakening the ability of consumers to make their
own choices and shape the market through those choices

32. Current debates/
• Uncertainty about how to manage the RAS
• Uncertainty about flexibility and pooling
• Failure to utilise providers and ISFs
• £0.5 billion wasted on ‘implementation’
• The burdening of care management
• The failure to look hard at in-house
services and block contracts

39. personalisation will work for
people
• needing support in the community
• managing long-term health
conditions
• trying to rebuild their mental
health
• wanting to die at home
• wanting more personalised
education
• trying to find work
• wanting to avoid prison

40. education reform
• What is at the heart of learning and
personal development?
• What are the other 26 pupils paying for?
• Schools as social networks for organising
learning
• Home school networks
• Nationalise private education
• Rethinking the problem of inclusion

41. place-based approaches to
complexity
• As needs become more complex so does the
complexity of the response
• Service professions, departments, organisational
boundaries lead to ‘privileged irresponsibility’
• The state struggles to recognise and support civil
society responses

45. this means real poverty is
1. Despair - having no hope
2. Loneliness - having no friends or
family
3. Exclusion - never being part of
anything
4. Disadvantaged - feeling deskilled
5. Powerlessness - having no control

49. success will be dependent upon
• ability to spot and support innovation
• celebrate and own civil society responses
• radically disinvest from current blocks
• shifting authority and control to local leadership
• new ‘constitutional framework’ with space for
innovation

50. Conclusion: Change?
• Resistance is inevitable
• Timescales are uncertain
• Intentional organisation is required
• Success will be a ‘constitutional’ shift
in power and control to citizens,
families & communities

52. strategies
• smallness provokes less resistance
• powerful ideas can create powerful
communities
• testing and evidence matter
• implementation

53. Contact Details
Simon Duffy
Centre for Welfare Reform
The Quadrant,
99 Parkway Avenue, Parkway Business Park
Sheffield, S9 4WG
T +44 114 251 1790
M +44 7729 7729 41
admin@centreforwelfarereform.org
www.centreforwelfarereform.org

54. 10
7.5
Hidden Voices:
Hidden Voices: Older People’s Experience of Abuse
Older People’s Experience of Abuse
An analysis of calls to the Action on Elder Abuse helpline.
Written by Action on Elder Abuse and published by Help the Aged
5
2.5
Help the Aged Action on Elder Abuse
0
Relative Risk
Home Sheltered Housing Action on Elder Abuse Data (2004)
Hospital Care Home
The regulation paradox - we regulate things
because they are unsafe, so people believe
they have become safe... ... but they are not