There are several myths about self-directed support and what makes it work effectively. This talk was for the Ministry of Health team and their partners and it tries to seperate out the myths from the helpful features of a new system.

1. Self-Directed Support
Dr Simon Duffy ￭ The Centre for Welfare Reform
￭ 27th August 2013 ￭ New Zealand Ministry of Health, Auckland
Lessons from the international
experience

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

6. Self-directed support has
developed slowly over 40 years
and has faced significant systemic
resistance. It has however led to
major change in many countries
and continues to spread.

7. You can picture this change as being a shift
from support being a professional defined gift
to it becoming a citizen controlled entitlement.

8. At its heart is a shift in power from
systems towards citizens.
However such power is not a
simple commodity and
transformative change is often
corrupted into merely
transactional change.

9. Social innovations often fail to overcome the
natural forces of resistance that protect existing
systems.

10. Although there is strong evidence
that self-directed support
improves outcomes and can
increase efficiency there is less
careful analysis of the factors that
actually help or hinder. Arguably,
some advocates may even focus
on the wrong factors.

12.  Brokerage fallacy - sometimes people get great help from independent
advisors, but most people can do things themselves or get assistance from
community or professionals
 Planning fallacy - planning can help people be creative, but too much
focus on planning is damaging to the person’s authority. Its more helpful to
simply link people up and encourage the sharing of experiences and good
ideas.
 Employer fallacy - some people do value being an employer, but its not
what everyone wants and its not essential to improve outcomes
 Purist fallacy - disabled people can make their own decisions, but often
family, friends, professionals or others can be competent decision-makers.
 Blank-sheet of paper fallacy - sometimes you must simply design support
and then cost it - but this is rarely good practice and will often lead to more
professionalised, expensive and unimaginative solutions
Common fallacies include:

13. My own hypothesis is that an
effective system of self-directed
support is one that best enables
citizens to make best use of
limited resources to achieve their
own goals and become more
effective citizens.

15. 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
These would seem to be some of the qualities of
an effective system of self-directed support.

16. 1. Rights
A clear entitlement both respects
the citizen and also provides the
foundation for confident planning
and personal freedom. Gifts
create dependencies and usually
foster more conservative
decision-making.

17. “It’s my life, my human rights”

18. 2. Control
Getting the right point of control
for the individual is critical to high
quality decision-making.
Decisions made at too great a
distance from the individual are
unlikely to be effective.

20. 3. Clarity
Knowing your budget, knowing
the rules, promotes creativity and
personal responsibility. When you
don’t know your own budget
then you must trust others to
make key decisions.

21. The old system - services first

22. The new system - people first

26. 4. Flexibility
Flexible resources can be put to
the most effective use. Inflexibility
locks people into the older
patterns of provision and
undermines personal authority.

29. 5. Ease of use
Where a system is easy to use
then there is no need to become
unduly dependent on others to
make key decisions. Complexity
reinforces professional control
and wasteful infrastructure.

33. 6. Community
The support that people need to
be full citizens is located in their
community and an effective
system encourages greater peer
and community engagement.
Isolation from community limits
citizenship and creativity.

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

36. 7. Sustainable
A good system is affordable,
develops organically over time
and increased its social and
political legitimacy over time.
Hurried systemic change often
unravels or becomes corrupted.

37. Positive change
can happen at
any levels, but
requires the
creation of
opportunities
for innovation

38. Innovation is complex, evolving and requires
different strategies at different stages.

40. The biggest risk for any system is
poor cost control - the second
biggest risk is the effort to
centrally manage decisions by
people or other local agents. The
key is to design cost control and
decentralisation in together.

41. Citizenship is the goal
The best test is to go back to the
purpose of the innovation and
test yourself by that. Is it helping
people acheive greater
citizenship? Is it consistent with
the dignity of citizenship?

43. If you found these slides interesting you might like to read...

44. Lots of free resources on all these topics and more:
@simonjduffy and @cforwr - follow
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