1.
Whole System
Reform
by Dr Simon Duffy,
e Centre for
Welfare Reform,
Sheffield,
20th September 2011

2.
The Centre for Welfare
• Independent research & development network
• Founded upon belief in human equality and diversity
• A community of 60 Fellows
• Innovators who created person centred planning,
individual budgets, self-directed support, support
planning etc...
• 200+ publications at www.centreforwelfarereform.org
working to democratise the welfare

3.
4 thoughts
1. We should change our objective - public systems of
support should aim at citizenship
2. We should change our perspective - real change starts
with the person, not with services
3. We should change our services - personalisation
puts people first
4. We should change the welfare system - fairness &
entitlement instead of powerful paternalism

4.
The welfare state is good

5.
The welfare state is good
it’s just designed wrong

6.
The welfare state is good
it’s just designed wrong

7.
Plenty of services...

8.
But people trapped in

9.
Poverty comes in many

10.
People with complex needs
• Mental illness - undermining hope and resilience
• Isolation & fractured relationships - institutionalised
abuse and hate crime
• Segregation & prejudice - limited opportunities to
contribute and make new friends
• Limited support to develop - poor incentives and low
expectations
• Powerlessness - money locked in services and
decisions put in other’s hands

11.
1. Citizenship is achievable
In practice citizenship means...

12.
1. being in control
2. with direction
3. enough money
4. your own home
5. enough help, and
6. being active in community
employment is a critical thread

13.
Citizenship
means
• Being equal - same rights, same worth
• Being unique - different is good
• Being needed - bringing your own gis
• Having needs - giving meaning to others

14.
Citizenship
means
• Being equal - same rights, same worth
• Being unique - different is good
• Being needed - bringing your own gis
• Having needs - giving meaning to others
living together with mutual
respect

15.
Real
Wealth..

16.
2. People have the capacity
Real
Wealth..

17.
Good help means

18.
Good help means
★ inspiring - hope and recovery
★ empowering - individuals & families
★ strengthening - personal development
★ connecting - to community
★ building - safer networks
not something you can do to
people

19.
3. Services can be redesigned

20.
3. Services can be redesigned
1. Personalised Support - high quality community
support for people with complex needs
2. Personalised Transition - educating and preparing
kids with severe impairments for active citizenship
3. WomenCentre - working in partnership with women
with complex needs

21.
Personalised
Support
flexible & creative
support

22.
the old care management system

23.
it’s really hard to

24.
it’s really hard to
• empower people - without entitlements

25.
it’s really hard to
• empower people - without entitlements
• strengthen capacity - focusing only on needs

26.
it’s really hard to
• empower people - without entitlements
• strengthen capacity - focusing only on needs
• connect to community - inside segregated services

27.
it’s really hard to
• empower people - without entitlements
• strengthen capacity - focusing only on needs
• connect to community - inside segregated services
• build safe networks - without family, friends and love

28.
replace care management

29.
replace care management
with self‐directed support

30.
this means we can

31.
this means we can
1. empower people - tell people their budget

32.
this means we can
1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes

33.
this means we can
1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes
3. access community - use funding flexibly

34.
this means we can
1. empower people - tell people their budget
2. strengthen capacity - focus on personal outcomes
3. access community - use funding flexibly
4. build safer networks - work with family & friends

35.
Personalised
Transition
control: health,
education & support

36.
Jonathan’s health needs are complex.In the 3 years before
leaving school Jonathan spent 150 days in hospital - responding
to problems with breathing. In the 3 years since leaving hospital
he has spent only 2 nights in hospital - for elective dental
treatments.
Jonathan’s family have overseen the development of a
personalised package of support for Jonathan with flexibility,
employment and learning - but not learning in college - but
learning on the job. Over the last 3 years, Jonathan has acquired
two City & Guilds Qualifications and is now learning new
independent living skills. Over the last 3 years, the individual
budget system has enabled Jonathan and his family to make
significant efficiencies in the costs of his care and support and
save the NHS:
•Over £100,000 in hospital stays
•Over £300,000 in residential care costs

37.
A couple of weeks ago in Sheffield, I met a wonderful woman
called Katrina. She's got three disabled sons. e oldest is
Jonathan, a charming, warm hearted young man of 19. He can't
walk or talk clearly, or feed himself alone. He's had a breathing
tube in his neck since he was a toddler. Under a scheme the new
Liberal Democrat council in Sheffield is extending, Jonathan's
just got his own individual budget and care plan.
Now he's doing work with a local charity, attending a music
group, has his own personal assistant - a child whose potential
seemed so limited. Finally as a young man, engaged in life in a
way he and his mother never thought possible. Katrina told me
with the biggest smile I've ever seen, she said: We've gone from
having nothing to having everything. I wish every child's needs
would be taken this seriously. (Nick Clegg, 17 September 2008).

