The proposal to shut three day centres in Glasgow and provide other services "in the community" is billed as a reform, but in fact it is only a step in a process which has been going on for years, of trying to cut the cost of learning disability (LD) services and at the same time introduce "personalisation" as the means of meeting needs and allocating scarce resources ("Kelman condemns closure of centres", The Herald, December 17, and Letters, December 17, 18 & 19).
The need to cut costs is real. Regardless of who is to blame for the current squeeze on local government resources, in the real world there is going to be less money to spend on all local government services for some time to come. It is therefore essential to focus resources on things which will do most good.
My disagreement with local authorities, and indeed the Scottish Government, is about how they go about planning and managing change. Whatever they say about putting the service users and the carers at the heart of the change process, in fact they always give the lead to professionals and it is the language and thinking of professionals which dominate the debate and determine the outcomes.
That is the wrong approach, not for ideological reasons, but because it does not work. For the last decade and more, professionals have tinkered with the system of LD services, with the dual aims of getting their costs down to a sustainable level and making them more responsive to the needs expressed by service-users and their carers. They have failed. The costs are still not regarded as sustainable and the fears and anxieties of service users and carers have not been addressed effectively. I see no reason why the changes currently proposed in Glasgow and other areas should be more successful than previous attempts.
A fundamental difficulty arises from the differences between the language and thinking of carers and professionals, which are striking. Carers tell me about the people they look after in terms of family, of abilities and aspirations for a fulfilling life of their children and siblings, and of the whole family's desperate need for a normal life. The language of professionals is all about the individual in isolation, about her or his "identified deficits" and about the need to support those deficits. Unpack the language about delivering outcomes and one finds that if one "supports" the "deficit", the job's done. The professionals are also confused about caring families, whom they sometimes describe as service providers, and sometimes as people with interests that conflict with service users' needs. The main reason why discussion between social workers and carers normally ends in frustration for both sides is that they do not speak, or think in, the same language.
Real reform of learning disability services is, indeed, essential, as David Williams, Glasgow City Council's executive director of social work services, wrote in his letter (December 19). But it will not happen without a comprehensive review of the help that people with LD and the carers need.
This review should be led by carers and service users and could usefully start by looking at the views they have expressed consistently for years about what they like and don't like about the services provided or funded by local authorities. To complete the review, it would be essential to face the hard financial facts, but here again it should be the carers and service users who set the priorities and agree the fairest means of allocating scarce resources.
May I add to all the contending political parties, who may see this issue as an attractive battlefield, that they should understand that in the past their practice, though not their rhetoric, has been to support the professionals in any disagreement they have with service users and carers. If they really want to make a difference, they should give the lead in this debate to the carers and service users and pay more careful attention to what they say.
Dr Christopher Mason,
Glasgow City Council Carers' Champion,
City Chambers, Glasgow.
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