Exploring the reality of self-directed support

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 1st October 2013 ￭ Perth, WA

building a better system together

Features of a good system (what to expect, demand, lobby for or build together).

Examples of self-directed support in practice (ideas, stories, models).

How to be strong and supportive of each other (people, families, providers and government).

Beginnings

• 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

There is not just one kind of institution

we bring the institution with us

Often English de-instutitionalisation

was institutions without the park

Being a citizen is better than being ‘normal’

it lets us be equal and different

Citizenship for all is practical, but requires social change

• always improves outcomes

• always increases demand

• sometimes reduces costs

• system design is critical

40 plus years of self-directed support

Positive NegativeRapid policy and large scale change (700,000 now have budgets).

Breakthroughs in flexibility and awareness of entitlement

System is financially sustainable

Avoided undue reliance on professional brokerage

Development of complex assessment and RAS, eroding trust

Support planning industryLevels of bureaucracy now increasing

Failure to engage providers effectively

System 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

Questions?

Rights

the government money fallacy...

...money can’t always be theirs

“It’s my life, my human rights”

Can we turn human rights into real entitlements?

What shouldn’t be cashed out?

Are people’s plans public property?

Is there an alternative to the language of entitlement?

Is self-directed support a service or an income adjustment or something else?

Questions

Control

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.

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?

Can people really be trusted?

Questions

Clarity

Can we do without a RAS?

Why do we want complex assessment systems?

What do we mean by ‘sufficient’ ‘reasonable’ ‘necessary’ ? Necessary for what?

Should we means-test love and community?

Questions

Flexibility

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?

Questions

Ease of Use

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?

Questions

Community

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?

Questions

Sustainable

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.

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?

Questions

Next Steps

As Western Australia develops a system of self-directed support what would I want to contribute?

Peer support - providing information, learning from

others

org

anis

ati

onal polic

ies

to b

ack

innovati

on a

nd c

reati

vit

y

Making sure there is real control and flexibility in how we deliver services - across whole

organisation. Make the block funding flexible.

An online forum for people, families and providers. Plus regular face-to-face events (computers don’t work for everyone)

Engage differently - use ‘entitlement’ - challenge more

People and families - being part of the dialogue of

development - make an input

Quality audits - show how people’s outcomes is the best response to ‘quality’

A p

arity

audit - p

eople

on o

ld sy

stem

Certificated programmes available to understand all of your disability rights, including funding

Decentralised approach

to service provision

Work with bell curve - how to support innovation and the people who are stuck

accept failures

Providers use infrastructure to support peer support

Push for more

innovation & change

watc

h o

ut

for

cuts

a system that is pro-community

inclusion and accessibility

amplify voices for rights: people & parents

MH and elder equity in NDIS

breaking down the age

discriminations

public register for support for financial advice, planning etc.

construct the entitlement argument

How will I contribute?