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Article
Publication date: 1 April 2007

Simon Duffy

There has been growing international interest in the idea that social care would be better organised as a system of self‐directed support, where people control their own…

Abstract

There has been growing international interest in the idea that social care would be better organised as a system of self‐directed support, where people control their own budgets for their own support. While there is significant evidence that this approach brings benefits to disabled people and those older people who need support, there is still an active debate about the efficiency and affordability of this approach. In Control has led work in England on piloting this approach, and has gathered some early evidence on the economic sustainability of self‐directed support. This article outlines the economic case for self‐directed support and some of the practical issues that will need to be confronted in order to implement self‐directed support successfully in the UK. In particular, it argues that the current service‐focused system of social care is structurally inefficient, and that self‐directed support makes much better use of the resources committed through public taxation. Finally, it contends that a rethink of the health and social care boundary will inevitably follow.

Details

Journal of Integrated Care, vol. 15 no. 2
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 2 March 2021

Valerie Bradley, Miso Kwak, Highsmith Rich and Bevin Croft

Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget…

Abstract

Purpose

Self-direction–also known as participant direction, personalization and self-directed care–is a service delivery model that enables people to manage their personal budget and purchase services and supports tailored to their needs based on a person-centered plan. This paper, the outcome of an international learning exchange on self-direction, describes approaches across four countries’ successful strategies, unresolved questions and recommendations to enhance self-direction globally.

Design/methodology/approach

The findings are a product of discussions at the 2019 International Initiative for Mental Health Leadership and International Initiative for Disability Leadership Exchange on Advances in Self-Direction. Participants included people who are self-directing, providers and caregivers who support people who are self-directing, advocates, fiscal agents and public managers who administer self-direction from the United States, England, Australia and New Zealand.

Findings

In all four countries, people who self-direct exercise high levels of choice and control and are able to individualize their services and supports to promote a good life in the community. The exchange also revealed challenges and possible solutions to improve and expand self-direction.

Practical implications

The results of the meeting provide guidance for public managers, providers and advocates for initiating and expanding self-direction.

Originality/value

This international meeting was a unique opportunity to compare self-direction across four different countries and across multiple perspectives, including people with disabilities, caregivers, providers and administrators.

Details

Journal of Integrated Care, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 3 August 2012

Fraser Mitchell

This paper aims to describe the implementation of self‐directed support (SDS) in transitions for disabled children and young people moving from children's to adult…

Abstract

Purpose

This paper aims to describe the implementation of self‐directed support (SDS) in transitions for disabled children and young people moving from children's to adult services; it also seeks to describe the use of realistic evaluation as an approach to evaluation of this particular policy implementation.

Design/methodology/approach

A participatory stakeholder approach utilising realistic evaluation as an approach to policy evaluation was integral to guiding the implementation strategy of the SDS in transitions pilot in Anyshire Council (anonymised name).

Findings

Learning from the early implementation of the pilot is described. Realistic evaluation was found to be a useful approach to the implementation of a complex policy initiative.

Research limitations/implications

The involvement of disabled children and young people in the strategic development of SDS has proved challenging.

Originality/value

This is the first evaluation of the implementation of self‐directed support in transitions that uses realistic evaluation as an approach.

Details

Journal of Integrated Care, vol. 20 no. 4
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 10 June 2019

Fiona Henderson, Kelly Hall, Audrey Mutongi and Geoff Whittam

This study aims to explore the opportunities and challenges Self-directed Support policy has presented to Scottish social enterprises, thereby increasing understanding of…

Abstract

Purpose

This study aims to explore the opportunities and challenges Self-directed Support policy has presented to Scottish social enterprises, thereby increasing understanding of emerging social care markets arising from international policy-shifts towards empowering social care users to self-direct their care.

Design/methodology/approach

This study used guided conversations with a purposive sample of 19 stakeholders sampled from frontline social care social enterprises; social work; third sector; health; and government.

