All Wales Strategy for the Development of
Services for Mentally Handicapped People
When I convened a special conference in Cardiff in November 1981
to discuss with those involved in the care of mentally handicapped
people how we should go about developing community based
services, there was general agreement that too little progress had
been male since the publication in 1971 of the Government white
Paper "Better Services for the Mentally Handicapped"; and that we
needed to redouble our efforts to correct the historic anomaly in the
development of National Health Service and local authority provision
which has left the bulk of public service provision in large and, for
many, remote hospitals whilst the great majority of mentally
handicapped people and their families receive little or no support in
their homes where it is most needed. This inadequacy of care in the
community creates a cycle of dependence on institutional care
because this is often the only option open to families who can no
longer cope on their own.
The main problems were clear and we believed that we had some
insight into the possible answers. Nowhere were services
comprehensive and fully integrated one with another; and additional
resources would certainly be needed to effect the transition from a
largely hospital based service to a community based one. These
insights were important but alone would not have made possible the
development of the new services. To move from an appreciation of
the problems and a broad idea of the way forward to a set of
workable proposals required the bringing together of the main
interests - the statutory providers of services, the professional
experts and, very importantly, the representatives of consumers of
services - to put flesh on the bones of what was said at the
November 1981 conference.
I therefore yet set up the All-Wales Working Party on Services for
Mentally Handicapped People. The Working Party submitted its
unanimous report to me in July 1982 and I issued it the same
month for a substantial period of detailed public consultation. The
Working Party’s achievement in so short a time promised well for
the future collaboration on which services will depend. I have
already placed on public record my thanks to all those who joined
with my Department to make the Report possible and it gives me
great Pleasure to do so again here. I would also like to thank all
those who, while not members of the Working Party, gave freely
and generously of their, ideas and time in the development of the
strategy. The best compliment to the Working Party is the public
reaction to its recommendations. We received 85 responses from a
wide range of organisations and individuals and, although most all
of them had helpful changes of emphasis or detail to propose, the
overwhelming majority welcomed wholeheartedly the Report’s
principle proposals.
In the light of this reassuring response, and of the suggestions
made, I have been able to make important improvements to the
strategy, without watering down the Working Party’s principle
proposals. The basic principles of providing care for mentally
handicapped people in their own homes or in ordinary domestic
housing, of developing equal access to services available to the
general public and of especially intensive development in vanguard
areas to test the viability and self-sufficiency of the new patterns of
services are reaffirmed, as is the emphasis on the close involvement
of the representatives of consumers of services at all stages. The
strategy which we now launch is defined in this document.
All involved – and that means the general public no less than those
with a professional or consumer interest – now have the opportunity
to play a part in fulfilling the goals of our strategy over the coming
10 years. I am delighted to commit the resources which make it
possible to embark on the progressive development envisaged by
the strategy, building up over the period to an additional £26 million
per annum on community services. It is up to us all to seize this
unique opportunity. We owe it to the mentally handicapped people
of Wales and their families to work wholeheartedly together in the
common cause. The evidence of the consultation, of the inaugural
meeting of the All-Wales Health Forum and of the service providers’
response to the challenge of producing early schemes to launch the
strategy, gives me confidence that it will be made to work and that
conditions and opportunities for mentally handicapped people in
Wales and their families will be transformed for the better in the
years to come. The principle measure of our success will be the
extent to which we can say, after 10 years, that mentally
handicapped people throughout Wales receive the respect and equal
opportunities that are their due.
Introduction
1.1 This document provides guidance on new patterns of services
for mentally handicapped people and in particular for the
preparation of detailed plans for provision at the local level. It
should be the touchstone for future developments in services and,
in particular, will be the basis for Welsh Office consideration of the
funding of developments.
1.2 The document begins with a statement of principles and
objectives which should govern the development of services for
mentally handicapped people. It then considers the extent to which
present services in Wales fulfill these; sets out the proposed new
patterns of service; estimates the need for these services; lays
down a framework for planning and management arrangements
including the way in which the strategy will be monitored and
evaluated; considers the staffing and training requirements; sets
out the arrangement for financing the new services; and explains
the programming of development.
2. Philosophy and Objectives
The provision of new services should be directed and proposals
assessed in pursuit of the following principles and objectives. It
should be emphasised that these general principles apply to all
mentally handicapped people, however severs their handicaps.
i. Mentally handicapped people should have a right to
normal patterns of life within the community. Mentally
handicapped persons should enjoy as full a range of life
opportunities and choices as their families, friends and the
community can provide. They should be enabled to become
respected members of their communities and should not be
devalued because of their intellectual impairment. They should
enjoy equal rights of access to normal services and be obliged to
rely on special services only when they have a special need which
cannot be met by services available to the general public. This
principle also means that help in making opportunities and
providing the kind of choices that make for a full life is not solely
the concern and responsibility of professionals, whether they are
working for a statutory or voluntary bodies, but is rather more for
society as a whole. Positive encouragement is needed for all those
who have the goodwill and the concern to help mentally
handicapped people to open out their lives. The role of professionals
should be to guide, to counsel as well as to provide direct services.
ii. Mentally handicapped people should have the right to be
treated as individuals. It is not to provide services and to
promote the integration of mentally handicapped people in their
communities unless these efforts help to develop independence and
self-fulfillment. No universally applicable formula or pattern of
service can be prescribed for all the needs of mentally handicapped
people. Each individual has different needs, capacities and
aspirations which need to be identified and which must guide the
efforts of service providers. This principle also means that mentally
handicapped people and their families must play a full part in
decisions which are intended to help them. Alongside the
recognition that care must be primarily a means of stimulating
development and widening opportunities for a fuller life, necessarily
goes the acknowledgement that it must also involve a degree of
adventure. Service providers will need the active guidance and
support of their employing authorities in an approach to the needs
of mentally handicapped people which emphasis development and
quality of life without being over-protected. The community at large
will also have an important part to play in this.
iii. Mentally handicapped people require additional help from
the communities in which they live and from professional
services if they are to develop their maximum potential as
individuals. This does not mean substituting professional or
outside lay judgments’ for those of mentally handicapped people
and their families. But it does mean developing contacts and
informing choices. The importance of supporting the caring efforts
of the families of mentally handicapped people cannot be over
emphasised. Something like four-fifths of severely mentally
handicapped people in Wales are currently supported by their
families in the community. Perhaps the greatest challenge is to
provide support services to relieve the hardships for families which
continue to care for mentally handicapped people, and those which
will enable mentally handicapped people to live as independently as
possible when they wish to leave home or when their families are
no longer able to care for them.
3. Present Policies and Services
3.1 This section asks how far present policies and patterns of
service fulfill the requirements of this philosophy and these
objectives. This question is answered in quantitative terms in
Section 5 below; this section takes a broader look at the issue.