38.
WomenCentre
a creative and
positive community

39.
• Real Total Place innovation
• Slashed re-offending rates - to less than 5%
• Success in protecting women and children
from abuse
• Significant improvements in mental health
• Modest funding - but now cut by 41%

40.
built on hope & trust

41.
For employment providers
• Build on personal capacity
• Stimulate local solutions
• Challenge faulty tax-benefit system
• Help shi power back to local communities
• Resist the temptation to just play the system

42.
Localism anyone?

43.
4. Systems can be fairer

44.
4. Systems can be fairer
1.Current tax-benefit system is
unfair and very complex
2.Current ‘reforms’ target cuts
on disabled people
3.ere is a fairer alternative

45.
Some things to keep in
1. e poor can be very poor indeed - the poorest must
live on £2,780 per year - compared to mean
household income of £50,000 per year (<6%).
2. e poor pay marginal taxes of around 100% on their
earnings and they pay more tax as a percentage of
their income than any other group (!!)
3. Poor lose income if they live together - 25% tax on IS
and have no incentive to save or invest.
4. e UK is the third most unequal society aer USA
and Portugal

46.
One cheer - there is a
growing recognition that
the tax-benefit system is
1. e recognition that the poor are over-taxed
2. at the benefit system is unfair and unduly complex
3. at the benefit system is stigmatising
4. at the tax and benefit systems should be integrated

47.
137 different
ways...
to give people
not very
much...
•linked or not
•means-tested or
not
•tax credits or
benefits
•disability related
or not
•employment-
seeking or not

48.
Citizens Advice acknowledges that the £1.5 billion cost of
fraud in the benefit system must be recovered, but we are very
concerned at the government’s persistent tendency to roll fraud
and error figures together. Errors account for the remaining
£3.7 billion of the £5.2 billion figure quoted...
In the meantime, the £5 billion cost to government through
fraud and error is dwarfed by the £17 billion of benefits and
tax credits that remain un-claimed every year, because people
don’t know they are entitled to claim, or because the system is
too complicated. e danger of making benefits more difficult
to claim is that people in real need will not receive the money
they need to pay their rent, keep their families warm, or feed
their children.
Teresa Perchard , Director of Social Policy at Citizens Advice

49.
Government defrauds the
poor at more than 11 times
the rate at which the poor
defraud the government

50.
1.5 million people with the most
significant disabilities will lose:
• £4.6 billion in social care support
• £4 billion in disability living
allowance
• Termination of ILF
• Cuts to Supporting People
• Many further cuts in housing
support and other benefits
Services perceived as universal are protected: pensions,
NHS and schools - services that are perceived as
marginal are cut: social care, disability benefits,
community spending...

51.
1.5 million people with the most
significant disabilities will lose:
• £4.6 billion in social care support
• £4 billion in disability living
allowance
• Termination of ILF
• Cuts to Supporting People
• Many further cuts in housing
support and other benefits
Services perceived as universal are protected: pensions,
NHS and schools - services that are perceived as
marginal are cut: social care, disability benefits,
community spending...
BUT they may not get away with it
www.campaignforasociety.org

52.
An alternative
• Growth has undermined older systems of security
(the land, the Church, the family or the firm).
• Growth will never provider sufficient income to
keep the poorest from unacceptable poverty
• As a community it is our role to make sure we
safeguard everyone from poverty

53.
An alternative
• Growth has undermined older systems of security
(the land, the Church, the family or the firm).
• Growth will never provider sufficient income to
keep the poorest from unacceptable poverty
• As a community it is our role to make sure we
safeguard everyone from poverty
premise - poverty can be
limited by our social

54.
Family Security
System:
• Universal income security
• Fair taxes for all
• Focus on women &
family structures
Underpinned by respect for human rights,
constitutional reform and transparent
systems for defining entitlements and
taxes.

55.
Thoughts for government
• Start focusing not on benefit caps - but underlying
security and key principles
• Create a transparent process for defining
underlying securities
• Create legal rights - to realise human rights - and
checks and balances to make rights real
• Make the system of income security universal

56.
The Centre for Welfare Reform
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