Top of the policy queue?

A recent blaze of activity has raised hopes
that the Valuing People strategy for people with learning
difficulties is back at the centre of the government’s agenda. But
are new structures and guides sufficient to make the strategy work,
asks Lauren Revans.

Ten months ago, people with learning
difficulties in England had every reason to believe that their lot
in life was about to improve. March 2001 marked the launch of the
acclaimed White Paper Valuing People: A New Strategy for
Learning Disability for the 21st Century¹ and, with
it, the promise of a new way of life entrenched in the principles
of rights, independence, choice and inclusion.

Since then, however, the Department of
Health’s agenda appears to have been taken over by hospital waiting
lists, care trusts, national service frameworks, national minimum
standards and much, much more, leaving learning difficulties vying
for attention.

Part of the problem, according to many in the
sector, was the government’s decision not to legislate on the dream
outlined in the Valuing People white paper. Others have
questioned whether there ought to have been a learning difficulty
national service framework. But the main offender, critics argue,
is the government’s continuing failure to back the proposals for
change with any serious money.

The only cash devoted to the white paper’s
implementation is the annual learning disability development fund,
which for 2002-3 stands at £20m capital funding and
£22.6m revenue funding.

Dismissing the fund as “almost loose change”,
David Congdon, director of public affairs for learning difficulty
charity Mencap, speaks for the sector when he warns of the
potential consequences of underfunding.

“The fundamental concern we have had all the
way through is that, although we fully support the four principles
and we fully support the implementation of person-centred planning,
none of it will be delivered without additional resources.”

There are also fears that, without a legally
binding duty to implement the proposals and meet the objectives,
local authorities and health authorities will not consider them a
priority in a pressured and ever-changing world where money is
already very tight.

“My fear is that the strategic agenda is going
to be difficult,” says Yvonne Cox, chief executive of Oxford
Learning Disability NHS Trust and a member of the government’s
Learning Disability Task Force. “I am not critical of all the
change to local authorities and the NHS. But it’s very hard for
people who are not working directly with learning difficulties to
put this anywhere near the top of the agenda.”

But all is not lost. The learning difficulties
sector has a new champion in the form of director of implementation
Rob Greig. And, just last week, the Department of Health seemed to
signal that learning difficulties were back on the government’s
agenda with the publication of the long-awaited guidance on
person-centred planning and draft guidance on partnership
working.

In addition, just before Christmas, the
government appointed the eight regional members of the Valuing
People implementation support team to work alongside Greig in
advising and supporting learning disability partnership boards and
developing regional networks. It also announced the 27 members of
the new task force, which will oversee implementation of the white
paper’s proposals and advise the government on the development of
learning difficulty policy.

So, with the momentum returned, things look a
little brighter. Learning disability partnership boards should now
exist in every local authority area and be in the process of
updating their learning disability joint investment plans (JIPs) to
take account of Valuing People’s objectives. And Greig is neither
deterred by the small amount of money on offer by nor those who
claim that Valuing People is at risk of being ignored.

“I think people really need to understand what
the money is for,” Greig argues. “The revenue [element] is not
intended for new services. Its intended to oil the wheels of change
and to help.”

“I think the big thing about Valuing People is
not about the service change that it talks about, but the change in
organisational and cultural behaviour that’s essential if people’s
lives are going to improve. The development fund is targeted at the
kind of things that will help achieve those changes. For example,
supporting the development of advocacy, helping implement
person-centred planning, helping people get to grips with
partnership work.”

By way of offering assurances that the white
paper will be implemented, Greig proposes four ways of applying
pressure: making partnership boards and service providers publicly
listen and answer to the people they are providing services for;
introducing national performance indicators and encouraging
partnership boards to set additional ones of their own; providing
training in leadership development and change management; and a
three-way performance monitoring arrangement between the
partnership boards, the implementation support team, and the Social
Services Inspectorate and health services inspectorate.

Greig dismisses fears that someone might end
up with fewer hours of service provision if, as proposed by the
white paper, they were to switch from attending a large day centre
to a more personalised service. He insists there is “no real
evidence” to suggest that it is more resource-intensive to offer
individual services or run smaller day centres than to run a large
residential or day centre.

“It’s about how you break into the cycle of
the belief system that the only way to get good quality services is
to have more conventional staff in conventional jobs,” he explains.
“There’s something about trying to find new alternative and
different ways of doing things and, by doing that, levering
different types of resources.”

Central to Valuing People’s goal to change
organisational culture and practice are person-centred planning and
person-centred approaches. The aim is to reach a point where care
management no longer starts from the perspective of what services
are available but what an individual wants and how that can be
achieved.

The guidance Planning With People: Towards
Person Centred Approaches² states that
person-centred approaches do not limit themselves to specialist
learning difficulty services but look to mainstream services and
community resources for assistance to build “a person-centred
organisational culture”.

Jean Collins, director of learning difficulty
charity Values Into Action and another member of the new task
force, agrees that there needs to be a “huge attitude change” in
order to achieve Valuing People’s objectives. But she questions
whether person-centred planning is the way to address
organisational planning, and whether there is a danger of
person-centred plans being trivialised if they are used for
everyone.

“Person-centred planning is about finding out
what people want for their life and how to get it,” she says, “its
not at all for looking at organisations. The white paper says
everyone should have person-centred planning. But what worries us
is that person-centred planning will be reduced to tick boxes.”

But the biggest concern shared by those in the
learning difficulty sector remains the lack of funds available.
Greig cites accessing funds from outside the learning difficulties
sector, particularly from housing, education and employment, as an
ideal way to reduce money troubles. But he also argues that
existing funds are not always being used effectively.

“For the past eight or nine years I’ve been
working as a development adviser across the country. I’ve worked in
nearly two-thirds of authorities across the country. And I’ve never
worked anywhere that cannot achieve better lives for people with
learning disabilities with the money they’ve got at the moment by
doing things differently.”

As the first anniversary of the Valuing People
approaches, the government may have gone some way towards meeting
the sector’s demands to put some flesh on the bones of white paper
with the publication of key guidance last week. But it is unlikely
to do anything to stem the cries for more cash and the accompanying
doubts about achieving the government’s objectives without
substantial financial aid.

¹ Department of Health,
Valuing People: A New Strategy for Learning Disability for the
21st Century, The Stationery Office, 2001, or at
www.archive.official-documents.co.uk/document/cm50/5086/5086.htm
 

² Department of Health,
Planning With People: Towards Person Centred Approaches,
DoH, January 2002, at www.doh.gov.uk/learningdisabilities/new.htm
 

Partnership board functions

Learning disability partnership boards
must:

– By 31 January 2002 – update their learning
disability joint investment plan (JIP) with local action plans
containing proposals for implementing Valuing People. This should
include plans for using the revenue funding and bids for capital
funding.

– By 31 March 2002 – undertake an initial
review of current development of person-centred approaches,
including person-centred planning.

– By spring 2002 – produce a framework for
introducing person-centred planning.

– By spring 2002 – produce an inter-agency
quality assurance framework.

– By summer 2002 – produce a social and health
care workforce and training plan

– By autumn 2002 – review the role and
function of community learning disability teams.

– By winter 2002 – produce a local housing
strategy for people with learning difficulties.

– By winter 2002 – produce a local employment
strategy for people with learning difficulties.

– By winter 2002 – produce their learning
disability JIP for 2003-4

– By 31 January 2003 – produce a day service
modernisation plan

– By summer 2003 – produce a framework for the
introduction of health action plans and identification of health
facilitators.

– By April 2004 – make arrangements so that
people currently living in NHS long-stay hospitals move to more
appropriate accommodation.