Dr. Simon Duffy discusses the complexities of designing sustainable systems within social care, emphasizing the balance between opportunities and risks during times of policy change. He outlines the processes of achieving positive system change, including the importance of leadership, integration, and community engagement while warning against the pitfalls of sterility and dogmatism. Duffy advocates for a more organic approach to change that encourages innovation and genuine progress rather than superficial adjustments.

1. Designing a new system
Dr Simon Duffy ￭ The Centre for Welfare Reform
￭ 27th August 2013 ￭ New Zealand Ministry of Health, Auckland
Achieving sustainable change

2. Moments when system can be
redesigned are full of wonderful
opportunities and enormous risks.

3. Positive Negative
Rapid policy and large scale
change
Breakthroughs in flexibility and
awareness of entitlement
System was financially
sustainable
Avoided undue reliance on
brokerage
Development of complex RAS,
eroding trust
Support planning industry
Increasing levels of bureaucracy
Failure to engage providers
effectively
System now abused to help
with 33% cut in care
recent changes in England

4. NB Systems do nothing. People
do things. Systems simply create
an environment of rules,
incentives, information and values
which can influence human
behaviour. Good system change
makes it more likely that humans
will make good choices.

5. Put simply...
...people can do bad things in
even the best system, people can
do good things in the worst.

7. It is important to look at the
whole system
self-directed support is at best
just one factor in a much wider
social system

9. Significant positive change is
inevitably organic and gradual.
[Rapid change is inevitably
artificial and shallow.]

11. 1. Realisation - Leaders emerge who try to pull off radically
different patterns. They often need protection. These early
leaders often go unrecognised but are a potentially powerful
resource.
2. Inspiration - As a new pattern begins to be seen as valuable
by some then there is often polarisation, fear and excitement.
Its important to use this energy but not to fall into the trap of
tribalism or blaming.
3. Simplification - A successful innovation proves its worth by
offering multiple benefits to growing numbers. But the
system often resists by trying to treat it as an ‘add on’. This
process should include competition, rationalisation and
evolutionary development - work, not dogma.
4. Integration - The most profound innovations are integrated
into the background system - they almost ‘disappear’.

12. It is not just the system that
‘resists’ - advocates can often
undermine their own goals.

13. 1.Sterility - Lots of talk, no action. No leadership emerges, no
risks can be taken.
2.Shallowness - Initial enthusiasm, lots of training, consultancy,
planning, and pilot projects.
3.Compromise - The adaptions to the old system are accepted
and not questioned and challenged.
4.Dogmatism - The new system is not seen as part of a greater
whole and becomes despite the need for more profound
change.

14. The conservative paradox - the
most radical change doesn’t force
people to change.

16. Vision must combined with
humility, peer support and a
genuine willingness to test and
learn.

17. 1.Diversity - Enable multiple opportunities for leadership,
testing and learning.
2.Community - Build an inclusive community of learners, willing
to inspire without blaming or attacking others.
3.Models - Publish a central model, but one which others can
test adapt and challenge (versions)
4.Reform - Provoke wider conversations about the meaning of
these changes and the policy and social enviroment in which
they are emerging.

18. If you found these slides interesting you might like to read...

19. Lots of free resources on all these topics and more:
@simonjduffy and @cforwr - follow
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