‘No Voice Unheard’ – Where is the vision for people’s lives?
The Government today produced its response to the consultation on the ‘No Voice Unheard, No Right Ignored’ green paper about learning disabilities. Having read it, I feel I’ve just gone back about twenty years in time.
A few days ago, I wrote a blog about NHS England’s latest post Winterbourne View proposals with the headline ‘Let’s not be Cynical’. Those proposals had flaws, most notably a national learning disability policy that was effectively led by the NHS and thus risked taking us back into a ‘medical model’ of service response. However, the proposals were cogent in themselves and had resulted from serious thought and analysis.
The Department of Health has overall responsibility for learning disability policy, and thus today’s document could have provided the over-arching policy framework that placed NHS England’s document into context. It totally fails to do that. The criticism from me and many others to the original Green Paper was that it lacked an overall framework or vision of what policy and services were trying to achieve for people with learning disabilities. The Green Paper contained some good ideas but focused only on issues for people at risk of coming into contact with NHS in-patient services. This document still lacks the framework and focuses narrowly in the NHS interface – but it has also kicked many of the good ideas into the long grass for ‘further discussion’.
To give three examples of why this Government response is so disheartening:
- It repeatedly promises new guidance to help change. Guidance already exists on everything they have promised (supporting people to live independently, involving people in the design of their services etc.) It was written during the Valuing People programme or soon after – was evidence based, collaboratively produced and supported by the sector. Ten years ago, people were starting to use it. Then the Government decided to close down the Valuing People website and that wealth of materials disappeared from public access.
- The one concrete idea in the document is for everyone with a learning disability to have a named social worker. Great idea (though interesting to ask how it relates to NHS England’s proposal last week for everyone to have a local care and support navigator). However, over the last five years, many local authorities have dispensed with named social workers. People and families now have to contact someone on the duty roster who knows nothing about them. The reason – not enough social workers. This good idea flies in the face of the reality of finances in a Social Services Department and simply cannot be afforded in the current climate unless it is just a paper exercise.
- The (sensible) proposal to take people with learning disabilities out of the scope of the Mental Health Act unless they also have a diagnosed mental illness (i.e. like the rest of the population) has once again been shelved for ‘further discussion’. This is exactly what happened last time it was discussed – in 2003. How much more discussion is needed?
The document is full of good exhortations, but what makes the Department of Health think that local authorities and the NHS - who have failed to integrate effectively, commission person centred community services, involve people in decision making and respect people’s rights - will do so now, just because this document asks them to? There are no actions or proposals in the entire document that make compliance more likely. As my psychologist wife says – the best indicator of future behaviour is past behaviour – unless something fundamental changes. This document changes nothing.
My own exhortation to people not to be cynical in response to the NHS England proposals rests heavy on me as I can only describe my response to this Department of Health document as being somewhere between despair and anger. Why do Governments seek to deny the past so much? What a lost opportunity.