Simon Duffy explores the lessons that can be drawn from the UK experience of self-directed support. He outlines the key features of a good system for people, families and professionals in Perth, WA.

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

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. • 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
Simon Duffy, some background

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

13. 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
recent changes in England

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:
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

15. Questions?

16. Rights

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

21. “It’s my life, my human rights”

22. 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?
Questions

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

30. Clarity

35. 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?
Questions

36. Flexibility

45. 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?
Questions

46. Ease of Use

49. Community brokerage... not another profession

52. 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?
Questions

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. 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?
Questions

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. 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?
Questions

68. Next Steps

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

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