The re-provision of learning disability services. Report 2 Service Innovations Background Research Rapid Reviews (SIBR3)

Over recent years there has been a continual de-institutionalisation process involving wide spread closure of long stay hospitals with an accompanying creation of multidisciplinary community teams. The focus of care for people with learning disabilities has shifted towards a more person-centred approach.

Transferring the responsibility of the provision of care for people with learning disability to local authorities has resulted in a decline in the number of residents of long stay hospitals and an increased focus on the services provided in the community. This transference has been thought to be beneficial for the patient leading to reduction in factors associated with institutionalisation, such as: loss of contact with the outside world, enforced idleness of mind and body and a loss of friends and possessions (Barr and Fay 1999).

Although the government has believed such transitions are the correct way to proceed (DOH, LAC(92)15), one must examine whether such a transfer could also place and disadvantages on the patient. This will be considered in greater detail.

The literature highlights a degree of confusion with regards to the co-ordination of services for people with learning disabilities (Gravestock and Bouras 1995, Bouras et al. 1995). Goh and Holland (1994) have suggested that unless service commissioners agree a framework for conceptualising need, there exists the possibility that services will become fragmented. This line of thought is maintained by Hassiotis et al., (2000) where the need for a separate or modified national framework, in order to provide equitable resources for all (including those with associated mental health problems) learning disability patients, is emphasised.

Fortunately, it appears that such a framework will be forthcoming, towards the end of the year, with the creation of the ‘Learning Disability Strategy’ as stated in the governmental circular MISC(99)56. The strategy is based upon the findings of a report entitled ‘Facing the Facts’ which was published in November 1999. In addition to this health and local authorities, with partner agencies, have been requested to complete a Joint Investment Plan (JIP) for adults with learning disabilities to cover the years 2001/2002 to 2003/2004 (DOH 2000).

These JIP’s may be the first step in discovering why, and to what extent, the vast regional differences in the provision and cost of services in local authorities are present. This variation has been highlighted in the ‘Facing the Facts’ report of 1999 and by authors such as Hassiotis et al., (2000). Evidence on the cost of service provision and on relocating patients to alternative forms of accommodation will be examined further on in the report.