How effective has the legislation and policy reforms been in practice
In this essay I will set out to identify key legislation, which has impacted and shaped the lives of my particular client group, adults with learning disabilities. Learning disabilities can be hard to define, but it is widely accepted that impairments in the ability to read, write, spell, speak or perform any mathematical calculations can lead to a diagnosis of learning disabilities. The campaign group Values into Action defines learning disabilities as “A disorder in one or more of the basic cognitive and psychological process involved in understanding or using written or spoken language”.
I will give an overview of service provision from the incarceration of individuals in long stay institutions to the present day practice of caring for these individuals in the community. The key legislation I will be focussing on is The N. H. S and Community Care (1990) Act; key components of this act were the concept of the therapeutic community, psychiatric rehabilitation, sheltered employment, day hospitals and talking therapy. I will also identify other key legislation and government reports, post 1990.
I will be examining what this act has meant in real terms for people who have learning disabilities. Most people would agree that provision is better now for this particular group than it’s ever been in the past, but gaps still exist in service provision. I will also discuss society’s perceptions and understanding of people who have learning disabilities, and how this mirrored government policies of the time. Historically the 18th and early parts of the 19th century were bleak times for individuals who had a learning disability or a mental health problem.
This time period saw the beginnings of the eugenics movements in Great Britain, by eugenics we mean the study of breeding healthier and “better” humans. “Focusing on hereditary nature of defects it led to wholesale incarceration and segregation of disabled people into institutions. There was no welcome for disabled people in the community”. (Slater, C. 1998 p. 3). Segregation of these individuals meant that they were placed in large institutions, often in remote and rural areas of the country. Lack of good transport links meant that it was difficult for people’s family and friends to visit them.
People with learning disabilities were often detained in these facilities for years under the 1913 mental deficiency act. This act allowed for people certified as “mental defectives” to be institutionalised against their will. This attitude was consistent with most of societies at the time. People believed that these so called “mental defectives” were highly promiscuous and were predisposed to leading a violent and criminal way of life. However, in his paper, “A History of Care for People with developmental Disabilities” John Francis stated, ” not all was blinded by the conventional wisdom of the times”.
Josiah Wedgwood, a radical MP from Newcastle-under-Lyme, criticised the legislation as the work of “eugenic cranks”, and was particularly critical of its attack on “feeble-minded” women”. This went some way in showing that not everyone shared these negative views and attitudes, although this M. P was seen as somewhat radical. Changes brought about by the National Health Service (Scotland) Act 1947 meant that the responsibility for the treatment of people who had learning disabilities and mental health issues was shifted from the asylums and long stay institutions to mainstream hospitals.
This also meant that the responsibility for caring for these individuals now lay with the state. This new strategy was actually adopted by the Mental Health (Scotland) Act, 1960. Past mental health laws usually meant the compulsory detainment in institutions for people who had mental health issues or learning disabilities but this new act allowed for people to go into hospitals on a voluntary basis. The 1960s and 70s saw the advent of patients rights and increased campaigning from pressure groups who championed their rights. The hospital closure programme had also gathered momentum.
The publication in 1961 of Ervin Goff man’s “asylums”, and what appeared to be a continuous stream of scandals regarding the abuse of vulnerable groups living in residential care, all supported the view that large institutions, or as Goffman referred to them “total” institutions should close. Not all people who had learning difficulties lived in institutions; some were looked after by their family. People within a family environment still felt excluded, and through the education and employment system were still facing segregation from mainstream society.
In Scotland the largest of the long stay institutions was Lennox Castle Hospital. At its peak it accommodated more than one thousand individuals who had a learning difficulty. When Lennox Castle opened in 1936, in terms of its resources and the quality of accommodation, it was seen as years ahead of its time. It was finally decommissioned in March 2002. Although all political parties agreed that community care would be a positive step and the introduction of new anti-psychotic drugs meant that it would be feasible for patients to return to the community, it wasn’t until 1990 that legislation was actually introduced.
It took another three years for the act to be implemented. The 1980s saw the advent of the new right, and typically new right thinking in the form of privatisation. The conservative government under the leadership of Margaret Thatcher firmly believed that the onus of care should be placed with the family and not the state. This thinking was dominant throughout conservative policies at the time. They believed that many of the people living in institutions did not have to be there and that they were a drain on resources.
It was decided that the individuals living in institutions would be cared for in the community by friends, family, neighbours or other agencies. Critics at the time said that this would become Care by the community and not care in the community. It was also decided that local authorities would loose their monopoly of care provision allowing them to become purchasers of care “packages” for the people who were leaving the institutions. The government at the time stated that the reason for this was that it would enable a person to have more choice in who provides their care, allowing for a “mixed economy of care”.