3.2 Existing policy is set out in the 1971 White Paper "Better
Services for the Mentally Handicapped" (Omd 4683). This set the
course which it was believed policy should follow into the 1990s and
specified service provision planning targets for authorities.
3.3
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The main thrusts of the White Paper’s recommendations were:
the development of coordinated health and social services for
mentally handicapped people in each locality;
a major shift in responsibility for the residential care of
mentally handicapped people from health to local authorities
thus involving a considerable increase in local authority
provision;
a considerable increase in adult training centre provision.
3.4 In Wales, as in England, progress has been much slower than
envisaged in the White Paper. The number of people in hospitals is
smaller than in 1971, but far fewer would be there if appropriate
alternative community provision existed. Community based services
have increased but these are currently at a level where they do not
meet the demands either of people in hospitals or those still
residing with their families.
3.5 Most progress has been made in the provision of places in
adult training centers (ATCs) and these centers now represent a
major aspect of community services for mentally handicapped
adults. Most were built and designed to provide industrial training
and occupation in the belief that a substantial proportion of those
attending would be sufficiently well trained to progress to outside
employment of an open or sheltered kind. Research findings
indicate that only about 2% of trainees move form ATC’s to these
types of employment.
3.6 Local authority residential services has developed much more
slowly and progress has been uneven. The majority of places are
purpose-built staffed hostels which reinforce dependence and
attitudes of protectiveness. It is doubtful whether these provide any
more appropriate a form of provision than hospitals except in the
sense that they may be nearer to the mentally handicapped
person’s place of origin.
3.7 Reactions from parents, voluntary organisations and many
interested professionals strongly suggests that families are not
receiving the help they need and have great difficulty in
understanding the services offered.
3.8 How far do present patterns of services fulfill the philosophy
and objectives described above? Quantitatively and qualitatively
there is no question that, notwithstanding the progress made in
recent years, present services fall badly short of the mark. In terms
of the quantum of services being delivered there is a substantial
unsatisfied demand for services in the community. In qualitative
terms, the services which are provided are in many cases
inadequate; facilities are too large, too impersonal and insufficiently
localised to provide for the integration of mentally handicapped
people in their communities and to offer the chance to develop a
variety of personal relationships. This is not to say that there are
not fine and imaginative examples of the right kinds of services; but
they are still the exceptions.
3.9 The other major deficiencies of present community services are
that they are piecemeal and nowhere comprehensive and fully
integrated. For this reason the hospitals continue to be asked to
take on people for whom inadequate care in the community is
available but who do not constant medical or nursing attention.
3.10 The following sections lay down a programme of development
in line with the thinking and objectives outlined above.
4. New Patterns of Comprehensive
Services
4.1 The concept of new patterns of comprehensive services lies at
the heart of the strategy. The term "services" is unavoidable, but it
may be misleading since it implies a series of discrete packages of
care. For this reason the services are described wherever possible in
terms of the human resources involved.
4.2 New patterns of services should embody the following
elements, available locally to all mentally handicapped people:
i. Full access without question to the same services, including
health services, that are available to the rest of the community.
This objective will not come about automatically. It will require
considerable attention and imagination. Those who provide services
for the general public should be helped to realise its implications for
the way they organise their work and the changes they may need to
make.
ii. Advice, support and teaching from social workers, community
nurses, care assistants, other parents and voluntary organisations
for mentally handicapped people and their families as and when
required throughout their lives. These services should always be
given sympathetically and sensitively. They should recognise the
pre-eminent importance of the family in the development of each
mentally handicapped person and the heavy burden on the family
that is caused by stress and lack of help in understanding what can
and should be done.
iii. Short-term relief should be readily available to support the
family. It will need to be locally cased, flexible and capable of
responding to emergencies, e.g. illness of a parent. It should be
available in a variety of settings but wherever possible should take
the form of providing a substitute family. It should therefore include
the development of foster schemes’ such as those in which families
make a commitment to care regularly for mentally handicapped
persons so that their parents or other relatives can take holidays or
breaks which would not otherwise be possible. The keynotes must
be range and flexibility of provision to cope with a variety of
individual needs with the minimum of disruption to the mentally
handicapped person’s pattern of life. Substitute family care should
be provided separately from the statutory care only if their
circumstances truly warrant legal protection.
iv. In each locality a planned network of volunteers who are
prepared to help mentally handicapped people and their families in
any way they can. The NIMROD* register of volunteers provides
one model, but each area will need to work out for itself the best
way to achieve this.
v. Support staff should be available to help run a range of
accommodation for mentally handicapped people which caters for
individual preference and ability. The accommodation itself should
be in ordinary houses and made available from local (public or
private) housing stock. This means that new purpose-built hostels,
hospitals or units should not form part of the patterns. The aim
should be to enable mentally handicapped adults to have a home of
their choice and to live as independently as possible in their home
communities. The level and nature of support staffing will vary
according to the needs of individual mentally handicapped people.
Minor assistance may be all that is required in some group homes.
Some will require resident support staff. Service providers will need
to develop expertise in determining the levels of support required,
which will vary from time to time for each individual and for each
group. In particular they will need to experiment in ways to support
and accommodate the most dependent people. Examples of radical
initiatives to provide accommodation for people with a wide range of
handicaps which should be developed locally include the innovatory
scheme based on MENCAP’s Pengwern Hall in Clwyd where staff and
mentally handicapped people work together to renovate homes in
the course of which people learn skills and develop independence;
the group home provided by Cardiff University Social Services; and
the staffed and grouped homes now being developed by NIMROD.
vi. A range of provision for recreational and social opportunities
should be developed in parallel with dwellings. The importance of
improving day-care facilities is discussed below. The community at
large can come into its own in the provision of companionship and
recreational activities as the MENCAP "Gateway" Clubs are showing.
The success of this policy will need to be judged by the extent to
which it enables mentally handicapped people to blend with
confidence into their communities. It will therefore depend to a
large extent on the involvement of the general public and service
providers should place special emphasis on sensitive and
imaginative efforts to develop this.
vii. A range of domiciliary support must be available. This should
include family aid services for mentally handicapped and their
families where they require assistance with everyday needs.
viii. A full range of day care services, aimed at developing
independence, should be readily available. For adults these should
include opportunities for recreation, training and work according to
individual needs. Currently adult training centers (ATCs) are the
only significant day care facilities. Not only is this too narrow a
range of provision, but many ATC’s are run so as to provide an allpurpose service which is not conducive to the promotion of
independence or responsive to individual needs. In many ATCs’
"training" is regarded as an end in itself with no definite purpose.
