self-directed funding in australia july 30 th 2009
TRANSCRIPT
Self-directed funding in Australia
July 30th 2009
Introduction To introduce the work of Julia Farr group To define and describe Individualised Funding To talk about some of the successes To identify the key issues To introduce In Control Australia To unravel the mysteries of resource allocation To summarise the considerations for service
agencies A framework of landmarks Safety and safeguards
Julia Farr Association
The latest organisation in a movement started by Julia Farr in 1878
128-year history as a largely institution-based service provider, as Home For Incurables and then Julia Farr Centre
Big changes in service delivery during 2004-06
All services passed in to Government in 2006, and Julia Farr Association was born
Julia Farr Association
Not a service provider Not government-funded Not a formal advocacy agency Focus on research, information, and
talking with the disability community Amplifying what we hear and learn, to
influence change
Why did we take a look at Individualised Funding?
Aspects of Robbi’s background› Work as a case manager in Wales, using person-centred
planning› Redevelopment of disability support services from
institution to community, in New Zealand› Reform of mental health services in Wellington, New
Zealand› Individualised solutions in South Australia, for people
leaving the institution JFA – disability community highly frustrated by
current disability support funding arrangements› No ‘picture on the box’› ‘back-foot’ service planning, and where people have to
give worst account of circumstances to have any chance of getting a service
› No real choice over what’s available
JFA publications on this topic
Individualised Funding: a summary review of its nature and impact, and key elements for success 2007
Individualised Funding: general considerations on implementation 2008 Both popular, with thousands of downloads
following publication Printed copies sent to all Parliamentarians in
Canberra, and will eventually go to all others around Australia
Self-directed funding (individualised funding)
Definition “..public funding that is allocated to the
individual based on his/her unique strengths and needs, and placed under the control of the individual to enable them to live in the community as a full citizen.”Dowson and Salisbury (1999)
Practical Components of Individualised Funding
Genuine control over the funds Equitable system for sharing out the funds
(in UK a growing number of Local Authorities are using a Resource Allocation system (RAS)
If wanted, support with planning If wanted, support with brokerage If wanted, support to manage the
arrangements Community development (with emphasis on
citizenship, participation and relationships)
Reported Benefits
If people gain control, their lives will improve and costs will decrease. Conroy et al (2002)
By giving consumers the flexibility and independence to spend their money as they see fit, (Individualised funding) encourages the evolution of long term care services that are responsible to consumer needs rather than to government regulations. Polivka and Salmon (2001, pg20)
“…all the available evidence suggests that (Individualised funding) leads to greater use satisfaction, to grater continuity of care, to fewer unmet needs, and to a more cost-effective use of scarce public resources Glasby and Duffy (2007)
Alleged challenges to the approach Exploitation of clients It will cost more No take up of the opportunity Diminishment of professional safeguards Exploitation of staff Diminishment of agency sustainability The burden of accountability Limited horizons Individual and community The danger of perceived panacea
Read our publication for our response in each case
Summing up the opportunity
A culture of relationship and integration Collaboration between funders, so that
Individualised Funding supports a range of lifestyle issues
A framework that is free from burdensome and invasive bureaucracy
A default assumption that people living with disability and their families have the capacity to be successful in organising their own support
Summing up the opportunity
Early access to information about the options
A tangible body of resources that are genuinely under the control of the person
The availability of support to assist the person to set out a personal vision, to identify support needs, and to organise arrangements that the person wants
The availability of support to assist the person control a range of management and compliance issues associated with being a budget holder, and an employer/director of staff
Summing up the opportunity
A Government-endorsed framework of appropriate safeguards and evaluation
Government commitment to regulating market conditions to avoid abuse and exploitation of one or more of the various stakeholders
The availability of resources that support authentic person-centred planning
A distinct and heartfelt emphasis, shared by all stakeholders, on individual/family/community capacity-building, so that there is a blend of paid and unpaid (freely given) supports in the person’s life.
