Self Directed Services The Way Forward

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Self Directed Services The Way Forward?

• How Will It Work For You?
• Monday 3rd March 2008
• Rick Wilson AWCLN

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What is this presentation about?

• It is about us as a community of providers.
• It is about our stance as the leaders of our
  organisations to this latest agenda of change.
• It is not about
• What is In Control
• The Detail of how it is working in other parts
  of the UK
• This will come from John Dalrymple.

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Where do we all begin?

• The Principles of the All Wales Strategy.
• Have a right to normal patterns of life within
  the Community
• Have a right to be treated as individuals
• Require additional help from the communities in
  which they live and from professional services if
  they are to develop their maximum potential as
  individuals.

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Pre Community Care -The world was very different?

• Regional Hospitals
• Local community hospital bungalows
• Residential Care Homes
• Lodging schemes
• Large day centres
• Strong Gateway clubs
• Family support was paramount.

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Pre Community Care -The world was very different?

• Fewer large establishments.
• Smaller professional community.
• Handful of principle decision makers.
• Strong structures for communication and training.
• The relationship between families and
  professionals was very structured, boundaries
  were clear.

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Community Care - Was a revolution!

• A mess of untried ideas.
• Stories from abroad about transformed lives.
• A loss of control for previous principal
  professionals.
• Lots of trendy young turks with flipchart pens.
• Biblical levels of expectation from families.
• Making it up as it went along.

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Community Care - Very real concerns

• Its about cost cutting
• You cant expect the community to just care.
• People will not get enough support in the
  community.
• It will create a mass of untrained low paid
  staff.
• Professionalism will be lost.
• People will be exploited, isolated and lonely.
• OK it is right for more able people, but not for
  the profoundly disabled.

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Community Care - Were these concerns valid?

• Yes absolutely!
• But what did we do about them as a community?
• We did our best to fix each one over years.
• We listened to people ambitions.
• We thought hard about how to keep people safe.
• We lobbied our Las and government.
• We helped each other and shared best practice.
• We built a network of services that we can be
  very proud of and that people value greatly.

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Community Care - Were these concerns valid?

• Was it worth it?
• Not every persons life got better
• Would anyone of us want people to go back
• Agencies that embraced change thrived.
• Can these services be made available to everybody
  who wants them? It is doubtful.

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Self Directed Services?

• Déjà vu anybody?Thinking about our response to
  the past should guide our behaviour in the
  future.
• This as a strategy that now has real momentum
  across the UK.
• Individualised budgets is now central in English
  and Scottish thinking.
• There is now a solid body of practice behind
  this.

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Self Directed Services? - Questions

• Is it in line with our principles and beliefs?
• What are our Very Real Concerns?
• What are the alternative futures?
• What should be our stance?

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Self Directed Services - Beliefs

• The Principles of the All Wales Strategy.
• Have a right to normal patterns of life within
  the Community
• Have a right to be treated as individuals
• Require additional help from the communities in
  which they live and from professional services if
  they are to develop their maximum potential as
  individuals.
• So isnt this the next step?
• From stakeholder to customer.
• From Person Centred Thinking to Person Centred
  Commissioning.

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Self Directed Services - Concerns

• Its about cost cutting
• You cant expect the community to just care.
• People will not get enough support in the
  community.
• It will create a mass of untrained low paid
  staff.
• Professionalism will be lost.
• People will be exploited, isolated and lonely.
• OK it is right for more able people, but not for
  the profoundly disabled.
• Are these concerns valid? absolutely yes
• The Question is what we do about them

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Self Directed Futures - Alternatives

• Current WAG steer on Self Directed Services
• Direct payments  as a mechanism to achieve
  service user empowerment in terms of taking
  control of purchasing their own services.
• Given current low uptake of Direct Payments will
  this change anything.
• Growth of Regional Commissioning of services.
• Large whole sale LA re-tendering exercises.
• Increasing medicalization of services through
  continuing care mechanisms.
• Clear failure of resources to meet needs

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Self Directed Futures - Alternatives

• The current commissioning environment lacks a
  clear ideological driver.
• This is resulting in
• Commissioning getting further from people.
• A downward pressure on cost and quality.
• The growth of institutional services.
• A decline in cooperation and shared problem
  solving from us as a community.

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Self Directed Services Our stance

• Will this happen in England and Scotland?
• Yes, it is now becoming a whole sale process of
  change, the world around us is now changing.
• Does this fit with our values as a community?
• Yes, it is the logical progression of everything
  we have done about user involvement and person
  centred thinking.
• All Wales People First are calling for this
  change.

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Self Directed Services Our stance

• What should we do about the concerns?
• Engage, be critical, get involved, come up with
  Welsh solutions, share, fix, innovate, we have a
  strong history of this!
• What about the lack of leadership?
• Let our values lead us, we can lead this process,
  the risks of doing nothing are now much higher.
• Let us work together to create shared strategy
  and allegiances.

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Self Directed Services Our stance

• The question is not whether this will happen
  anywhere else in the UK.
• It is not whether the model has serious flaws or
  creates major concerns (every new idea does).
• It is how we will work together to use Self
  Directed Services to create safe and empowering
  opportunities for the people we serve in Wales.