Health secretary Alan Milburn has been talking about revolution.A revolution in care to ensure there are no more forgotten generations of people with learning disabilities.
But behind the ministerial hyperbole which surrounded last week's launch of the learning disabilities white paper, there is real excitement. The people in the know are optimistic that services for people with learning disabilities will never be the same again.
And it is not just specialist services that will feel the change. The strategy's emphasis on civil rights and inclusion - backed, for the first time, by national objectives and robust implementation arrangements - means that the whole of the NHS is going to have to wake up to a group of patients that until now has been easy to ignore. External adviser to the Department of Health on the strategy, Dr Bob Greig, director of the Community Care Development Centre at King's College, London, insists that the white paper 'really is very fundamental for the NHS'.
'It says that specialist services have got to change their focus to one of supporting mainstream services. So the expectation is that people will get most of their healthcare through primary care.
That is a challenge for primary care trusts.'
Dr Greig says this white paper is 'progressive and radical' - and supported by just about every learning disabilities organisation.
The boost given to self-advocacy arrangements is going down particularly well. Expectations have been raised by the development fund (worth up to£100m over two years, from 2002) which will be driving initiatives to modernise services. And There is relief that outdated funding arrangements have been changed to stop the steady siphoning off of learning disabilities money into other local government priorities. 'Old long-stay funding' - money which follows former residents of longstay hospitals until they die, when it often disappears elsewhere - will now be directed to the development fund, where it will make up the revenue element, worth about£60m.
But the government's good intentions might have been met with faint praise were it not for the muscle behind them - the implementation programme.
'One of the huge problems in learning disabilities has been that for 10 years national policy has been fairly sound, but across the country it just hasn't been implemented. There is no mechanism to help people do so, ' says Dr Greig.
This time round policy will be rolled out by a national taskforce (in place by the summer), which will monitor progress and act as a 'champion for change' at local level. There will also be an implementation support team with a development worker in each NHS region charged with promoting good practice. An implementation support fund of£2.3m over three years will go towards initiatives in key areas such as personcentred planning.
One of the most important changes will be the creation of local partnership boards to bring together all the key players in learning disabilities - ranging from health authorities and primary care trusts to housing and employment services. The boards will be responsible for joint investment plans as well as delivering government objectives.
It will also be up to the boards to make sure that every person with learning disabilities is offered a health action plan, detailing their health needs, by 2005. A health facilitator will have the job of making sure the plan is carried out. All of this should make it harder for the NHS to ignore that people with learning disabilities need as much or more healthcare as the rest of the population.
Kathryn Downton, South West London Community trust director of services for people with learning disabilities, says the strategy is long overdue: 'It brings people with learning disabilities into the mainstream of service provision and recognises the gaps there have been in people's access to generic services.'
No-one imagines that delivering personally tailored healthcare to people with learning disabilities is going to be easy. Staffing problems may make it tough for the public sector services to achieve the white paper's objectives, points out Barbara McIntosh, codirector of the learning disabilities programme at the Institute for Applied Health and Social Policy at King's College London.
But at least now everybody will know if they are failing. Chief executive of Oxfordshire Learning Disabilities trust Yvonne Cox says:
'For the first time in 30 years there is clarity about what the expectations are. It is very clear what services should be, how they should be delivered and what outcomes are expected.'
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