For many mentally handicapped people (and especially for most
people of retirement age) training for work is not a realistic
objective and more appropriate forms of constructive activity need
to be developed. These may take many forms according to need, for
example sheltered employment, courses in colleges of further
education, the use of community leisure facilities, running shops,
placements in old peoples homes. There is a need for imaginative
developments along the lines of MENCAP’s "Pathway" Employment
Scheme to create employment opportunities and for better career
guidance and work preparation courses. More local forms of
provision should be developed to avoid the present situation in
which large numbers of people spend considerable periods of time
travelling between home and day care.
ix. The keynotes of educational provision for mentally handicapped
people should be the maximum possible access and integration with
ordinary education facilities in accordance with the provision of
section 2 of the Education Act 1981. These aims should extend to
further education.
Note *New Ideas for Mentally Retarded in Ordinary Dwellings,
Cardiff.
x Staff should work together with mentally handicapped people and
their families in the preparation, implementation and regular review
of individual programme plans for the development of the mentally
handicapped person. The precise purposes and nature of these
plans are discussed more fully in section 6 below. These plans
should form an integral part of care wherever it is provided,
including hostels and hospitals. Their objective should be to provide
the mentally handicapped person with opportunities for choice and
the development of independence.
xi The existing mental handicap hospitals will continue to care for
considerable, though reduced, numbers of mentally handicapped
people until such time as the community services have been
successfully developed to take on the whole job. This does not
mean that patterns of care in health and hospital services should
stand still. On the contrary, it is essential that the hospital should
improve the quality of life for those remaining in their care and
prepare them for life in the community. Mentally handicapped
people in hospital should not by virtue of that be given second-class
consideration. The same principles and objectives that are to guide
care in the community need to be pursued by the hospital services
since the objective will be to prepare residents to return to the
community. This will mean increasing staff: patient ratios and
making hospital provision more domestic in character, with the
emphasis on independence and development rather than care
person. The management of change in the hospital sector will be a
considerable challenge. It is vital that it should be pursued in a
positive way. The Welsh Office will initiate discussion with the
Health Authorities about this and their other essential contributions
to the strategy.
xii Health authorities must also ensure that generic services, such
as dentistry and chiropody, are as readily available to hospital
residents as to those in the wider community.
xiii They do need additional support. The voluntary sector has three
main roles. The first is representing the interests of mentally
handicapped people and their families in the planning and
management of services. This aspect is dealt with in section 6
below. The second is in the direct provision of certain services
developed in co-operation with and complementary to statutory
services. The voluntary sector in Wales has a notable record of
innovation and this should continue. It is especially well placed to
provide advice to the families of mentally handicapped people and
to bring people together in schemes of mutual assistance and social
activity. Statutory providers will have their part to play in these
areas too, as organisers and facilitators. Third, the voluntary sector
has a unique contribution to make in promoting the acceptance of
mentally handicapped people in a community and in encouraging
other to live and work alongside mentally handicapped people so
that they develop opportunities in their lives.
4.3 Building up a comprehensive pattern of provision within each
locality in Wales means far more than the ad hoc development of
particular components of service. It will entail providing a full range
of locally based services and ensuring that these services are
carefully coordinated and readily available to clients. Section 6
below on planning and management arrangements shows how such
a comprehensive service might be achieved. In order to promote
new patterns of service the following policies will need to be
followed:i. As soon as the development of community services permits in any
particular locality, there should be no further hospital admissions.
This will require close co-operation and joint decision making about
the care of mentally handicapped people involving all service
providers, the mentally handicapped person and the family. The
strategy is intended to open up opportunities for mentally
handicapped people and their families, not foreclose them.
Accordingly, professionals should not take unilateral decisions
affecting the way of life on mentally handicapped people.
ii. The Welsh Office and the health authorities will together review
the future of specialist hospital provision in the light of progress in
developing community services.
iii. Operational policies should be developed by the Health Service
to provide unfettered access for mentally handicapped people to
services available to the community at large and the elimination of
segregation on grounds of mental handicap.
iv. The Health Service must recruit essential support staff in parallel
with the development of the community care by the social services
authorities and the voluntary sector. More community nurses
(mental handicap), psychologists, speech therapists,
physiotherapists, occupational therapists, remedial gymnast and
son on will be needed.
v. Service providers and the voluntary organisations should work
together to devise codes of practice to ensure that mentally
handicapped people and their families are counseled in the best
possible way.
vi. Education authorities should continue, in co-operation with social
services departments, to develop access for mentally handicapped
people to the full range of educational provision with the aim of
promoting integration wherever possible.
vii. Education authorities should ascertain in consultation with the
Manpower Services Commission, what services exist and what
opportunities need to be created for mentally handicapped people
school leavers. The findings should be carried through into the
curricular of schools and of institutions of further education so that
courses take into account the needs of subsequent placement as
well as wider educational systems.
viii. ATC’s should provide a prospectus of the services they provide,
including a clear statement of aims and objectives.
ix. Statutory service providers should support voluntary systems
by:a. Co-operating fully to ensure that the mechanisms which make
the statutory services sensitive to need and accountable to
consumers work as effectively as possible (see Section 6 below);
b. Providing for voluntary involvement in local management groups
for those community based facilities which are needed to
supplement informal care;
c. Encouraging those engaged in informal systems of care to form
mutual support associations and to create information systems.
x. The voluntary organisations in Wales concerned with mental
handicap are taking steps in an attempt to speak, so far as possible
with one voice. These efforts are welcome and, subject to a
successful outcome, issues relating to the development of the allWales strategy will be referred to whatever joint forum emerges
and due account will be taken of its views. The Welsh Office would
expect to consult such a forum about those who might play a part in
the all-Wales advisory arrangements (see Section 6.2 below).
xi. The voluntary organisations in Wales should establish advocacy
schemes for mentally handicapped people. Advocacy should be
available for those in existing as well as newly established services.
They should be organised so as to be completely independent of the
service providing agencies. (For an explanation of these schemes
see Annex 3 of the Report of the All-Wales Working Party on
Services for Mentally Handicapped People – July 1982).
xii. Service providers should discuss development proposals with
the local planning authority as far as possible in advance to
establish the current planning position. It may be that, having
regard to the residential nature of the use, ordinary housing can be
used without the need for planning permission (but this may only be
determined with certainty on the facts of each particular case). In
considering applications on their merits, planning authorities should
give full weight to the strategy, with its emphasis on equality of
opportunity for mentally handicapped people in the community.
xiii. Policies in other fields affecting services for mentally
handicapped people should be coordinated by central government
and service providers in such a way that they promote the
principles and objectives contained in this document. A review
should be carried out so that the conclusions and results can be fed
into the coordinated plans which are to be drawn up by the social
services authorities and which will form the basis for the
development for the new patterns over the next 10 years.
xiv. Finally, much could be achieved by improving the management
and deployment of existing services without calling for additional
resources, al service providers, in full consultation with mentally
handicapped people and their families, should review the use of
present resources in the light of this strategy.
