Dr. Simon Duffy has worked for 25 years developing systems of self-directed support. He led the development of the self-directed support model adopted in England, which gives individuals more control over their social care. Duffy argues that self-direction was inspired by justice, citizenship and community rather than consumerism. He discusses both the progress and challenges of implementing self-directed support in the UK and opportunities for Australia to learn from the UK experience.

1. Journeys towards self-direction
Talk by Dr Simon Duffy for the Australian Government
Department of Social Services, 5 December 2014

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. 1. Problems of language
2. Advancing citizenship
3. UK experience of self-direction
4. The role of community
5. Structural innovations
6. Innovation as process
7. Opportunities for Australia

4. words, words, words, words, words, words, words
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'.
Origin of “agora” "assembly
place," 1590s, from Greek agora
"open space" (typically a
marketplace), from ageirein "to
assemble," from PIE root *ger- "to
gather" (see gregarious ).
Word Origin of “Market” n. early 12c., "a
meeting at a fixed time for buying and
selling livestock and provisions," from Old
North French market "marketplace, trade,
commerce" (Old French marchiet, Modern
French marché), from Latin mercatus
"trading, buying and selling, trade, market"
Origin of “Support” late 14c., "act of
assistance, backing, help, aid," from
support (v.). Meaning "one who provides
assistance, protection, backing, etc." is
early 15c. Meaning "services which enable
something to fulfil its function and remain in
operation" (e.g. tech support) is from 1953.

6. We’ve lost sight of
citizenship and
what it means

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

10. international themes
• indicative budgets or
not
• independent brokerage
or not
• battles re flexibility and
waivers
• supported decision-making
and capacity
• services or community
• means-testing and
benefits
• safeguarding and
quality
• innovation and market
entrance
• who plans and how

13. These innovations were not
inspired by consumerism,
neo-liberalism or a desire
to create a ‘market’. They
were inspired by a desire
for justice, citizenship and
community.

14. “We are obliged to
surrender to the will of
the strong. Big
companies, cities and
municipalities decide
what is best for us. This
is about power. Why do
I feel a lack of power
in my own life?”
Sami Helle at European
Parliament, November 2013

15. Self-directed support in
the UK and ‘austerity’

17. self-direction in UK
• 1970s indirect
payments to
people
• 1988 - ILF v1 (high
demand)
• 1993 - ILF v2
(linked to local gov.)
• 1996 - Direct
Payments (steady
growth)
• 2007 - Personal
Budgets (major
policy shift)
• 2009 - healthcare
• 2011 - children
with disabilities
• 2010 - austerity

21. The government
money fallacy
it can’t always be
government money:
where did government get it from?

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

29. 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.

30. Strengths to build on
• Clear up-front
budgets that people
can use flexibly
• People choose
community not
services
• Flexibility around
planning - use of peer
support
• Leadership is vital
• 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

32. 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}

34. Service providers are not
providers - at their best
they are partners in
community

45. • Better targeted support
• Different kinds of support
• Community connections
• Natural support
• Teaching
• Technology
• Getting housing right
• Lower management costs
• Lower salary costs… not in these examples

46. The structures
themselves should be
capable of organic
innovation

47. Help & Connect in Newcastle

52. Social innovation is
inspired by social
justice

57. Opportunities and
risks for Australia

58. Fees: explicit