The management challenge
One of the first priorities in the management approach was to assess the task. East Lothian had reasonably accurate information of adults with a learning disability because of the network that had been developed amongst parents and the dedication of the sole mental welfare officer for the County Council, the late Douglas Webster. No formal register existed however and the main basis of estimating need was as follows:
- Adults attending the Haddington Adult Training Centre: 40
- Adults resident in East Fortune Hospital: 121
- Adults resident in other hospitals: 25 (est.)
A Scottish Office review in 1972 noted that while progress had been made since 1961 in the provision of senior training centres and day care centres, less had been done by Local Authorities in the field of residential care. As one councillor for Midlothian, East Lothian and Peebles Social Work Committee said to me in 1974 ‘why should the ratepayer develop this service and save the government from spending money on hospital beds through the N.H.S?’
Separate initiatives were in hand in Scotland in the early seventies to provide better estimates of need for planning future services and included the following:
- SHHD/SED (April 1972) Services for the Mentally Handicapped [The Blue Book]
- Scottish Society for the Mentally Handicapped (April 1975) Regional Patterns in the Education and Training of Severely Mentally Handicapped School Children in Scotland
- HMSO (1979) Report on Services for the Mentally Handicapped in Scotland – ‘A Better Life’ [The Peters Report]
The Blue Book had recommended a further total of 200 beds in two separate hospitals neither of which were to be situated at the existing hospital at Gogarburn while ‘A Better Life’ addressed the quantitative aspects of future day care needs. In contrast, the National Development Group in England published pamphlets from 1976 on Planning Services for the Mentally Handicapped which adopted the initial approach of establishing who they should be providing services for. They also saw the more immediate advantage of drawing up a list of people known to each authority rather than setting up a new case register for this purpose. Almost ten years later in 1985, Lothian Region established a system of Joint Planning Committees. The Committee on services for people with a learning disability considered that one of its first tasks should be compilation of a register. By 1995, the first database of adults with a learning disability was finally completed based on information supplied by managers of services throughout Lothian.
Estimate of target population (adults with a learning disability in East Lothian):
|Adult Pop 16+(1995)||Est. of 3/1000 adults||Peters Est.1979||Actual|
(Note: the actual figure included 49 residents in Hopetoun Unit and excluded residents of Algrade at Humbie who were all originally from outwith East Lothian)
It was ironic that after 20 years of social work in Lothian Region, this work was giving us the first reliable information base at the same time when there was uncertainty of how this might continue amongst the four new local authorities for East Lothian, Midlothian West Lothian and Edinburgh. Indeed, one of my last tasks before leaving Lothian Region in January 1996 was an attempt to get a commitment for the four authorities to continue with the collection of this data across Lothian subsequent to the April 1996 reform of Local Government.
Looking back over the years, what did all this regional joint planning activity lead to? In East Lothian, joint work was operating between social work services, housing services and health from 1978/79 and a local joint approach had evolved to the irritation of the formal Regional system set up in 1984. Also, by 1986, it was possible to declare that the social work department was in touch with 159 families with someone over the age of 16 who had a learning disability, and that the hospital service were in contact with 80 other families (with an estimate of 315 adults living in the area of whom 185 would have a moderate to severe handicap). Underpinning the management approach was the three-tier strategy for the management of change and a commitment to have joint planning at the centre of operational practice rather than it being a marginal activity. It was in 1977 that the social work department in East Lothian under my management implemented a management approach on specific service objectives for each of the main client groups. The model of service strategies was later replicated elsewhere in the department with a statement of minimum levels of service provision and was assisted with the appointment of specialist resource workers in each of the department’s 17 area teams.