With my own eyes and ears
I visited the UK to look at their move to Individualised Budgets
History in UK
Direct Payments, enabled by legislation in 1996› Growth in use› ‘all or nothing’ – take traditional arrangements or
organise everything yourself› Not easily accessible to people with differing
capacities, or not wanting to do all the organising themselves
› Emergence of Individualised Budgets, that: Took a fresh approach to allocation Gave more choice about how much involvement people
want to take on Early results promising, and now UK Government is
pushing for wider availability
highlights
Where it’s working well, it is really good:› Simple› Creative› Good outcomes for the person and family› Not more expensive than traditional
arrangements
Where it’s not working well
Implementation has been made complicated. Poor communication, and heavier bureaucracy, especially around risk management and other constraints
No encouragement for people to ‘think outside the box’ and imagine better
With insufficient information, people are more likely to arrange what they had before
Financial benefits become clouded
Where public funders are doing it well, you find…
A commitment to the values and the journey of transition
A coherent and cohesive leadership team
Investment in arrangements that assist people and their families to explore what’s possible
Key issues – 1the future of ‘case management’ Successful Individualised Funding demands
changes in the way ‘case management’ happens› Shift away from rationing and gate-keeping,
towards partnering and checking› Information, including technical stuff about
housing/legal/employment etc› Researching what’s available locally› Facilitation, including circles of support› Support planning› Brokerage of supports› Negotiation and mediation› Advocacy – supporting the person's choices› Shifting culture away from professional control
Key issue 2 – investment in community development
Community mapping is critical – finding out what is out there and who is doing what
Akin to Asset-Based Community Development
Key issue 3 –investment in sector resources for people to work through what’s possible
The voices of people living with disability and families are embedded in service systems – both governance and operations
Consumer/family led agencies governed by people living with disability, and agencies governed by family members, are available to assist people with planning, brokerage and/or hosting
Key issue 4 – shifting to ‘front-foot’ planning
Most human services are organised on the ‘back foot’, where people have to be in crisis before there is a significant response
A shift to the ‘front-foot’ demands Investment earlier, and Based on people’s strengths not their
deficits, and Focused on capacity-building
Key issue 5 – imagining better
If you don’t, you’ll organise what you had before
Reclaiming the right to ‘ordinary’. Don’t think about ‘service’, think about getting a life
Reclaiming the right to dream big Managing risk safely Perseverance – getting to ‘better’
happens one step at a time
The Picture On The Box When you do a jigsaw puzzle, it is much harder to
complete it if you don’t have a picture on the box. It even becomes harder to work out if you have the right pieces in front of you.
It is the same with building a lifestyle for you and your family. If you don’t have a vision for how you want your life to be (the picture on the box) it becomes much harder to work out the pieces you need and how they fit together
It is the same for funders and service agencies and communities. If they don’t build a vision for what they want their funding/efforts to achieve, then they won’t know what pieces they need and how they come together.
In Control Australia is a movement of voices – individuals and organisations – seeking the widespread availability of self-directed funding, and associated supports
In Control Australia is a place for: Reference, information and awareness Critical enquiry and reflection Dialogue and exchange Collaboration Leadership and influence
In Control Australia’s current work, to help Change thinking and Practice Website
Developing communities of interest, so that people in similar situations can connect together people living with disability Families Service agencies etc
Forums in every state and territory Telling stories Partnering with individuals, service providers and
government Encouraging research and critical enquiry
Underlying Principles
Self-directed funding is much more than getting funding …
1. Right to Independent LivingI can get the support I need to be an
independent citizen
2. Right to a Personal BudgetI know how much money I can use for my
support
3. Right to Self-DeterminationI have the authority, support or
representation to make my own decisions
4. Right to AccessibilityI can understand the rules and systems and
be able to get help easily
5. Right to Flexible FundingI can use my money flexibly and creatively
6. Accountability PrincipleI will tell people how I used my money and
anything I’ve learnt
7. Capacity PrincipleGive me enough help, but not too much;
I’ve got something to contribute too
Its just...Its just... yes but... no but...yes but... no but...
