What Good Support Looks Like

Dr Simon Duffy ￭ The Centre for Welfare Reform ￭ 8th October 2013 ￭ for NDS and DSC, Perth, WA

reflections for service providers

1. Background

“It’s my life, my human rights”

• 1990 in London: brokerage, individual funding, person-centred planning and supported living

• 1996 in Glasgow: new models of service provision and Individual Service Funds

• 1999 in Scotland: self-directed support with local government

• 2003 in England: piloting of self-directed support via In Control

• 2009, established The Centre for Welfare Reform, global community for social innovation

Simon Duffy, some background

We still have much still to learn

Things to remember

1. The goal is citizenship

2. Support will need to change

3. Services will need to change

4. NGOs can play a leading role, if...

After the big institutions were closed

People were not free

People were not included

Citizenship is the right goal

2. SDS/NDIA/MW...

Professional Gift Model

• Help is received as a gift for which I must be grateful - difficult to change or challenge

• Help de#ned by someone else and delivered as a #xed service.

• Help is inherently incompetent it takes control away from me

• Blame moving up and down systems of hierarchical control

• Community cut off from awareness of its own proper role.

Citizenship Model of Support

Challenge: a new paradigm - but one that has to be developed from within the old system itself.

• Individual in control

• Life led in community

• Clear entitlement to funding

• Support agreed with professionals

• it improves outcomes

• it increases demand

• it can reduce costs

• design details matter

40 years plus of self-directed

support tells us

Self-directed support is a system to enable citizenship.

Ideally it has 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

Self-directed support in England involved multiple changes to the existing system.

Change how money works

Its the person’s money

Phase One Report2006

Phase Two Report2008

Place N Change

6 Sites Phase I Report 60 -18%

17 Sites Phase II Report 128 -9%

13 Sites IBSEN Report 203 -6%

Northants 17 -18.7%

City of London 10 -30%

Worcestershire 73 -17%

In the UK in the best places...

• Citizens and families are trusted more.

• Citizens and families are stronger and more in control.

• People’s lives are much better.

• People use services less, community more & have more friends.

• Money is citizen’s and can be used $exibly.

• People drive the design and delivery of their support.

• No new support systems of ‘brokers’ - instead better use of community and professionals.

• It costs much less than the old system.

Mistakes and failures

• Pseudo-scienti#c assessment tools (RAS Versions 3, 4 & 5)

• Failure to build-in ‘time limits’

• Support plan treated as a contract

• Not enough focus on peer support

• System was not easy for professionals and people

• System tries to ‘make’ people be creative

• ‘Person-centred planning’ industry

• On-going means-testing income & social capital

• No clear legal right to entitlement for support

The UK experience is paradoxical

Commissioners invest in institutional services, despite associated risks, regulators regulate institutional services and observe on-going failure, but letting citizens take control is seen as risky.

There has been rapid growth in individualised funding, but services have changed slowly

Service providers led developments in individual funding, but are mistrusted by commissioners.

Systems have taken steps to invest more trust in citizens, but shown less trust in civil society.

3. Innovation process

Government’s don’t innovate - but they can support innovation (or not).

Development of self-directed support is a complex and evolving innovation that requires change at 3 levels

4. The challenge

Can we build a respectful partnership with people and a new balance of power?

5. Personalising everything

What I am most proud of

You can use Individual Service Funds to have your budget managed for you

6. Supporting families

7. Staff as people

8. Peer support

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

9. Safety

10. Support with life

For the 3 years before 150 days in hospital - responding to problems with breathing.

In the 3 years after leaving hospital he has spent only 2 nights in hospital - for elective dental treatments.

Personalised learning - on the job - 2 City & Guilds Qualifications.

Saving NHS, LA & Education

•Over £100,000 in hospital stays

•Over £300,000 in residential care costs

•Over £100,000 of funding contributed by the LSC

Jonathan’s story

Schools can lead the way...

11. Community assistance

community brokerage

rethinking advocacy

12. The bond of trust

Women’s organisations...

understand personalisation

13. Community change

the government money fallacy...

...money can’t always be theirs

14. Commissioning...

15. End thoughts

1. Ask providers to lead the process of change and deliver efficiencies

2. Build in peer support at every step.

3. Treat the money as if it already was people’s money.

4. Innovate and seek to foster innovation.

5. Work together, learn, share and change.

Intework is going to remember that it is always the client’s money

Interchange is going to build more peer supports

St Jude’s will be focusing on more individual community-based supports.

Therapy Focus we are committed to peer supports, individualising and innovating.

GIFSA will encourage choice and control, remembering its the client’s money.

For more information:

Web: www.centreforwelfarereform.org

Twitter: @CforWR and @simonjduffy

Blog: www.simonduffy.info

Facebook: centreforwelfarereform

Campaign: www.campaignforafairsociety.org

© Simon Duffy. Rights Reserved. Full copyright details at www.centreforwelfarereform.org

For more information go towww.centreforwelfarereform.org

These slides are © Simon Duffy 2013 ￭ Publisher is The Centre for Welfare Reform ￭ Slides can be distributed subject to conditions set out at www.centreforwelfarereform.org ￭