Published: 16/05/2002, Volume II2, No. 5805 Page 23

I was encouraged to see HSJ giving prominence to the topic of learning disability services ('Over the Wall', Bob Hudson, 18 April), but disappointed to read an article so out of step with modern community-based healthcare.

Indeed, to suggest a modern healthcare system is based on the 1960s medical model identifies a distinct lack of research. This negative view of specialist health services was also an unfortunate feature of Valuing People, which failed to build on the positives of the good-practice guidance Signposts to success.

The principles of social inclusion are the fundamental values which have underpinned modern specialist health services since the 1980s.

Most people may never need specialist support. However, a significant minority with complex needs do require it to achieve anything approaching social inclusion.

Partnership boards have been appropriately facilitated by local authorities to ensure engagement of partners who were previously reluctant to contribute to effective planning.

Partnership boards are responsible for service modernisation through effective commissioning. This will have a profound effect on statutory social care provision, as modernisation of congregate day and residential care will lead to the outsourcing of supported employment and living alternatives. This will leave only minimal levels of statutory social care provision for people with a range of complex needs.

Modern specialist learning disability health services provide a range of specialist teams and services, which interface with a range of partners to facilitate effective social inclusion for people with the most complex needs. If this specialist support is not available we will repeat the mistakes of the 1980s resettlement process and see people sent out of county to so-called specialist placements or hospital. Indeed the developmental agenda and the priorities for the capital element of the development fund are to provide local services for these people.

If you consider this developmental agenda alongside the modernisation agenda and outsourcing of mainstream social care provision, the main function of the remaining statutory services will be to provide a range of communitybased specialist services for people with complex needs that facilitate social inclusion.

Modern specialist health providers are best placed to take on and deliver this integrated provider role.

Specialist trusts do cover a wide geographical area, but this need not lead to centralised decision-making. Indeed, my own trust has a locality structure which reflects partnership board areas. The trust plays a central role in partnership boards influencing the promotion and development of local services, as well as promoting a whole-system perspective.

The critical mass formed within the organisation has led to a strong focus on what would be the 'Cinderella' service in most multi-functional organisations, with greatly improved leadership, recruitment and retention, clinical governance, education and training and service development.

I invite Mr Hudson to look beyond the 1960s and the policy rhetoric and analyse the complexities of supporting individuals with complex needs to live socially inclusive lives.

Paul Newton General manager Learning disabilities Tees and North East Yorkshire trust