International developments in self-directed support
Dr Simon Duffy ■ The Centre for Welfare Reform ■ 12th August 2013 ■ Wellington
Emerging themes
An overview of the international development of self-directed support, the emerging themes and challenges, issues of leadership, rights and sustainability. What has worked well and what hasn’t and why.
• 1990 in London, brokerage, individual funding and service design
• 1996 in Glasgow, new models of service provision and Individual Service Fund
• 1999 in Scotland, working on self-directed support with local government
• 2003 in England, led piloting of self-directed support
• 2009, established The Centre for Welfare Reform, global community for social innovation
• trying to combine practice and theory
Simon Duffy, some background
• always improves outcomes
• always increases demand
• sometimes reduces costs
• system design is critical
40 plus years of self-directed support
Positive Negative
Rapid policy and large scale changeBreakthroughs in flexibility and awareness of entitlementSystem was financially sustainableAvoided undue reliance on brokerage
Development of complex RAS, eroding trustSupport planning industryIncreasing levels of bureaucracyFailure to engage providers effectivelySystem now abused to help with 33% cut in care
recent changes in England
A system of self-directed support is a system of funding for support that helps people to achieve full citizenship. It can have 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
Being a citizen is better than being ‘normal’
it lets us be equal and different
Citizenship for all is practical, but requires social change
There is not just one kind of institution
we bring the institution with us
RightsRights
the government money fallacy...
...money can’t always be theirs
“It’s my life, my human rights”
Are people’s plans public property?
What are the political realities of the language of entitlement?
Is self-directed support a service or an income adjustment or something else?
system design issues
ControlControl
It’s not about doing everything for yourself
Is the system even-handed towards all the control options?
Is changing the point of control an appropriate safeguard?
system design issues
ClarityClarity
Can we do without a RAS?
Why do we want complex assessment systems?
What do we mean by ‘sufficient’?
Should we means-test love and community?
system design issues
FlexibilityFlexibility
Can people use their money to buy things which are not ‘services’?
Can people use their money flexibly and pool it with their other resources?
Is self-directed support transformational or merely transactional?
system design issues
Ease of UseEase of Use
We don’t know enough about abuse; but we do know institutions increase the risk of it and having relationships
reduces the risk of it.
Community brokerage... not another profession
What purpose is served by complexity?
Can providers evolve to embrace, support and underpin self-directed support?
Do we need a new professionals?
What of social workers and other existing professional groups?
How do you resist the plausible regulation?
system design issues
CommunityCommunity
O’Brien’s five basic tasks of support
The changing role of advocacy and development
agencies
We haven’t begun to tap the power of peer support
How do local communities engage with self-directed support?
Is it helpful to abandon the commissioning model?
What helps people connect, contribute and create new solutions?
system design issues
SustainabilitySustainability
Positive change can happen at any levels, but requires the creation of opportunities for innovation
Innovation is complex, evolving and requires different strategies at different stages.
system design issues
How can you ‘design in’ affordability?
How can system change be both liberating and evolving?
When change is inevitable how do you frame it helpfully?
How can you let everyone to join in?
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