1) The document discusses the progress and obstacles of self-directed support (SDS) like personal budgets and personal health budgets in England. (2) While England was initially a leader in SDS, austerity and bad policy have slowed progress in recent years. (3) The document provides strategies for advancing SDS locally, such as building alliances, identifying champions, and connecting innovations to shifting resources and a changing vision for local government and health.

1. Dr Simon Duffy | Centre for Welfare Reform & Citizen Network | 18 May 2020
Getting round the obstacles to
self-directed support
A workshop for the Changing Our Lives team

2. Questions
from the Changing Our Lives team
• Where things are at now in relation to PBs, PHBs and ISFs and any good
practice areas and individuals it would be useful for us to link with?
• How high is this on the agenda nationally?
• What do you see happening over the next couple of years?
• What types of pressure could we put on local authorities and CCGs to push
PBs, PHBs and ISFs?
• We will share our upcoming work co-producing the Personal Health Budget
strategy in Wolverhampton and our developing exploration of how we can
embed human rights into our work?

3. Progress in England
England was a leader in self-directed support for a few years
• 1994 Direct Payments Act remains an important landmark.
• From 2008 saw ambitious commitments to a more universal approach,
including all groups, ages and people with health conditions.
• 2014 Care Act provides some legal basis for these ambitions and they remain
a practical goal for many local authorities and the NHS.
• There was rapid progress to shift many people’s into using direct payments
for domiciliary and day time support.

7. No or slow progress in England
Austerity and bad policy have slowed effective progress
• Residential Care was ‘protected’ from self-directed support after lobbying by the
sector.
• Austerity accelerated some growth in direct payments, but this has led to some
exploitation of people and families on low cost, poorly supported packages.
• Progress on ‘supported’ personal budgets or ISFs has been very slow indeed, partly
for legal and cost reasons.
• Centrally run development programmes in social care, health and education have
been incredibly wasteful and have not developed local capacity.
• Care Act 2014 is confusing and has not created the foundation for a fundamental
change in social care

12. Opportunities and obstacles
We are in very unusual and uncertain time
• Central government abdicated leadership in the field in 2010.
• Personalisation is a marginal project within wider NHS changes.
• Progress will largely depend on working with people with integrity and using
self-directed support to solve pressing problems.
• COVID-19 will create a period of chaos and may cause some deeper
rethinking, but the outlook for social remains negative.
• However some local areas are starting to think differently as they are freed
from their accountability to central policy-making.

13. Strategies for progress
in confusing times
• Build your own community of allies locally - create an action learning group.
• Work in partnership with the Centre for Welfare Reform and Chris Watson.
• Spot current or future champions, families and people with desire for
something different and use peer support and networking to advance change.
• Spot major problems and crises and use self-direction as part of your
approach to helping shift resources.
• Find allies in local government or health for a different vision of the future and
the desire to innovate.

14. Continuing value of self-direction
in confusing times
• Self-direction guarantees support solutions that make sense.
• Self-direction leads to innovation and innovation creates efficiency.
• Self-direction CAN fit within a growing shift in thinking towards local power,
control and neighbourhood action.

19. • If the leadership does not come
from above can we not be
guardians of the fire alongside
people and families?
• If people learn and develop by
listening to peers how can we
change our approach so that peer
learning is always involved?
• If local government is starting to
abandon markets and is starting to
focus on investing in
neighbourhoods how can we
support this change?
• If England is going backwards can
we stay connected to countries that
are going forward through Citizen
Network?
• If we need to develop new
innovative approaches to make
self-directed support easier and
more accessible can we connect
with others in the Centre for Welfare
Reform who are trying to do the
same?

20. Further reading
…and follow the links and ask for help
• SDS Network - https://citizen-network.org/resources/selfdirected-support-network.html
• Heading Upstream - https://www.centreforwelfarereform.org/library/heading-upstream1.html
• Self-Directed Support and Human Rights - https://www.centreforwelfarereform.org/library/selfdirected-support2.html