Services for People with Learning Disabilities

Services for People with Learning Disabilities

Services for People with Learning Disabilities

Services for People with Learning Disabilities


Services for People with Learning Disabilities provides a broad review of available services for people with learning disabilities. It describes the present network of services and explains the NHS and Community Care Act (1990) in terminoloy accessible to health care professionals and others engaged in this area. It looks in detail at the concepts underpinning new legislation, including care-management and assessment, quality and inspection, and inter-agency planning, and it supplies up-to-date information on current topics such as advocacy and empowerment, and recreation and leisure. An invaluable resource for all practitioners in health and community care, Services for People with Learning Disabilities will also give professionals and carers a much greater understanding of the changes and improvements that are still needed.


This book comprises a second edition of Services for the Mentally Handicapped (Malin et al., 1980). It includes extra chapters relating to the implications of the National Health Service and Community Care Act (1990) and chapters on advocacy and empowerment, and recreation and leisure services. Otherwise the format is the same as the original: an exploration of main service developments. Some of the arguments presented in the original text are echoed in this edition: people leaving hospital face an uncoordinated patchwork of local resettlement schemes, management and accountability of services at local level remains elusive and disparate, support given to carers far understates acknowledged levels of need, educational and day provision are dominated more by service considerations than planning for individual users.

Since the publication of the first book there have been both contextual and ideological changes in delivery of services. Care in the community has given emphasis sometimes more rhetorical than practical to the deployment of systems of support in ordinary life settings (rather than using residential homes and day centres) and to looking at individual need holistically. in planning, this has been illustrated by efforts to create networks of providers based less on resources of the statutory sector and more on an evolving independent sector. Also, it has become common for users to play an important role in the way services are costed either through making a direct contribution or in being party to contracts drawn up between the user and providers.

Government policy remains that of closing long-stay hospitals for people with learning disabilities but, as Jean Collins' recent research has shown, there are still around 20,000 people in England living in such units and government reliance on local discretion means those opposed to the closure of institutions are able to exploit the difficulties associated with good community services as replacement for institutional provision (Collins, 1993). 'Purchasers (in nhs trusts) are operating under instructions to reduce expenditure. They rarely have the expertise, finance or options available to ensure the service they are buying is what the user wants.' (Ward, 1993).

If legislation on community-based services is to become reality then more

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