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 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 all- purpose 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 all- Wales 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 50- 70) 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 co- operation 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 non- existent; 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 semi- independent 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 post- basic 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 full- time 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