4.4 It will not be possible to achieve a comprehensive pattern of
services at the same pace in each locality. In those areas where it is
not possible to move immediately towards the establishment of
comprehensive community-based services future service
development should be planned so as to lead eventually towards
comprehensive local services. Priorities will need to be determined
at a local level on the basis of need, but with particular attention to
the following:i. The establishment of teams to deliver and plan local services
should have a high priority. These teams will form the nuclei of the
comprehensive patters of services.
ii. The development of community services to preclude the need for
hospital admission should have high priority. Of these services, one
of the most urgently needed is the provision of short-term relief to
families. It is also vital to ensure that there is suitable small-scale
accommodation so that when mentally handicapped people wish to
have to leave home they do not have their choice limited to
residential care in hospitals or in traditional large-scale local
authority hostels accommodation.
iii. Policies and procedures in existing local authority hostels must
be reviewed. The objective of hostels, as elsewhere, must be to
develop the independence of the people living in them. It is vital
that staff are selected and trained in such a way that they share
this objective and orientate their efforts towards its implementation.
Thus, institutional, rigid and over-protective patterns of care must
be avoided. The privacy and personal possessions of residents
should be respected. Steps should be taken to reduce the high
density of occupation in many hostels ; as well as reducing pressure
on staff, this should make it easier to create a more domestic style
of environment which promotes personal development and growth.
iv. There is also a need to extend the range, the quantity and the
quality of day care and employment services and opportunities for
all age groups. Authorities should review the operational policies of
their ATC’s and seek to develop a range of alternative sensitive to
individual needs and potential.
v. Training officers in the mental handicap hospitals should design
training programmes and a more domestic style of accommodation
with the aim of promoting independence and personal development.
This should be done in co-operation with the social services
department as the preparation for discharge to the wider
community.
vi. Health authorities should themselves take initiatives in
community care while local authority services are being developed.
For example, nurses should be enabled to go with patients into
domestic style housing. However determined the attempt to create
a more appropriate environment on hospital campuses, the physical
separation and large scale of hospital militates against the most
effective rehabilitation of those who have been, for whatever reason
hospitalised.
5. The Estimation of Need
5.1 Section 2 above described briefly the state of present services
and the extent to which they fulfill the principles and objectives of
the strategy. This section takes the analysis a step further by
assessing in broad terms the quantitative gap between present
services and the new services required.
5.2 The All-Wales Working Party on Services for Mentally
Handicapped People (referred to hereafter as the Working Party)
estimated that there are some 10,000 severely handicapped people
(IQ below 50) and about 40,000 mildly handicapped people (IQ 5070) in Wales. Severely mentally handicapped people require a wide
range of services to help them achieve maximum independence and
as normal a life-style as possible. A wide range of services will also
be required for more mildly handicapped people, but each individual
may require only one or a few components from time to time.
5.3 The needs of severely mentally handicapped people vary
according to the degree of their mental handicap and the degree
and nature of any associated disabilities. It is estimated that about
33% of this group are physically well developed and have no
additional disabilities beyond their mental impairment. A further
very small proportion – perhaps 1% - are able in all respects expect
that they cannot walk without assistance. About 30% are of
medium dependency, meaning that they are mildly behaviorally
disturbed, occasionally incontinent or only partially capable of
feeding, dressing and washing themselves. This leave 25% who are
profoundly handicapped and highly dependent, 5% who are able in
all respects but have severe behavior problems and 6% who have
both severe behavior problems and medium dependency.
5.4 The Working Party examined the extent to which people in
each of these dependency categories were likely to live at home or
in long-term care elsewhere. This analysis was necessarily
conditioned by the existing patterns of care and it is intended that
the move to accelerate development of community provision will
alter the balance of provision. The Working Party found, in the case
of those known to service providers, that for most dependency
groups most are cared for at home and half in long-term care. The
only significant exceptions are that approaching two-thirds of those
whose additional disability is severe behavior disturbance live at
home, whereas only just over one-third of those who combine
severe behavior problems with medium dependency are cared for in
this way. These general findings do not of course apply in the case
of very young children. For obvious reasons most of them are highly
dependent, but at the same time all but few are cared for at home
and those that are not should be adopted or fostered rather than
placed in residential care.
5.5 Special needs also arise as the result of specific disabilities.
Most notably, many severely and mildly mentally handicapped
people need speech therapy and physiotherapy services. The
Working Party also estimated that some 100 mentally handicapped
people would at any one time require hospital treatment for mental
illness, but this will need to be assessed as the new services
develop and be taken up in the detailed discussions between the
Welsh Office and health authorities.
5.6 A further special need is to provide facilities for the small
number of people – mostly criminal offenders – who may need
accommodation in conditions of greater than normal security. Most
are now inappropriately cared for in the special hospitals. However
there are also an unknown number in the custody of the prison
service. In addition a few people are accommodated in private
hospitals in England. The Working Party estimated that special
Health Services provision was required for at least 30 people.
However, further work needs to be done by the Welsh Office in cooperation with the Home Office and the health authorities to
establish the numbers for which Health Service provision should be
made. The Welsh Office, in consultation with the health authorities,
will decide the precise scale and form of provision. it may require
purpose built accommodation and it will certainly require superior
staff to patient ratios.
5.7 The calculations of need of the Working Party revealed a very
large gap to be filled. To give just a few key examples, it suggested
that suitable accommodation in the community was virtually nonexistent; that present community provision in general was modest
(about 1,100 places mostly relatively large residential hostels of the
traditional kind); that there was as shortfall in suitable housing for
some 11,000; that there was a shortfall of about 5,000 day-care
places; and that short-term relief services hardly existed.
5.8 There are only some 2,200 mentally handicapped people
currently resident in the hospitals and not all of these can be
expected to take their place in the community in the short to
medium term. The bulk of the new provision is needed for those
already in the community who are being cared for by their families
and who are coping without adequate support. The consequence of
this is often to place an intolerable strain on families and leads
ultimately to resort to long-term institutional care when families are
no longer able to cope. So the identified shortfall in accommodation
is largely in provision to allow mentally handicapped people to leave
home when they wish to do so: that in the short-term care service
to help mentally handicapped people and their families to lead more
tolerable lives and to avoid resort institutional forms of care; and
that in day-care and recreational facilities to increase the range and
quality of choices and opportunities open to mentally handicapped
people. Only experience in establishing services will tell whether
these estimates of need are of the right order.
5.9 The Working Party considered, but was unable to make a firm
estimate of, the numbers of mentally handicapped people who could
be discharged from hospital now, subject only to the development
of appropriate facilities in the community. Nonetheless, it did not
there are substantial numbers who could do so given adequate
preparation. The numbers will depend primarily on the rate and
progress of developing the new patterns of community services.
5.10 These estimates of need are for Wales as a whole, but there
is evidence that the prevalence of mental handicap and the need for
particular services varies widely between localities. It will therefore
be essential for local estimates of need to be calculated carefully in
the planning of services in accordance with the strategy. In
practice, however, the pace of development will not be so rapid that
there will be a risk of over provision.