By this we mean private and voluntary organisations bidding to become providers, allowing local authorities to “shop around” for the best value service. Critics and cynics alike at the time said it was purely a cost cutting exercise and nothing else. I988 saw the publication of two very influential reports. The Wagner report which focussed mainly on Residential care and perhaps more importantly the Griffiths report which actually paved the way for the Community Care Act 1990.
The government white paper: Caring for people, which was heavily influenced by both these reports, set out a list of six objectives ” the need for good case management; the promotion of the independent sector; clarification of the responsibilities of the agencies involved in community care to make them more accountable; the introduction of a new funding structure to remove the bias towards residential care”. (Moore, 1988 pg 201). At the end of the Conservatives term in office, the Direct Payments (1996) Act was introduced.
This piece of legislation allows people to “buy in” their own care services, but lack of guidance and support for people who could potentially benefit from direct payments has led to a poor “take up” rate. In 1997, when the New Labor governments were voted back into power, many people anticipated that they would redress the balance of funding back to state provision; this was not to be the case. New labour also realized the importance of the private and voluntary sector in the provision of care.
It could also be said that the New Labour policies were less aggressive than the policies of the previous conservative government. New Labour policies placed more of an emphasis on helping people to help themselves. In their policies relating to community and social care parallels can be drawn with the past Clinton administration in the U. S. A. For example, welfare to work and the compulsory training of individuals to get them back into work. In relation to people who have learning disabilities, New labour ideological thinking has been very much based on the principles of normalisation and social inclusion, i. . living as normal a life as possible within the local community. Former residents of long stay institutions are now being supported to Live in their own homes with a staff team providing support where required. For people who have very complex needs or who challenge services, shared accommodation on a very small scale, with a highly trained staff team is usual type of supported living arrangement. The belief that everyone is born included and only later become excluded is a thread that runs through new labour community care policies.
Although most would agree that these living arrangements are far superior to living in an institution, concerns have been raised that vulnerable people will not get the appropriate levels of support that they require. The devolved powers of the Scottish Executive has meant that Scotland has been able to go it’s own way with regards to the care of it’s most vulnerable citizens, e. g. the policy of free personal care for the elderly. The Scottish Executives carried out a major review of services for people with learning disabilities “The Same as You”. This was the first review of services for this particular client group for over twenty years.
It contained twenty-nine recommendations for improving services. This document also played a big part in the drafting of the National Care Standards. The Regulation of Care (Scotland) Act 2001 is currently being implemented throughout Scotland. This act set up both the Care Commission and the Scottish Social Services Council (S. S. S. C). The Care Commissions main responsibility is to ensure the registration and inspection of social service provision and providers, using the care standards as a benchmark to measure the quality of care being provided.
The S. S. S. C will oversee the registration of the social care workforce. The governments main aims for establishing both these bodies were to eradicate bad practice alleviate the fears of the general public regarding vulnerable groups not being given the protection that they required. It was also acknowledged people were being supported and cared for by people who were not of good character therefore an act of disclosure was needed and that a certain level of training was required when working in the field of social care.
In a recent magazine interview Jim Dickey, the president of the social services council stated that ninety per cent of the social care workforce believed that having a register would “deliver higher standard of care”. The Disability Discrimination Act 1995 and the Special Educational Needs and Disability Act 2001, both underpin service provision. The former laid down new rights in terms of employment and access to goods and services, as well as the selling or letting of land and property. It was also responsible for the establishment of the National Disability Council.
Until relatively recently the emphasis of social services provision was to address the needs of disabled people rather than concentrating on their rights and abilities. The act attempted to redress this balance and tried to make disabled people less reliant on family and friends for support. It is now, eight years on from the acts inception that it is becoming compulsory for public buildings to have disabled access. This is being phased in gradually but for most people who have a disability, it has been a long time coming.
The Special Educational Needs and Disability Act 2001 is a relatively new piece of legislation, which covers the education of students who have a disability up to the age of 19. In conclusion, I have looked at key pieces of legislation, from a historical perspective and to the policies of our present day government. Community Care that the service Users know today is very different from the care people with learning disabilities received during the early part of the 19th century. Hospitals like Lennox Castle are now closed.
Individuals whom society deemed to be too vulnerable to live independently are now living in their own homes and being supported to access all sorts of provision, provision which they are entitled too. Since its inception in 1990 the N. H. S and Community Care Act has been fraught with controversy. Many people believed that the closure of the long stay institutions would mean that people with learning disabilities would be “dumped” into homes or houses unable to support themselves. It was felt that the government would be reluctant to put enough resources into social care or provide enough provision.
Many believed social care provision would become another “bottomless pit” as far as funding was concerned. It is evident that community care is working. New legislation like the Special Educational Needs and Disability Act 2001 and the Regulation of Care (Scotland) Act 2001 are just now only beginning to make a difference. With this new legislation all the signs point to the fact that the Government have put social care provision quite high on their agenda and are taking the issue of community care seriously.
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