Joint planning: the National Agenda
In September 1983, I was given the opportunity through the Association of Directors of Social Work to link up with a colleague and to submit papers to the Scottish Office on a suggested programme for a collaborative effort between ADSW and the Social Work Services Group on mental handicap services.
The paper we presented at the time suggested that:
- Scotland was performing consistently badly across the range of service provision in comparison with England and Wales.
- Four specific areas could be identified:
- The service model had been to work with traditional ideas and had evolved in the 1960s, with substantial investment in campus based, large scale, institutional care by the Health Service as the main provider of alternative permanent homes and the continued adoption of the 30-bedded unit.
- There was no real understanding of Care in the Community or of normalisation principles in service design with a Scottish plan of twice the rate of hospital places to that in England (120 beds per 100,000 pop.).
- The Scottish support finance scheme was not designed to facilitate change in the pattern of services with a proposed 400% greater investment in hospital admission compared with community care, which would ensure that community alternatives would never emerge.
- There was no indication of any political commitment to change to a ‘care in the community’ approach by John McKay M.P., the Scottish Office Minister at the time.
We concluded that any significant change in the pattern of service would only be possible with a national plan to redirect existing resources and protection of development finance.
In November 1985, I was given the opportunity to represent Directors of Social Work at a conference in Blackpool to consider the recommendations of the Short Committee report on Community Care of the Mentally Handicapped. My notes of the time mention that since the publication of the report, there had been a ‘deafening silence’ from Central Government although Brian Rix of Mencap, had been to see Mrs.Thatcher, the then Prime Minister, and we were told that he seemed to know what was likely to happen. My advice from Scotland was that we had a different vision, ‘to replace and rebuild hospitals’.
Chris Heginbotham, National Director of Mind, suggested eight practical short-term objectives:
- commitment to the objective and vision;
- locally based planning;
- development of a neighbourhood base;
- a major effort to involve GPs;
- implementation of training and retraining programmes;
- welfare-benefit education campaigns;
- the development of monitoring and evaluation techniques to ensure a good quality of care in the private sector;
- initiatives to foster collaboration with health, the voluntary sector and housing.
I only attended this conference for one day but I formed a lasting impression of the dangers of a joint planning bureaucracy. Hampshire had carried out a computer analysis of the time involved and identified costs of 650 different external meetings involving senior management. But the most depressing thought was that here we were again inventing the wheel.
A previous House of Commons committee (chaired by Peggy Jay M.P.) had reported in 1979 (following 3 years’ work and 31 meetings) and reviewed policy statements from a 1971 White Paper and the proposals of a Royal Commission of 1957.
In November 1987, the Audit Commission for Local Authorities in England and Wales had published a paper on Community Care and the Development of Services for People with a Mental Handicap which addressed the challenge of the complexity of the £1 billion business and the need for better organisational and financial solutions to deliver a more effective service. This paper included a restatement of the Jay Committee’s proposals for action.
Against that background, in Scotland:
- A new 72-bed hospital unit was opened in the grounds of Herdmanflat in 1983 with 24 beds in each ward.
- A Scottish Office statement in January 1987 referred to the four new 30 bed units at both Lennox Castle and the Royal National Hospital at a total cost of £5 million and included an assurance to nursing staff that ‘there is a secure future for them in the Health Service’.