6. Planning and Management
Arrangements
6.1 This section describes the planning and management
arrangements which offer the best prospects for bringing the new
services into being. There are 3 principal levels for which distinct
but inter-related planning and management arrangements are
necessary – the all-Wales level, the county level and the local level.
Wherever possible these are built on existing arrangements and
with close regard to existing best practice. Equally, they include
new organisational solutions where these seem essential to the
successful implementation of the strategy.
6.2 The all-Wales level
6.2.1 The most important single factor influencing planning and
management arrangements at the all-Wales level is the source of
funding for the development of the new services. Most of the
additional finance is expected to come from the Welsh Office (see
Section 9 below) in the first instance, with funds to be made over to
local authorities to for part of their "normal" budgets once the new
services are substantially in being. With this in mind, the all-Wales
arrangements are designed for the period which the mew services
are under development.
6.2.2 The duration of this transitional period will depend on
progress in implementing the strategy. Financial issues relating to
the long-term funding of the services once they have been
satisfactorily established will need to be resolved by the Welsh
Office and the service providers collectively.
6.2.3 Against this background, the all-Wales arrangements need to
fulfill the following functions:




to provide a mechanism by which the strategy is financed;
to assess the compatibility of locally prepared plans with the
strategy;
to provide guidance on the preparation and implementation of
local plans for the implementation of the strategy;
to encourage the pooling of ideas and information and to
disseminate good practice;
to monitor and evaluate the development of services to
ensure that they are provided successfully in accordance with
the strategy, that value for money is secured and that lessons
learnt are applied to successive phases of development.
6.2.4 These functions will be the formal responsibility of the Welsh
Office since the level and phasing of funds to be added to what local
authorities, health authorities, voluntary bodies and others make
available to finance the strategy will be determined by the Welsh
Office.
6.2.5 The Welsh Office will need some assistance to carry out
these functions. It will need advice from experts in the field and,
insofar as the evaluation of service provision is concerned, from
those technically equipped to carry out such an exercise. An
informal all-Wales panel of experts will therefore be drawn together
by the Welsh Office from the ranks of providers and consumers of
service. In terms of membership, the emphasis will be on expertise
rather than representation, and will include those will relevant
expertise in social services, education, consultant psychiatry, clinical
psychology, and nursing, plus administrative and financial experts
and members from the voluntary bodies. The panel will be used to
bring expertise to bear wherever it is to be found. There will be no
fixed or formal membership. This panel will not have formal powers
or executive functions
6.2.6 The panel’s functions will be:to advise the Welsh Office in respect of any of its functions listed
above (paragraph 6.2.3);



to act as a consultancy (either as individual members or
collectively) to assist service planners and providers and
voluntary organisations in the drawing up of plans in the
development of services;
to act as a catalyst for the pooling of ideas and information
and the administration and the dissemination of good
practice; and
to advise on the monitoring and evaluation of the strategy.
6.2.7 Those contributing to the panel will not normally be paid a
fee although they will be compensated for any essential travelling
and subsistence expenditure they incur. Fees may be payable to
those carrying out special consultancy exercises on behalf of the
Welsh Office.
6.2.8 The day to day monitoring of the quality and development of
services will be the responsibility of individual service providers and
consumers (see Section 6.3 below). The Welsh Office will also have
responsibility for monitoring and evaluation by virtue of its financial
accountability for expenditure on the development of services, and
in particular to ensure that the new services are implemented:i. In the intended way.
ii. To good effect.
iii. Within authorised limits (both in terms of total costs and the
cost of individual components and packages of care);
iv. to establish the value for money provided by different types of
service provision.
v. so that ways of improving the strategy and county plans, are
considered fully.
6.2.9 The Welsh Office may seek advice on these issues from the
all-Wales advisory panel. It will also be necessary to commission
independent scientific research to evaluate the new services.
Evaluation will be conducted with a view to improving the ability of
service providers to deliver better, more efficient services to
mentally handicapped people, whether in Wales or elsewhere.
6.2.10 There will be a formal review of progress after 3 years, ie
at the end of the financial year 1985/86. Responsibility for the
conduct of this review will fail to the Welsh Office, but it will wish to
call on outside bodies and expertise including the all-Wales panel to
contribute to the review. This may lead to revision of the strategy
and changes of emphasis in resource deployment. There will be a
subsequent formal review or reviews during the 10 years of the
strategy at dates to be determined after the initial review.
6.3 The county level
6.3.1 The following functions will need to be carried out at the
county level:i. The preparation of plans for comprehensive services which,
insofar as they are to be centrally funded, will be submitted to the
Welsh Office for approval;
ii. Responsibility for the provision of services under the approved
plans;
iii. Coordination of the efforts of individual service providers;
iv. Monitoring the quality of service provision at the local level and
ensuring the maintenance and improvement of standards where
necessary; and
v. Ensuring that lessons learnt nationally in the implementation of
the strategy are made known and applied to the development of
services at the local level; and generally the dissemination of good
practice.
6.3.2 Present arrangements for the planning and management of
services differ markedly between counties. Some have formally
constituted joint care planning teams comprising representatives of
health and local authorities, while other favor a more loosely
structured approach to inter-agency co-operation. There are also
differences between counties in the extent and nature of voluntary
sector participation in planning and management. The value of
building on the existing patterns of arrangements is acknowledge,
but at the same time the radical change in the balance and nature
of service provision envisaged in the strategy means that special
attention has to be paid to the adequacy of present arrangements
to respond to this challenge.
6.3.3 No one blueprint is prescribed for planning and management
arrangements at the county level. Rather, when submitting
proposals to the Welsh Office for the central funding of new
services, authorities should demonstrate that they have
arrangements which are capable of fulfilling the functions outlined in
paragraph 6.3.1 above and which can be expected to bring about
the successful implementation of the services. This will mean that
all service providers will need to review their patterns of work and
agreed procedures to ensure that they are capable of responding to
the demands involved in implementing the new services.
6.3.4 Notwithstanding that a blueprint is not proposed for the
planning and management of services, the following important
points are of general application:i. Given that the development of the new services will be the
responsibility primarily of social services authorities, those
authorities should take the lead in the preparation and submission
to the Welsh Office of plans for the introduction of comprehensive
services in accordance with the strategy. In doing so they must
consult fully the health authority, their matching education
authority, housing authorities, voluntary bodies and other relevant
service providers and consumers to ensure that their necessary
contributions to the support and development of services will be
forthcoming. The outcome of these consultations should be
recorded in the submitted plans, but this will not compromise or
dilute the responsibility of individual service providing agencies for
their own services.
ii. In particular formal and informal arrangements must be made to
involve the representatives of mentally handicapped people and
their families in the planning and management of services. It is
acknowledged that there can be difficulties in finding fair and
accepted procedures, especially as regards the means of
determining who shall represent consumers. For this reason no one
method is insisted upon. This will have to be determined locally.