Findings

An inconsistent social care market has emerged across Scotland as a result of policy change, providing both opportunities and challenges for social enterprises. Social innovation emerged from a supportive partnership between the local authority and social enterprise in one area, but elsewhere local authorities remained change-resistant, evidencing path dependence. Challenges included the private sector “creaming” clients and geographic areas and social enterprises being scapegoated where the local market was failing.

Research limitations/implications

This study involved a small purposively sampled group of stakeholders specifically interested in social enterprise, and hence the findings are suggestive rather than conclusive.

Originality/value

This paper contributes to currently limited academic understanding of the contribution of social enterprise to emerging social care markets arising from the international policy-shifts. Through an historical institutionalism lens, this study also offers new insight into interactions between public institutions and social enterprise care providers. The insights from this paper will support policymakers and researchers to develop a more equitable, sustainable future for social care provision.

Details

Social Enterprise Journal, vol. 15 no. 4
Type: Research Article
ISSN: 1750-8614

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Article
Publication date: 9 September 2013

Ann Laura Rosengard, Julie Ridley and Jill Manthorpe

The purpose of this paper is to consider the role of housing and housing support services in working with systems of self-directed support (SDS). The paper draws upon…

Abstract

Purpose

The purpose of this paper is to consider the role of housing and housing support services in working with systems of self-directed support (SDS). The paper draws upon findings from an evaluation and follow up study of three SDS Test Sites in Scotland and wider research.

Design/methodology/approach

The evaluation of the SDS Test Sites took place in 2009-2011 with a follow up study in 2011-2012. Methods included a literature review; an analysis of secondary data on the use of SDS in Scotland; interviews with key stakeholders; learning sets in the three areas; 30 depth individual case studies and a large-scale stakeholder event prior to finalising the report. These data are drawn upon to reflect on the implications for housing providers and practitioners.

Findings

The interviews revealed that some SDS users had housing and related support needs, such as to prevent or resolve homelessness, to facilitate resettlement, to prevent hospital admissions, to access supported accommodation or to move from shared to independent housing. For some people flexible housing support seemed to enhance community living, also well-informed independent advocacy could make a difference to outcomes. While there was policy support for the Test Sites, it was notable that linkages between agencies at strategic level were limited, with neither housing nor health services greatly involved in strategic planning. Training, alongside liaison and partnerships, may help to broaden SDS.

Research limitations/implications

While housing and related support needs and services were not specifically investigated in this evaluation, data suggest that the contribution of housing services may be both under-developed and under-researched in the context of SDS. There are indications that SDS may act as a catalyst for improving housing opportunities provided that collaboration between housing and care services is maximised.

Practical implications

This paper suggests approaches that may improve and consolidate the role of housing in achieving SDS objectives of maximising user control and choice, improving outcomes and sustaining ordinary living.

Originality/value

This paper considers the less charted territory of the implications of SDS for the role of housing services. While drawing primarily on recent research in Scotland the themes raised will have wider relevance to housing and care services generally.

Details

Housing, Care and Support, vol. 16 no. 3/4
Type: Research Article
ISSN: 1460-8790

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Article
Publication date: 22 July 2009

Edward Hall

A central element in the shift to a ‘personalised’ care system in the UK is the opportunity for disabled people to hold and manage budgets for the purchase of care and…

Abstract

A central element in the shift to a ‘personalised’ care system in the UK is the opportunity for disabled people to hold and manage budgets for the purchase of care and support, to replace local authority services. The delivery mechanisms of ‘Direct Payments’ and ‘Individual Budgets’ have allowed many disabled people to control their care and support better, and have promoted their social inclusion. However, the particular contexts and issues for people with learning disabilities in holding personal funding have been little considered. The paper sets out the broad themes of the introduction of personalised care, and examines the limited use by people with learning disabilities of Direct Payments and the subsequent development of Individual Budgets. The paper considers the challenges to the nature, spaces and relations of care commonly used by people with learning disabilities that personal budgets present, in particular for those with more severe disabilities. The paper concludes by suggesting ways in which people with learning disabilities can use personal budgets, whilst maintaining the collective relations and spaces of caring desired by many.

