Self-Directed Supportinternational best practice

Dr Simon Duffy Centre for Welfare Reform on behalf of Inclusion Ireland & Down Syndrome Association Ireland

• The growth in the economic cost of health and social services is an international problem.

• More expensive, more centralised and more institutional services grow in cost, but do not become more efficient.

• Greater value lies in supporting citizenship, families and local communities, but investment in this is reducing.

• How can we move resources upstream to solve problems earlier and more efficiently?

The socio-economic challenge

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• Personal budgets is one powerful way of moving resources out of the wrong services and back to citizens and local communities.

• Personal budgets are flexible and they let people be creative and use resources in their local community.

• Personal budgets help community organisations to get funding from people - outside the procurement systems that often leads to centralisation.

Self-directed support has been growing for 50 years

People take control and so can become full citizens playing and active part in community life

• Personal budgets are different to vouchers, benefits or other systems of ‘customer choice’ or ‘money follows the patient’.

• They can be controlled by the person, family, community organisations or government professionals.

• They have led to significant improvements in life, satisfaction and efficiency.

Control & creativity, not just choice

If budgets can be used flexibly then people use money differently and connect to community

Location N ChangeEngland - 6 Sites Phase I Report 60 -18.0%England - 17 Sites Phase II Report 128 -9.0%England - 13 Sites IBSEN Report 203 -6.0%England - Northamptonshire 17 -18.7%England - City of London 10 -30.0%England - Worcestershire 73 -17.0%England - Southwark 85 -29.8%Scotland - Glasgow 12 -44.0%USA - Denver - Disabled Children - -34.0%USA - Florida - Disabled Children - -30.0%

4 strategies to ensure efficiency1. Transform how existing funding is

used - don’t spend new money while leaving the old system in place.

2. Make sure there is funding in place to make rights real - delegate money to local areas as much as possible.

3. Don’t restrict too much who can provide support or help people manage their budgets - keep the system open.

4. Make sure people can use money flexibly, so that they can build on what is already good in their life.

4 implementation challenges1. Systems tend to try and take

back control via regulation and bureaucracy.

2. Systems should become easier to navigate and control should be made easier over time.

3. Rights need to be underpinned by legal and advocacy measures.

4. Policy-makers need to focus on the legal and policy barriers.

5. Implementation should be lean and focus on improving value.