A form of rationing rights-based
For people with some types of disability
all people with disability
For people with disability to employ support workers
all service forms
For a few for everybody
Direct PaymentsMany different management
routes
Citizenship Model
Citizens live in communities
Citizens have rights Citizens have
responsibilities Citizens should be able
to shape their support to fit their lives
Services serve citizenship
Self-Directed Self-Directed FundingFunding
Building a new System
There are at least 6 sources of support to help people decide what to do with their budget and to manage their budget
6 control options
Resource Allocation System (RAS)
The Challenge of organising public funding
• We live in a cash-limited world and public funds are finite (unless you’re a banker)
• Public accountability demands that funds be allocated and distributed:
• With a measure of equity• With a measure of prioritisaiton
• Which imparts a sense of accountability and responsibility to the government office(r)
The Challenge of organising public funding• Traditionally achieved in two main ways:
– Block contracts for services– Individual contracts for services
• Both characterised by the public funder retaining control over what is bought and what is available to be bought. Paternal-passive relationship (we’ll figure out what you need and what you can have
• The time (and public funds) involved in gate-keeping
Professional in control Community merely a tax payer
Services dominated by professional and provider interests
Individual is rightless - unable to control their own support
Resources are inflexible and cannot be personalised
Perverse incentives set up for the individual and family
Change in paradigm
Countering the irony of professional intervention
Reclaiming personal authority
Re-engineering (there must be a better way) Efficiency (it costs less to do it) Effectiveness (added value in terms
of benefits for those targeted) Work-shifting (making sure a task is
done by the person best-suited to do it)
Re-engineering and RAS
Re-engineering has helped semi-automate the gate-keeping function
The RAS takes it another step further, where the link between ‘the needs I have’ and ‘the funds available to me’ is fast and simple
“I have a need for assistance and the RAS tells me how much pubic funds I may be able to get” – the magic box
RAS
‘Magic Box’ Where a person’s support needs score
corresponds to an indicative allocation of public funds
RAS - some typical ingredients• Population-based information about people’s need
for assistance• In formation about what the service responses
have cost per person, in dollar terms• Clearly stated public policy imperatives
– The driving values, such as choice and control by individuals and families
– The prioritised areas of demand
• Clarity about the amount of funds available overall• A sensible way of quickly and easily assessing a
person’s support needs, to produce a score that translates to a funding allocation
Immediate benefits #1 – funds gate-keeping is smoother
All the main thinking about rationing is done once when the scheme is designed, and converted into: the scoring of the self-assessment tool The formulae within the RAS (using
something as simple as a spreadsheet)
Immediate benefits #2 – person/family are centrally involved in the process
The support needs assessment tool is REALLY easy to use
Based on two premises People are the best experts on their own
support needs You don’t need a complicated assessment
tool tyo work out the level of assistance someone needs
Immediate benefits #3 – case manager resources can be used for something else
CM is no longer the heavily involved gate-keeper
CM is no longer the default professional assessor
CM moves into a role of interpreter All of which means you need less
traditional CM time
DISCLAIMER
RAS, and the control it affords people, is a means to an end
Other important conditions include; Good information Imagining better Networks ‘good neighbour’ community
development
For service provider agencies Providers need to get the point Transition in the way businesses
operate will be a significant journey, particularly for larger providers
That journey is much harder to initiate and sustain if the organisation’s leaders don’t connect with the point of it all
The need for leadership beyond ego
Summary steps for service agencies Make a commitment to the values
associated with Individualised Funding Communicate those values across the
organisation, and live them Use a methodology like the McKinsey
Seven Ss (i.e. Shared values, Strategy, Systems, Structure, Skills, Staff, Style) to identify what needs to change
Build strategy Run change process
Landmarks
CitizenInfluence
Legislation-based entitlement to practical support e.g. National Disability Insurance Scheme
Legislation-based protection of rights as
citizens
© Julia Farr Association
2009
QUALITY OF LIFE: custody or community
vulnerability
Exclusive (Custody)(Invisible)
Safeguards
Safety Security
Opportunities Inclusive (Community)
(visible)
DUTY OF CARE
DUTY OF CARE
© Julia Farr Association 2009