Details

Mental Health Review Journal, vol. 14 no. 2
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 1 January 2008

The purpose of this paper is to offer a review and summary of a research paper, which claims that self‐directedness is a key aspect of learning and development in the…

Abstract

Purpose

The purpose of this paper is to offer a review and summary of a research paper, which claims that self‐directedness is a key aspect of learning and development in the workplace and investigates how feasible it is.

Design/methodology/approach

This paper is prepared by, an independent writer, who adds their own impartial comments.

Findings

The paper finds that in a paper on organizational competence published in 2000, J.D. Jurie wrote that “Organizations which hamper or stunt the free development of their members or constituents … limit their own effectiveness”. Few executives, surely, would see this as in any way a contentious point. Yet in pointing out what may seem the obvious, this statement tacitly draws attention to a common division between philosophy and practice. It is logical that having a workforce that is encouraged to learn new skills and develop existing ones will improve company performance and thus its bottom line. Actually putting this theoretical encouragement into effect practice, however, is often easier said than done.

Practical implications

The research in the paper covered 12 differing enterprises but further investigation would be needed to make claims about the wide application of the findings. It also suggests that more research should be conducted to advise on how to teach workers how to learn.

Originality/value

The paper offers guidance to learning and development personnel on feasible strategies to use within their own organization to assist with the development of self‐directed learning among employees, as well as outlining some of the difficulties.

Details

Development and Learning in Organizations: An International Journal, vol. 22 no. 1
Type: Research Article
ISSN: 1477-7282

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Article
Publication date: 1 February 2009

Rachel Fyson

Services for adults with learning disabilities are currently based on the promotion of four key principles: rights, independence, choice and social inclusion. This paper…

Abstract

Services for adults with learning disabilities are currently based on the promotion of four key principles: rights, independence, choice and social inclusion. This paper will argue that, while these principles are welcome, they need to be balanced against a fifth principle ‐ that vulnerable adults must be protected adequately against the risk of abuse. It will draw both on recent high‐profile cases of violence and abuse against people with learning disabilities and on research evidence to explore whether current plans to transform adult social care through the use of self‐directed support and individual budgets offer a safe future.

Details

Journal of Integrated Care, vol. 17 no. 1
Type: Research Article
ISSN: 1476-9018

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Article
Publication date: 17 September 2009

Rachel Fyson

Services for adults with learning disabilities are currently based on the promotion of four key principles: rights, independence, choice and social inclusion. This paper…

Abstract

Services for adults with learning disabilities are currently based on the promotion of four key principles: rights, independence, choice and social inclusion. This paper will argue that, while these principles are welcome, they need to be balanced against a fifth principle ‐ that vulnerable adults should be adequately protected against the risk of abuse. It will draw on both recent high‐profile cases of violence and abuse against people with learning disabilities and research evidence to explore whether current plans to transform adult social care through the use of self‐directed support and individual budgets offer a safe future.

Details

The Journal of Adult Protection, vol. 11 no. 3
Type: Research Article
ISSN: 1466-8203

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Article
Publication date: 1 October 2007

Simon Duffy

Care management is a central part of the current health and social care system, but the development of Self‐Directed Support raises significant questions about the future…

Abstract

Care management is a central part of the current health and social care system, but the development of Self‐Directed Support raises significant questions about the future of this function. Moreover, if the current design of the care management function is to change, then this will raise significant challenges and opportunities for those professionals who currently act as care managers. These changes may even allow social workers to return to a way of working that fits better with their professional ethos.

Details

Journal of Integrated Care, vol. 15 no. 5
Type: Research Article
ISSN: 1476-9018

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