Talk given to Ministry of Health, Education and Social Development officials in Wellington, new Zealand in August 2013. International progress on self-directed support remains slow, but important themes are emerging about what helps in system redesign and what is not helpful.

1. International developments in self-directed
support
Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 12th August 2013 ￭ Wellington
Emerging themes

2. 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.

3. • 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

4. • always improves outcomes
• always increases demand
• sometimes reduces costs
• system design is critical
40 plus years of self-directed support

6. 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

8. 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

10. Being a citizen is better than being ‘normal’
it lets us be equal and different

11. Citizenship for all is practical,
but requires social change

12. There is not just one kind of institution
we bring the institution with us

14. Rights

17. the government money fallacy...
...money can’t always be theirs

18. “It’s my life, my human rights”

19. 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

20. Control

23. It’s not about doing
everything for yourself

25. Is the system even-handed
towards all the control options?
Is changing the point of control
an appropriate safeguard?
system design issues

26. Clarity

31. 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

32. Flexibility

38. 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

39. Ease of Use

41. 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.

43. Community brokerage... not another profession

46. 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
system design issues

47. Community

50. O’Brien’s five basic tasks of support

52. The changing role of advocacy and
development agencies

53. We haven’t begun to tap the
power of peer support

56. 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

57. Sustainability

58. Positive change
can happen at
any levels, but
requires the
creation of
opportunities
for innovation

59. Innovation is complex, evolving and requires
different strategies at different stages.

61. 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?

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

67. Lots of free resources on all these topics and more:
@simonjduffy and @cforwr - follow
www.centreforwelfarereform.org.uk - subscribe
like The Centre for Welfare Reform on Facebook