Nonetheless, the local authorities will need to demonstrate to the
Welsh Office that they have developed such arrangements, in
consultation with consumer representatives.
iii. In submitting plans to the Welsh Office, social services
authorities should include details of the manpower resources which
they propose to deploy. Where a new comprehensive range of
services has to be created the magnitude of the development task
and the exceptional managerial skills required should not be
underestimated. Special appointments for the development task will
be eligible for Welsh Office funding.
iv. The Welsh Office will discuss with the health authorities their
contributions to the development of the new services.
v. The Welsh Office will consider with voluntary bodies and other
service providers their essential contribution to the strategy,
particularly insofar as these may require central funding.
6.4 The Local Level
6.4.1 Introduction
Again, no one blueprint for implementing local arrangements is
prescribed. However the following outline of principal features which
a local service should compromise and which will need to be
adapted to local circumstances is recommended. Once again, in
submitting proposals to the Welsh Office, authorities should
demonstrate that their planning and management arrangements are
capable of delivering the new services satisfactorily.
6.4.2 The needs of clients and their families
In achieving as independent a life as possible, mentally
handicapped people and their families may need access at different
times to a wide range of individuals working within many
organisations. These will include doctors, nurses, psychologists,
occupational therapists, speech therapists, dentists, teachers, social
workers, residential staff, day care staff, home helps, housing
officers and social security officers. Problems commonly faced by
mentally handicapped people and their families in relation to these
services include the following:Help is not available or not easily accessible when required.
Inappropriate or inadequate help is given.
Conflicting help or advice is given, sometimes by different
professionals in touch with the client at the same time.
There is not always a sensitive response to individual needs.
6.4.3 It is clearly not sufficient to assume that having the
appropriate professionals in post will ensure that mentally
handicapped people and their families receive an adequate service.
Local services therefore need to be organised to ensure that:mentally handicapped people and their families have ready access
to the help they require, when they require it.
the help provided is of an adequate quality.
The efforts of professionals are coordinated so that the number of
separate interventions by professionals is kept to a minimum and
conflicting advice is avoided as far as possible.
6.4.4 It is not possible to identify a unique organisational solution
to these problems. However, a number of concepts are relevant.
Some of these are:i. Community mental handicap teams
Some of the professions work on a long-terms basis with a number
of clients in various settings. There are major advantages if these
people work together as a team, sharing administrative base,
secretarial support and a common method of organising their work.
The team then provides a single point of contact for mentally
handicapped people and their families.
ii. Key workers
A named professional should be assigned as the main point of
contact with each mentally handicapped person and family. This
person would build up a close working relationship with the client
and be responsible for assisting the client to obtain the help
required at any time. (See also 6.4.12 below)
iii. Individual plans
The individual plan is a way of planning and coordinating services
around each individual client. At any one time it is likely that a
number of professionals will be helping the client (e.g. social
worker, community nurse (mental handicap), residential staff,
psychologist, school or ATC staff, doctor). The individual plan is a
means of enabling these people to form a collaborative partnership
with the client and family in order to plan and deliver the services
required by that client and family in order to plan and deliver the
services required by the client. All professionals concerned with an
individual meet at regular (6 monthly) intervals together with the
client and family to plan the short and long-term aims for that
person. Individuals at the meeting (which must include the client
and family and any relevant voluntary workers) then "contract" to
undertake tasks. In this way a team is assembled for the individual
client, the objectives for that client are regularly reviewed and all
concerned can agree specific responsibilities. The plans can be
changed in day to day work in the light of experience, but the
planning system provides a framework for collaboration and
accountability. A few clients may not need this degree of close
scrutiny of their progress. With the co-operation of the client’s
family the team should be able to advise the stages when this is
desirable. The importance of the full involvement of the mentally
handicapped person and their family in the preparation,
implementation and monitoring of individual plans cannot be
overstated. Plans must not at any stage be the product of
professional assessment alone.
iv. Professional support
A professional support system would ensure that the professional
worker
obtains the resources necessary to work effectively
receives regular feedback on the quality of his/her work
receives help and guidance in overcoming problems
obtains the support of other professionals when necessary
v. Clear operational procedures
It has been customary to provide only a brief operational policy for
any service component and to rely upon the initiative of those
working within the service to develop appropriate objectives and
working relationships. Whilst this gives scope for occasional
examples of excellence, the usual result is that staff have an
unclear view of their objectives and are not organised so as to
provide the best possible services for clients. A major improvement
tin services can only take place if operational policies are
disseminated which establish clear goals and working
arrangements.
6.4.5 A possible local structure
A possible local structure incorporating the above points is outlined
below. It should be emphasised that this is just one possible
example. It will need to be adapted to suit local needs and
circumstances.
6.4.6 Within an area/district (or other appropriate sub-division of
the local authority) a range of services will be provided for mentally
handicapped people and their families. These may include:Community mental handicap team(s) (see below)
Residential accommodation providing short term care, assessment.
Rehabilitation, and long term care (both staffed and unstaffed).
Access to the normal range of health care.
Schools and further education.
Portage services.
Employment, training and occupation services.
Leisure services.
Volunteer services.
Housing services.
6.4.7 The size of the district will vary but generally should not
exceed 100,00 population so that the services can be locally
identified. In dispersed rural areas the district may serve a smaller
population 30-60,000 in terms of natural geographical or
administrative boundaries. In such cases there may be only one
local mental handicap team serving the district, but in larger areas
or more densely populated districts more than one mental handicap
team will probably be required. The community mental handicap
team may, for example, consist of the following specialist workers:Social workers (offering support, help with management, access to
services and resources, etc).
Family aides (offering sitting-in, domestic help, "nanny" services,
etc).
Home advisers (offering individual learning programmes, regular
support, etc).
Community nurses (mental handicap) (offering specialist care
services, designing and implementing individual training
programmes).
Psychologists (giving advice on the design of individual programmes
and working with residential staff).
Health advisors (offering specialist advice as they would for any
family).
Group home supervisors (assisting clients living in semiindependent accommodation).
6.4.8 Individual members of the team may come from either the
Health Authority or Social Services Department and will maintain
links with their professional base. However, it will also be important
for team members to work collaboratively (for example in directing
clients towards the most appropriate local services).
Representatives from voluntary organisations should also be part of
the team where they are playing an active part in the provision of
services in the area.
6.4.9 The function of the Community Mental Handicap Team
should include:the provision of support and advice to the parents of newly
diagnosed mentally handicapped children (including the
development of opportunities to contact their families). They will
need to work closely with generic child care services (see paragraph
4.2xv above);
The preparation and rolling forward of an individual plan for each
client;
The mobilisation of community resources.
The promotion of contacts between mentally handicapped people
and their families and the local voluntary services (for leisure
services, sitting-in services, advocacy etc).
