Workshop by Dr Simon Duffy for ACS in South Australia, 2 December 2014 in Adelaide

Creative Support - lessons from self-directed support in the UK

Dr Simon Duffy

I’ve worked at developing systems of self-directed support for 25 years, working as a service provider and working with (and against) government. My training is in philosophy and my practice has involved an on-going effort to think about why we do what we do.

After working on individualised funding in early 1990s I developed Inclusion Glasgow - an innovative service provider in 1996. In 2003 I led In Control and developed the model of self-directed support which was (to some extent) adopted by the English government.

In 2009 I set up The Centre for Welfare Reform as hub for social international social innovation and a platform for challenging injustice. I am currently involved in various campaigning efforts in the UK to combat the way ’austerity’ is targeting people with disabilities and people in poverty.

• Overview of UK developments

• Citizenship and individual service design

• Practical issues for service providers

• Power of peer and community support

Words are important

• Is it helpful to think of ourselves as consumers?

• Can you consume care?

• Is care the kind of thing you can direct?

• Is it helpful to convert community into a market?

Origin of “Consumer” early 15c., "one who squanders or wastes," agent noun from consume. In economic sense, "one who uses up goods or articles" (opposite of producer) from 1745.

Origin of “Care” Old English caru (noun), carian (verb), of Germanic origin;

related to Old High German chara 'grief, lament',

charon 'grieve', and Old Norse kǫr 'sickbed'.

brief history of self-direction

• Began in California 1960s (c. 50 yrs!)

• Progress real, slow and patchy

• Outcomes always positive

• Efficiency & cost-control are variable

• Design details really matter

• Resistance to change high

Reform were not inspired by consumerism, neo-liberalism or the market.

People don’t shop for services they build stronger community.

It seems more fruitful to think about real wealth, citizenship and community.

Brief History• Post-war responsibilities

split between NHS (bigger) local government (smaller) for services.

• 1970s - Growth of ‘disability benefits’

• 1980s - Creation of an open-ended ‘entitlement’ to residential care created bubble - capped by handing money to local government.

• 1988 - Creation of Independent Living Fund.

• 1990s - Pressure from families and professionals led to NHS closing institutional care.

• 1996 - Direct Payments Act makes emerging practice legal. Progressively opened up to more groups.

• 2007 - Putting People First marks intention of government to make personalisation universal. Progressively opening up to health, education etc.

The care home resident population for those aged 65 and over has remained almost stable since 2001 with an increase of 0.3%, despite growth of 11.0% in the overall population at this age. Fewer women but more men aged 65 and over, were living as residents of care homes in 2011 compared to 2001; the population of women fell by around 9,000 (-4.2%) while the population of men increased by around 10,000 (15.2%). The gender gap in the older resident care home population has, therefore, narrowed since 2001. In 2011 there were around 2.8 women for each man aged 65 and over compared to a ratio of 3.3 women for each man in 2001. The resident care home population is ageing: in 2011, people aged 85 and over represented 59.2% of the older care home population compared to 56.5% in 2001. [Office of National Statistics. Part of 2011 Census Analysis, Changes in the Older Resident Care Home Population between 2001 and 2011 Release]

The total number of people receiving services in 2013-14 was 1,267,000 (down 5 per cent from 1,328,000 in 2012-13 and down 29 per cent from 1,782,000 in 2008-09). Of these, 1,046,000 received community based services (a fall of 5 per cent from 2012-13), 204,000 received residential care (a fall of 3 per cent from 2012-13) and 84,000 received nursing care (which is 3 per cent down from 2011-12). [National Statistics. Community Care Statistics, Social Services Activity, England - 2013-14, Provisional release}

• More people with direct payments (25%) but shared management under-used.

• Most people (75%) have a ‘budget’ but no real control.

• Sometimes more creativity is allowed - sometimes.

• Resource allocation and support planning processes often complex.

• New innovative forms of practice emerging.

• Service providers have remain captured by old forms of contracting.

• Austerity has targeted social care for cuts.

• Some people now pushed into taking direct payments with inadequate support.

Reality of personalisation

• Clear up-front budgets that people can use flexibly

• Flexibility around planning - use of peer support

• Possibility of abandoning process control and shift to outcomes

• Ability to add and develop existing roles - no fixed structural template

• Extension sideways into health, education and other areas

Strengths to build on

Individualise Everything

My Money

Admin

€

Funding from one or more sources

[enables integration]

brokerage unexpected costsoverheads

Coordinator Insurance FundRestricted Funding

Individual Service Fund

Social Work

Inclusion Glasgow

Individual Service Fund

Service Coordinator

Lynn & her sister

Paid help from a neighbour © S

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We make citizenship real by1. Finding our sense of purpose

2. Having the freedom to pursue it

3. Having enough money to be free

4. Having a home where we belong

5. Getting help from other people

6. Making life in community

7. Finding love

This protects our dignity1. Our life is seen to have meaning

2. We are not on someone else’s control

3. We can pay our way - we’re not unduly dependent

4. We have a stake in the community

5. We give others the chance to give

6. We contribute to the community

7. We are building the relationships that sustain community

How is greater efficiency possible?

• Better targeted support

• Different kinds of support

• Community connections

• Teaching

• Technology

• Getting housing right

• Lower management costs

• (Lower salary costs… mmm)

What different roles can you play in CDC?

• Can you plan with people?

• Can you give people their own money?

• Can you keep people’s money sate for them (roll over)?

• Can you let people use their money flexibly?

• Are you part of the same community as the citizens?