Download - Introduction to Self directed support
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Self-Directed Support
Dr Simon Duffy ■ The Centre for Welfare Reform ■ 17th June 2013 ■ Centre de la Gabrielle
An Introduction to an International Innovation
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1. The background to self-directed support
2. The idea of citizenship
3. How self-directed support works
4. Evidence and examples
5. Problems and opportunities
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Our dark history
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At the end of the nineteenth and the for most of the twentieth century it was common for people to think that people with intellectual disabilities were different - they were not citizens.
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The powerful eugenic movement which spread across Europe, America and the British Empire led eventually to the murder of over 250,000 people with disabilities in Nazi Germany.
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The process of de-humanisation had seven steps:
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The factors that weakened people’s grasp on their shared humanity:
1. Mass morality
2. Rootlessness
3. State power
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The factors that allowed people to destroy the victims:
1. Rightlessness
2. Poverty
3. Segregation
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After World War II the focus has changed. Human rights, the demand for independence and the welfare state have helped change society.
But there is still a long way to go.
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Big institutions have slowly closed across Europe. But often they have been replaced with other kinds of institutions.
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There is not just one kind of institution
we bring the institution with us
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This shows spending in one part of England after the institutions were closed:
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Often English de-instutitionalisation
was institutions without the park
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Discovering citizenship
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If you have been doing things wrong for a long time it is important to think carefully and to be confident that you know what to do now.
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What is wrong with institutions1.Devalued lives - self-expression and personal
development threaten institutional thinking
2.No freedom or control - it is very hard to be heard when you have no authority
3.Impoverishment - economic power is nullified
4.Sheltered, but homeless - a home is more than a roof - vital to control privacy and security
5.‘Care’ not support - ‘care’ already assumes the passivity and lower value of the person ‘in care’.
6.Disconnected- it is other citizens who report abuse and it is structures of power within institutions that make that harder
7.Loveless - the shift to focusing on abuse not crime is a symptom of institutional thinking
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1.Direction - Its risky if my life lacks meaning and value
2.Freedom - Its risky if I cannot direct my life, communicate or be listened to.
3.Money - Its risky if I lack money or if I cannot control my own money.
4.Home - Its risky if I cannot control who I live with, my home and my privacy.
5.Help - Its risky if I’ve no one to help me and if I cannot control who helps me.
6.Life - Its risky if I am not a valued member of my community.
7.Love - Its risky to have no friends or family.
Why citizenship is better
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Citizenship is the right goal
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Being a citizen is better than being ‘normal’
it brings us together as equals
but also as unique free individuals
Equal and different
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Citizenship is also very practical. We can use the idea of citizenship to think about how to help someone.
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Citizenship is possible for everyone
it just might take some extra thought
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Patrick’s Story
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Tailor everything to the individual...
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Reforming the system
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The system gave people gifts
not rights, not citizenship
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The old system - services first
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The new system - people first
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These ideas are being developed and tested throughout the world.
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Quality always goes up
Costs can go up, down or stay the same
Demand increases
Citizenship can increase alot
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It is not about increasing choice
It is not about markets and consumerism
It is about life, community and citizenship
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Progress and innovation
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This kind of system change is very complex
It changes everything
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It is important that people get the right support to help make decisions
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Different people might control the budget
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Its important money can be spent flexibly
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The change in England came from communities first
Innovation is possible in most existing systems
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Early successes includedShifting towards entitlements - not gifts
Getting people truly flexible budgets
Focusing on outcomes - not services
Avoiding the trap of ‘brokerage’
Process of collective innovation
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It is important to let innovations develop properly
Rushing innovations will lead to false change
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Government spent £0.5 billion on implementation:
•more processes - not less•more specialist IT - in an open source world•more ‘consultants’ •more middle-management•over-complication rather than simplification•burdening people and professionals•attention going upwards
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Problems and challenges
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Today individualised funding is the norm in Denmark, Norway and Sweden. England and Scotland will have moved everyone over to self-directed support in the next 5 years. Australia is developing a new national system. Many US and Canadian states and New Zealand use SDS in some form.
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But there are fears.
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Will budgets be protected in tough times?
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The UK Response to ‘Austerity’
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Will budgets be allowed to be flexible?
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Will money be allowed to go into communities or just kept for services?
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Can this be extended to health or education?
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Self-directed support is still changing and developing - it is not yet underpinned by proper rights to support or rights to control support.
But its an important innovation that respects people’s citizenship.