The provision of regular practice advice and guidance to parents
and care staff (including those in homes, ATC’s and schools) to help
them to teach the mentally handicapped person skills and to enable
them to deal effectively with difficulties).
The provision of practical help to clients and their families (e.g.
shopping, bathing and dressing).
The provision of advice and advocacy to ensure that the mentally
handicapped person and family receive their financial and other
entitlements, including access to the full range of health, social and
other local services.
The provision in the team office of a central point of contact and
information for clients.
The transmission to their employing authorities of information
regarding deficiencies in local service provision; and participation in
the planning of local service developments.
6.4.10 The establishment of community mental handicap teams
will not of itself resolve many of the problems. It will not ensure
that a community develops comprehensive services nor that the
individual receives the balanced provision of services for his needs.
But the establishment of teams is an important pre-requisite of
these developments, above all in the way in which it should
promote the integration of services. The organisation and operation
of teams will need to be specified carefully and the members trained
to ensure that high quality services are delivered.
6.4.11 In addition to the core team identified above, a number of
professionals in health, social services, education, housing,
employment services etc will have an important role in providing
services for mentally handicapped people. These will either
providing services directly (e.g. doctors, speech therapists) or may
have managerial responsibilities (e.g. ATC manager, nursing officer,
head occupational therapist). A system of individual plans as
outlined above will help ensure that a team of all relevant
professionals is assembled around each client at regular intervals to
agree objectives, to contract to provide services and to review
progress.
6.4.12 The key worker would be identified as the main point of
contact with a client and may come from one of a range of
disciplines, but it is most likely to be the social worker, psychologist,
member of the nursing team or ATC staff. A particular professional
input is not the important matter. What is crucial is that the client
and family have ready access to the expertise of the Community
Mental Handicap Team and its contacts. This access will be most
effectively provided if a key worker is identified as the main contact.
He or she will also be the focus of new initiatives taken with the
client which will be reported at subsequent planning meetings. It is
important, however, that the role of the key worker should nit dilute
the responsibility of other professionals for the client.
6.4.13 In addition, it is suggested that there will be an important
function for a coordinator of local services at a senior level within
the district. Such a person would have overall responsibility for
developing the local service and for obtaining the collaboration of all
agencies involved. This need not be a new appointment (although it
could be if the work load justifies), but it might be someone, for
example a social worker or senior community nurse, with
responsibility for providing services to clients who also gave
oversight to the following functions:maintaining a register of all local clients
liaising with local voluntary groups and the general public
liaising with local consumer groups and ensuring their involvement
monitoring the quality of services provided and making appropriate
arrangements for their review. This will include meetings of staff
and consumers involved in the district services
managing aspects of the local service (e.g. fostering services,
resource centers, residential services).
managing the budget for the local service
coordinating local plans for the development of services
drawing attention to deficiencies in local service provision
chairing and "Area/District Officers Group" (where one exists, see
6.4.14 below)
reporting to the appropriate county planning and management
group.
6.4.14 Service providers and consumers may find it useful to
formalise their relationship through the creation of an Area/District
Officers Group which would consist of those officers at area/district
level responsible for services for mentally handicapped people and
their families. These services would be:Social Work.
Community Nursing (mental handicap).
Day Care.
Short Term Relief.
Residential Care.
Medical Services.
Education
Housing.
Transport.
Employment.
Links with DHSS Supplementary Benefits.
Psychological Services.
Remedial Therapies
6.4.15 Whilst certain of these officers would need to meet
regularly, others could be involved as appropriate. Whatever
arrangements are made, formal or informal, these people within the
framework of an agreed operational policy will be essential to the
co-ordination of services at local level.
6.4.16 Whatever detailed arrangements for team working are
developed locally, it is essential that they should include the
involvement of representatives of mentally handicapped people and
their families.
6.4.17 In sum, for local structure to work effectively there is a
need for clear operational policies, consumer representation, a
system of professional support for each worker involved, a system
of individual plans for each client and the of a key worker for each
client. Although, as noted above, no one blueprint for arrangements
is to be imposed, local arrangements should include these
fundamental elements.
7. Staffing and Training
7.1 Section 4 emphasised the human resources involved in the
provision of the new patterns of services. This section makes
proposals regarding the way in which staff will need to be recruited,
trained and utilised in the new patterns of services. Too little is
known of the needs of the kinds of comprehensive community
services which are envisaged for the proposals in this documents to
be definitive. They do point the direction of change but they will
need to be reviewed and developed as the implementation of
strategy proceeds. Moreover, even with the most favourable
resource assumptions, it would not be practical in the short-term to
recruit and train all the staff necessary for comprehensive
community services throughout Wales. These consideration point in
favour of a phase implementation of the strategy.
7.2 The key staffing and training deficiencies of present services
are:Generally inadequate staffing levels leading to unacceptable
emphasis on custody rather than the development of mentally
handicapped people, making it impossible for staff to undertake
sufficient in-service training.
Inadequate ratios of staff to untrained staff.
Inadequate co-ordination of the training of those involved in the
care of mentally handicapped people.
Lack of a clear sense of purpose in the management and delivery of
services.
Too low a level of involvement of qualified staff in curricular
development, leading to a lack of commitment to the ‘on the job’
development of trainees’ academic training.
Inadequate emphasis in training on the development of problem
solving and practical skills. This is linked with the failure to delegate
responsibility to the lowest possible level which leads to caution and
over-protectiveness on the part of the staff.
Inadequate or non-existent training facilities in many areas.
Excessively formalised views of training and a disjunction between
theory and practice.
In-service and post-basic training is funded from service budgets.
They tend therefore to be squeezed for resources by the demands
of services.
7.3 In the light of these deficiencies and the knowledge that the
novelty of the philosophy and objective of the new pattern of
service is widely underestimated, the following policies are
necessary:7.3.1 Staff working in new patterns of the service for mentally
handicapped people will need to be given a fresh orientation to the
necessary ways of working and new or additional training.
7.3.2 There should be a detailed examination of recruitment and
procedures by service providing agencies that the right people are
selected for the new services.
7.3.3 The emphasis should be on the acquisition and use of
practical skills, especially problem-solving skills.
7.3.4 Decision making should be delegated to the lowest possible
levels and staff given the opportunity to take initiatives and
calculated risks so as to develop the independence and skills of
those in their care.
7.3.5 The philosophy and objectives of the strategy should inform
the provision of services at all levels and places and be translated
into detailed objectives for staff at the local level;
7.3.6 All staff should have agreed job descriptions which set out
these objectives and define their responsibilities and scope for
action.
7.3.7 Training bodies should try to ensure that training is regarded
at all levels of service as a continuing process and should encourage
front-line managers in their role as providers of in-service training.
7.3.8 In-service training should take place in a variety of service
settings as well as in further education colleges.
