Liz Jones of Carers Solidarity Forum has thoughtfully asked what my views are on the ‘NICE guideline: short version’ publication up for consultation this month.
‘Learning disabilities and behaviour that challenges: service design and delivery’.
On the whole I thought it was very well written and covers much needed ground. My major concerns remain regarding who determines the critical issues of policy direction and implementation?
Much of this report covers a series of events that were developing in the last quarter of the 20th century. This was built mainly on the work of individual reputations that were never fully challenged nor debated. Consequently, changes have taken place which gave the authority to dictate misguided policy direction to the wrong people, namely, NHS England. the Association of Directors of Adult Social Services, and the Local Government Association.
Bear in mind that despite the outstanding efforts of stalwart carers to retain them, the latter two organisations have been responsible for decimating the ‘local support services’ now so desperately needed to reduce demand on NHS inpatient resources and ATUs. The knowledge that these same people helped form elements of the new national ‘transformation policy, ‘Building the right support (2015)’ and are likely to retain considerable power, can give carers little confidence that the future contributions these organisations will make will be any better than that of the past.
The NICE report states that: “Local authorities and clinical commissioning groups should jointly designate a single lead commissioner who is responsible for commissioning health, social care and educational services for children, young people and adults with learning disability, including those whose behaviour is described as challenging”. It continues: “This commissioner should have in-depth knowledge and experience of working with people with a learning disability and behaviour that challenges.”
Regrettably, finding the right people with such commendable qualifications is not an easy task. Decades ago the structure that existed, and the professional and practitioners involved, ensured that people of the calibre sought were plentiful and identifiable. The ongoing decimation of specialized services has had a serious impact on all areas requiring skills and dedication. Yes, there are still such people around, but they are now a relatively small market. Experience has shown that when plum jobs such as ‘commissioners’ surface those who have shown skill and dedication are passed over as being ‘dinosaurs’, whilst the plum jobs are usually picked up by ‘fringe’ people such as ex-Directors of Social Services. These people are more likely to conform to whatever happens to be the politically correct fashionable policy at the time. And so, until sanity returns and control of policies are unified under an outstanding leadership that reaches for a rational and equitable national policies, there can be little hope for improvement.
The previous popular politically correct one-size-fits-all proposals to get everyone regardless of complexity of disability into paid employment may have been commendable and ambitious but time has exposed how irrational this proved to be. This proposal has been followed by yet another one-size-fits-all doctrine based on direct payments and the extent of personal choices outlined in this publication. Much as this may be right and proper, one must question to what extent hopes will be raised and dashed when the financial and logistical implications of extending these concessions to all who deserve a fully independent lifestyle are taken into consideration?
It is my view that this NICE document has comprehensively addressed most of the areas of concern that need to be addressed, but has not effectively addressed the critical management structure that could bring this about.
Hard evidence leads me to believe we are instead about to embark on a repetition of a similar disastrous circle of events that took place in the 1980s. It must be a matter of serious concern that nothing, absolutely nothing, has been learnt from past experience.