Talk by Dr Simon Duffy for the Australian Government Department of Social Services, 5 December 2014

Journeys towards self-direction

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.

1. Problems of language

2. Advancing citizenship

3. UK experience of self-direction

4. The role of community

5. Structural innovations

6. Innovation as process

7. Opportunities for Australia

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'.

Word Origin of “Market” n. early 12c., "a meeting at a fixed time for buying and selling livestock and provisions," from Old North French market "marketplace, trade, commerce" (Old French marchiet, Modern French marché), from Latin mercatus "trading, buying and selling, trade, market"

Origin of “agora” "assembly place," 1590s, from Greek agora

"open space" (typically a marketplace), from ageirein "to

assemble," from PIE root *ger- "to gather" (see gregarious ).

Origin of “Support” late 14c., "act of assistance, backing, help, aid," from

support (v.). Meaning "one who provides assistance, protection, backing, etc." is

early 15c. Meaning "services which enable something to fulfil its function and remain in operation" (e.g. tech support) is from 1953.

words, words, words, words, words, words, words

We’ve lost sight of citizenship and what it means

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

international themes• indicative budgets or

not

• independent brokerage or not

• battles re flexibility and waivers

• supported decision-making and capacity

• services or community

• means-testing and benefits

• safeguarding and quality

• innovation and market entrance

• who plans and how

These innovations were not inspired by consumerism, neo-liberalism or a desire to create a ‘market’. They were inspired by a desire for justice, citizenship and community.

Sami Helle at European Parliament, November 2013

“We are obliged to surrender to the will of the strong. Big companies, cities and municipalities decide what is best for us. This is about power. Why do I feel a lack of power in my own life?”

Self-directed support in the UK and ‘austerity’

self-direction in UK• 1970s indirect

payments to people

• 1988 - ILF v1 (high demand)

• 1993 - ILF v2 (linked to local gov.)

• 1996 - Direct Payments (steady growth)

• 2007 - Personal Budgets (major policy shift)

• 2009 - healthcare

• 2011 - children with disabilities

• 2010 - austerity

The government money fallacy

it can’t always be government money:

where did government get it from?

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

• 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

• People choose community not services

• Flexibility around planning - use of peer support

• Leadership is vital

• 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

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}

Service providers are not providers - at their best they are partners in community

• Better targeted support

• Different kinds of support

• Community connections

• Natural support

• Teaching

• Technology

• Getting housing right

• Lower management costs

• Lower salary costs… not in these examples

The structures themselves should be capable of organic innovation

Help & Connect in Newcastle

Social innovation is inspired by social justice

Opportunities and risks for Australia

Fees: explicit