The document summarizes a workshop given by Dr. Simon Duffy on lessons from self-directed support in the UK. Duffy has 25 years of experience developing self-directed support systems and founded In Control, which developed the self-directed support model adopted in England. In the workshop, Duffy discusses the history and development of self-directed support in the UK, issues with current implementation, strengths to build on, and the importance of citizenship, community, and moving beyond concepts of consumers and care markets.

1. Creative Support - lessons from
self-directed support in the UK
Workshop by Dr Simon Duffy for ACS in South Australia,
2 December 2014 in Adelaide

2. Dr Simon Duffy
I’ve worked at developing systems of self-directed support for 25
years, working as a service provider and working with (and against)
government. My training is in philosophy and my practice has
involved an on-going effort to think about why we do what we do.
After working on individualised funding in early 1990s I developed
Inclusion Glasgow - an innovative service provider in 1996. In 2003 I
led In Control and developed the model of self-directed support
which was (to some extent) adopted by the English government.
In 2009 I set up The Centre for Welfare Reform as hub for social
international social innovation and a platform for challenging injustice.
I am currently involved in various campaigning efforts in the UK to
combat the way ’austerity’ is targeting people with disabilities and
people in poverty.

3. • Overview of UK developments
• Citizenship and individual service design
• Practical issues for service providers
• Power of peer and community support

4. Words
are important

5. Origin of “Consumer” early
15c., "one who squanders
or wastes," agent noun from
consume. In economic
sense, "one who uses up
goods or articles" (opposite
of producer) from 1745.
Origin of “Care” Old
English caru (noun), carian
(verb), of Germanic origin;
related to Old High German
chara 'grief, lament',
charon 'grieve', and Old
Norse kǫr 'sickbed'.
• Is it helpful to think of ourselves as consumers?
• Can you consume care?
• Is care the kind of thing you can direct?
• Is it helpful to convert community into a market?

7. brief history of self-direction
• Began in California
1960s (c. 50 yrs!)
• Progress real, slow
and patchy
• Outcomes always
positive
• Efficiency & cost-control
are variable
• Design details really
matter
• Resistance to change
high

8. Reform were not inspired
by consumerism, neo-liberalism
or the market.

12. People don’t shop for services they build
stronger community.

14. It seems more fruitful to
think about real wealth,
citizenship and community.

15. Brief History
• Post-war responsibilities
split between NHS
(bigger) local government
(smaller) for services.
• 1970s - Growth of
‘disability benefits’
• 1980s - Creation of an
open-ended ‘entitlement’
to residential care created
bubble - capped by
handing money to local
government.
• 1988 - Creation of
Independent Living Fund.
• 1990s - Pressure from
families and professionals
led to NHS closing
institutional care.
• 1996 - Direct Payments
Act makes emerging
practice legal.
Progressively opened up
to more groups.
• 2007 - Putting People First
marks intention of
government to make
personalisation universal.
Progressively opening up
to health, education etc.

16. The care home resident population for those aged 65 and over has
remained almost stable since 2001 with an increase of 0.3%, despite
growth of 11.0% in the overall population at this age. Fewer women but
more men aged 65 and over, were living as residents of care homes in
2011 compared to 2001; the population of women fell by around 9,000
(-4.2%) while the population of men increased by around 10,000
(15.2%). The gender gap in the older resident care home population
has, therefore, narrowed since 2001. In 2011 there were around 2.8
women for each man aged 65 and over compared to a ratio of 3.3
women for each man in 2001. The resident care home population is
ageing: in 2011, people aged 85 and over represented 59.2% of the
older care home population compared to 56.5% in 2001. [Office of
National Statistics. Part of 2011 Census Analysis, Changes in the Older
Resident Care Home Population between 2001 and 2011 Release]
The total number of people receiving services in 2013-14 was 1,267,000
(down 5 per cent from 1,328,000 in 2012-13 and down 29 per cent from
1,782,000 in 2008-09). Of these, 1,046,000 received community based
services (a fall of 5 per cent from 2012-13), 204,000 received residential
care (a fall of 3 per cent from 2012-13) and 84,000 received nursing
care (which is 3 per cent down from 2011-12). [National Statistics.
Community Care Statistics, Social Services Activity, England - 2013-14,
Provisional release}

19. Reality of personalisation
• More people with direct
payments (25%) but
shared management
under-used.
• Most people (75%) have a
‘budget’ but no real
control.
• Sometimes more creativity
is allowed - sometimes.
• Resource allocation and
support planning
processes often complex.
• New innovative forms of
practice emerging.
• Service providers have
remain captured by old
forms of contracting.
• Austerity has targeted
social care for cuts.
• Some people now pushed
into taking direct
payments with inadequate
support.

20. Strengths to build on
• Clear up-front budgets
that people can use
flexibly
• Flexibility around
planning - use of peer
support
• Possibility of
abandoning process
control and shift to
outcomes
• Ability to add and
develop existing roles -
no fixed structural
template
• Extension sideways
into health, education
and other areas

22. Individualise Everything

23. My Money
Funding from one
or more sources
[enables integration]
€
Coordinator Admin
Insurance Fund
brokerage overheads unexpected costs
Restricted Funding
Individual Service Fund

27. Social Work
Individual Service Fund
Inclusion Glasgow
Service Coordinator
Lynn & her sister
Paid help from a neighbour
© Simon Duffy. All Rights Reserved.

31. We make citizenship real by
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 love

32. This protects our dignity
1. Our life is seen to have meaning
2. We are not on someone else’s control
3. We can pay our way - we’re not unduly dependent
4. We have a stake in the community
5. We give others the chance to give
6. We contribute to the community
7. We are building the relationships that sustain community

44. How is greater
efficiency possible?

45. • Better targeted support
• Different kinds of support
• Community connections
• Teaching
• Technology
• Getting housing right
• Lower management costs
• (Lower salary costs… mmm)

46. What different roles
can you play in CDC?

50. • Can you plan with people?
• Can you give people their own money?
• Can you keep people’s money sate for them (roll
over)?
• Can you let people use their money flexibly?
• Are you part of the same community as the
citizens?