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Citizenship & Professional Gift Models

The Citizenship Model is a new paradigm for public services where support is treated as an entitlement which can be shaped and driven by the citizen, in the context of their community life. This model contrasts with the Professional Gift Model, which remains the prevalent model for public services, whereby support is defined by professionals and given as a unilateral gift to needy people.

Background

The Citizenship Model and the contrasting paradigm of the Professional Gift Model were developed by Simon Duffy in 1991 and used to shape early reforms at Southwark Consortium (now Choice Support). It proposes that in a just society any individual who needs support receives that support in a way that is consistent with citizenship. This model was later written up as part of Unlocking the Imagination.

Professional Gift Model

The prevalent model for the delivery of many public services, including health care, education and social care, is the Professional Gift Model. People find themselves at the receiving-end of a chain of power and control that starts when we pay our taxes. Taxes go to the government (both central and local) and the community leaves to government the job of working out how to take care of people who are deemed needy.

The government in turn transfers that funding to various professional bodies (Social Service Departments, providers of care, the NHS) so that they can take care of disabled people. Finally those needy people are assessed by professionals to establish what kind of professional care is appropriate; this care is then provided by other professionals who are paid for by the first group.

In fact the current situation is far worse than this. The control of disabled people by professionals is not always benign; and powerlessness can combine with segregation to rob people of their citizenship twice over. Even today, when there is lots of information about why institutional services work badly, these segregated services continue to be the standard service provided to disabled people.

The reason for this is not that disabled people demand segregated services. Instead, like all systems, the present system tends to serve its own interests; not the interests of disabled people but the interests of the professionals who earn their living within it. The services people receive are much more likely to be based upon what is already available rather than what people really need. The kind of service that is available is exactly the kind of standardised and segregated care that is poorest at meeting people’s needs and is holds people back from citizenship.

Changing these institutional services into better services that people can control and use to live their own lives takes time and energy and demands that the staff in those services have to make changes to their work practices and even their forms of employment. But the existing services naturally resist making such changes and so funding remains locked into old-fashioned forms of care. So, the professional’s free gift turns out to be a gift that mostly suits the interests of the giver, not a carefully tailored present that suits the individual disabled person.

This may seem too strong: there are many good professionals continually battling to offer people what they really need and to help people take up their rightful place as citizens. But the system is stacked against them, because power and control is in all the wrong places. People are not in control of their own lives.

Citizenship Model

Things don’t need to be this way. There is nothing natural about organising social care around the Professional Gift Model. Instead we can imagine a system where disabled people actually have real power and responsibility and where the relationships between the disabled person, professional groups and government are much more balanced. 

In which:

  • The citizen is in control of their life, and any support they need to lead that life.
  • The citizen leads their life as part of a community of family, friends and fellow citizens
  • Where necessary additional support is provided by the state through an entitlement, whose rules and responsibilities are fair, open and appropriate.
  • The citizen can shape any extra support they need by using their resources to negotiate additional support from within, or from outside, their community
  • Professional services are available and agreed on the basis of an equal relationship between the citizen and the professional.


The publisher is The Centre for Welfare Reform.

Citizenship & Professional Gift Models © Simon Duffy 2011.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.