Bills ignore users’ views

If social care still has a distinctive voice at the highest levels
of policy-making, there is evidence this week that it is not being
listened to. For people who use services, the experience of being
marginalised is nothing new. But for those covered by mental health
and mental capacity legislation, it appears the government is
either ignorant of some of the most important principles
established by the service user movement or is deliberately
undermining them.

For a start, the concept of advocacy is distorted in the Mental
Capacity Bill. The Bill proposes “independent consultees”,
supposedly “a form of advocate”. But they are no such thing. An
advocate’s role is not to determine an individual’s best interests,
but to represent that individual’s views and wishes. They are not
mediators but representatives.

Meanwhile, the draft Mental Health Bill for England and Wales has
disappointed service users and social care professionals at every
turn. It threatens to poison the relationship between them. Again,
the government is either utterly ignorant of the nature and
importance of those relationships, or is deliberately undermining
them. Even the relationship between service users and carers could
be threatened by the effective house arrest of people under
compulsory treatment, which would have to be policed by their

All these developments have one thing in common: the principle of
user-led services, of starting with an individual’s needs and
wishes and building services around them, is being jettisoned in
favour of speed, reducing costs, and controlling behaviour.

The huge strides made in establishing new values in social care
over the past decade are forgotten. Any idea that closer ties
between agencies could encourage the NHS to align itself more with
those values is belied by moves such as practice-based
commissioning, in which mental health services in particular could
suffer because GPs, unlike primary care trusts, do not have to
consult with service users.

Social care professionals are only the leaders in service user
empowerment because the user movement has fought battle after
battle, and is still fighting. Now the government seems intent on
snatching back the spoils of those battles, and setting back by
years the relationship between those who deliver services and those
who need them, to the detriment of everyone.

The relocation of the National Institute for Mental Health in
England from the Department of Health to the Social Care Institute
for Excellence provides a ray of hope. Scie is intent on moving
social care values forward, with the experience of service users at
its centre.

It may be too late for the move to influence the Mental Health
Bill. Scie must act decisively, strongly – and fast.

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