1. Exploring the reality of self-directed support
building a better system together
Dr Simon Duffy ￭ The Centre for Welfare Reform
￭ 1st October 2013 ￭ Perth, WA

2. 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).

3. Beginnings

4. Simon Duffy, some background
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

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

7. Often English de-instutitionalisation
was institutions without the park

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

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

11. 40 plus years of self-directed support
always improves outcomes
always increases demand
sometimes reduces costs
system design is critical

13. recent changes in England
Positive
Negative
Rapid 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 industry
Levels of bureaucracy now increasing
Failure to engage providers effectively
System now abused to help with 33% cut in care

14. 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:
Rights - robust rights that give people effective entitlements
Control - person, or someone close to them, controls budget
Clarity - systems, rules and budgets are clear
Flexibility - budgets can be used in many different ways
Ease of Use - it is easy to plan, manage and control assistance
Community - person’s contribution to society grows
Sustainable - system is affordable, innovative and supported

15. Questions?

16. Rights

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

21. “It’s my life, my human rights”

22. Questions 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?

23. Control

24. 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.

27. It’s not about doing everything for yourself

29. Questions Is the system even-handed towards all the control options?
Is changing the point of control an appropriate safeguard?
Can people really be trusted?

30. Clarity

35. Questions 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?

36. Flexibility

45. Questions
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?

46. Ease of Use

49. Community brokerage... not another profession

52. Questions 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?

53. Community

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

57. The changing role of advocacy and development agencies

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

61. Questions 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?

62. Sustainable

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

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

67. Questions 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?

68. Next Steps

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

70. How will I contribute? A parity audit - people on old system
Quality audits - show how people’s outcomes is the best response to ‘quality’
construct the entitlement argument
amplify voices for rights:
people & parents
An online forum for people, families and providers.
Plus regular face-to-face events (computers don’t work for everyone)
watch out for cuts
accept failures
public register for support for financial advice, planning etc.
Work with bell curve - how to support innovation and the people who are stuck
Peer support - providing information, learning from others
Decentralised approach
to service provision
A parity audit - people on old system
breaking down
the age discriminations
Engage differently - use ‘entitlement’ - challenge more
Providers use infrastructure to support peer support
How will I contribute?
a system that is pro-community
inclusion and accessibility
to back innovation and creativity
organisational policies
Making sure there is real control and flexibility in how we deliver services - across whole organisation. Make the block funding flexible.
Push for more
innovation & change
Certificated programmes available
to understand all of your disability rights, including funding
People and families
- being part of the dialogue of development
- make an input
MH and elder
equity in NDIS