7.3.9 Every person who enters the mental handicap services as a
care worker (i.e. a person in day-to-day contact with mentally
handicapped people) should undertake a role preparation course.
Modules should be developed in both the Health Services and local
authorities.
7.3.10 Health and social services authorities should consider
means of providing training programmes where areas of experience
can be shared, both within basic and in-service training. These
should take account of the outcome of consultation on the report of
the joint GNC/CCETSW* Working Group on the training of nurses
and local authority staff caring for mentally handicapped people,
which has provided a timely contribution on the practical steps
which might be made in this direction in the period while community
services are being developed.
7.3.11 Staff at all levels should enjoy ready access to information
about in-service training and education.
7.3.12 No one model is proposed for training. Pilot training
projects should be designed locally.
7.3.13 In the period in which services are being developed the
Welsh Office, with advice from the all-Wales panel will monitor and
advise on innovation in training for the new services. Details of
training proposals should form part of any plan for the development
of local services.
7.3.14 Training officers should review existing in-service and postbasic training provision in the light of this document and subject to
any further guidance from the Welsh Office.
7.3.15 Staffing establishments will need to be increased to
facilitate the release of staff for training.
7.3.16 Curricula should be reviewed regularly in consultation with
staff at the grass-roots level.
7.3.17 Further consideration needs to be given to how the local
education activities could contribute more to the training effort.
7.3.18 Additional funds will need to be provided for in-service and
post-basic training programmes. These funds should be identified
separately from service budgets.
7.3.19 The Welsh Office is taking steps to establish a training
resource information capability and support and encouragement will
be given to the establishment of local centre’s disseminate
information.
7.3.20 Special attention needs to be paid to the training of those
who will be responsible in turn for the training of care workers. It is
absolutely vital that these trainers are properly instructed and
orientated to the needs of the new service.
7.3.21 Multi-disciplinary in-service and post-basic training teams
should be set up in each social service district. They will not
necessarily be engaged full-time on this activity, although they will
need to devote considerable time to it in the early stages of the
strategy. The Welsh Office will give special emphasis in the funding
of early developments to the establishment and training of these
teams. These measures will be supplemented by a limited amount
of special training for direct care workers who will be expected to
pass on their experience to colleagues locally.
7.3.22 Those responsible for medical training (specialist and
generic) will need to take account of the requirement of new
patterns of services in making changes in undergraduate and higher
medical training.
7.3.23 The training of other generic professional staff should
include a substantive element concerned with service provision for
mentally handicapped people. This will both assist the process of
providing equal access to such services and help the professions
involved to support care workers. Much would be gained by proving
common modules of training in relation to metal handicap for
several disciplines.
7.3.24 Volunteers should be trained for their role in support of fulltime staff. Wherever possible their training should be integrated
with that of care staff.
7.3.25 Parents and representatives of mentally handicapped people
should also enjoy access to appropriate training including that
relating to planning and management aspects of service provision
and those to bear their unique personal experience.
___________________________________
*Note: General Nursing Council/Central Council on the Education
and Training of Social Workers.
8. The Estimation of Cost
8.1 The Working Party attempted, on the basis of its estimation of
need, to estimate cost* of providing comprehensive services
throughout Wales. It estimated the gross revenue costs to local
authorities at between £81 million and £135 million per annum;
those of community health services at just over £10.5 million per
annum; and those of medium secure accommodation for 30 people
at about £1.2 million per annum. It added that these estimates
were inevitably subject to wide margin of uncertainty given the
current stage of development of planning for the service to be
provided.
8.2 The Working Party also estimated the gross revenue savings to
the hospital service which would arise from the transfer of patients
to the community. These ranged from over £2.8 million per annum
(based on a 33% reduction in in-patients at the four largest
hospitals with no reduction in staffing) to a theoretical potential of
over £17 million per annum.
8.3 The Working Party therefore estimated the net revenue costs
of comprehensive community-based services throughout Wales to
be in the range of £90 million to £130 million per annum and
suggested a figure of £112 million per annum as a reasonable
working basis.
8.4 These calculations took no account of possible capital costs and
the receipts which could accrue from the disposal of hospital sites.
Although some capital expenditure would be necessary, it is
envisaged that existing buildings should be used wherever possible
e.g. by renting housing and using community facilities such as
leisure centers. The Working Party’s costing of new services had to
be based largely on the costs of present services. Accordingly on
the new services develop the costs will be tested and kept under
continuous review. The Working Party concluded that, while the new
services were not a cheap option , it would be possible to provide
considerably improved community services at far less cost than the
theoretical calculation of the total costs for comprehensive services
for the total population of mentally handicapped people in Wales. As
it pointed out social services authorities currently spend only some
£8 million per annum on these services.
_____________________
*Note: All figures revalued to the Government’s cash planning
prices for 1983/84.
10.The Programming of the Strategy
10.1 The strategy will proceed on the basis of the rapid
development of comprehensive services initially in 2 vanguard areas
and with the balance of funds distributed throughout the rest of
Wales. This will test the viability and self-sufficiency of the new
services and enable the rest of Wales to benefit from this
experience, yet at the same time make possible substantial
progress towards community services throughout Wales. In order to
provide a sufficiently broad case of experience in the patterns of
care, the proportion of the resources devoted to the vanguard
localities will be about one third of the total additional Welsh Office
resources made available over a 10 years period. Once authorities
responsible for the vanguard area have done the initial planning, it
should be possible to develop comprehensive services within a
period of 5 or 6 years. The remaining two-thirds of additional Welsh
Office funding will be available for steady expansion in accordance
with the strategy in the rest of Wales and for a variety of
progressive schemes to relieve the worst hardships and reduce
significantly the need for institutional care.
10.2 The two vanguard areas will be Rhondda social services
district of Mid Glamorgan and the Anglesey and Arfon social services
districts of Gwynedd.
10.3 There will be flexibility in the allocation of resources from
year to year having regard to the extent and pace of development
in the vanguard areas. The aim will be to bring on the rest of Wales
as quickly as resources and other operational considerations permit.
In the first instance most development will take place outside the
vanguard areas to give the social services authorities responsible
for them the time to develop detailed proposals and agree them
with other service providers, representatives of consumers and the
Welsh Office. No fixed timetable is laid down for the completion of
these detailed developments there can begin during 1984/1985 and
it will be the aim to launch training initiatives and other essential
foundation developments in the financial year 1983/84.
10.4 Plans for the development of services over the 10 years of the
strategy should also be prepared by all social services authorities
for areas outside the vanguard localities. These should be
formulated with other service providers and the representation of
consumers and discussed with the Welsh Office and members of the
all-Wales panel. These will be the basis for the allocation of
resources from 1984/85 and should be submitted to the Welsh
Office no later than October 1983. In 1983/84 the Welsh Office will
fund ad hoc developments which are in accordance with the
strategy and which it is satisfied will form part of the ultimate
patterns of comprehensive and integrated