1. Deinstitutionalization and developing Community Based services International overview Zsolt Bugarszki, PhD

2. Methodology August-November 2015 Policy and document analysis Interviews Focus groups In 7 countries and in 4 regions of Estonia

3. Methodology Czech Republic Slovakia Hungary Romania The Netherlands United Kingdom Sweden

4. Definitions and references United Nations Convention on the Rights of Persons with Disabilities Guidelines of the European Expert Group

5. UN Monitoring Committee on the Rights of Persons with Disabilities. The Committee is a body of 18 independent experts which monitors implementation of the Convention on the Rights of Persons with Disabilities.

6. Policy framework

7. Institution vs. community based care

8. The first wave of Deinstitutionalization Sweden 1993 – group of group homes, segregated disability blocks The Netherlands – parallel system Hungary – planning 150 beds new institutions in 2009 Romania – modernising and renovating existing large institutions Slovakia – investing 200 million euros into large institutions

9. UN Monitoring committee’s Concluding Observations “The Committee is concerned that across the European Union persons with disabilities, especially persons with intellectual and/or psychosocial disabilities still live in institutions rather than in local communities. It further notes that in spite of changes in regulations, in different Member States the ESI Funds continue being used for maintenance of residential institutions rather than for development of support services for persons with disabilities in local communities.”

10. The second wave of Deinstitutionalization New attitude of the European Commission for the 2014-20 period: Structural Funds regulations include an explicit reference to the transition from institutional care to community living Only those actions that help to establish the conditions for independent living should be supported by the EU. Any measure contributing to further institutionalisation of disabled people or the elderly should not be supported by ESI Funds.

11. The second wave of Deinstitutionalization New strategy for Deinstitutionalization in Slovakia and Hungary National Plan in Czech Republic for the period of 2015-20 Relevant reduce of hospital beds and institution beds in the Netherlands Second turn of deinstitutionalization in Sweden

12. Developing community based services Shared responsibilities Centralization (Hungary) vs. decentralization (Czech Republic, Netherlands, Sweden) Local stakeholders vs. large service providers Regulation, protocolization vs. flexible and responsive services PR and communication of Deinstitutionalization

13. Developing community based services Service provision Strong evidences about the effectiveness of community based services (UK, Sweden, Netherlands) But community services are not cheaper alternatives to hospital/institution based solutions Community resources, community participation vs. traditional welfare solutions Local responsibility – local flexibility

14. Level of social expenditures

15. Developing community based services Financial structure Sustainable local governments Co-finance system (health vs social services, centralized vs. local services) Tailored balance, instead of schematic solutions Well targeted direct payment and personal budgeting schemes

16. Developing community based services Employment Strong tradition of sheltered workplaces (Hungary, Romania, Czech Republic) Promising tendencies to emphasise more integral solutions (supported employment, social enterprises, vocational rehabilitation, job coaching) Estonian employment policies belong to this second group but there are uncertainties around Work Ability reform and incentives, programs for companies are far from ideal.

17. Developing community based services User involvement Sweden – co-determination. Users have strong influence on the support and services they receive UK – Recovery orientation, user led services, peer support workers Netherlands – strong emphasis on community resources (eestvedaja) Person centred vs. service centred solutions Supported decisions making, personal budgeting, user involvement