Tizard Learning Disability Review Emerald Article: Deinstitutionalisation and Community Services in Greater Glasgow John Dalrymple Article information: To cite this document: John Dalrymple, (1999),"Deinstitutionalisation and Community Services in Greater Glasgow", Tizard Learning Disability Review, Vol. 4 Iss: 1 pp. 13 - 23 Permanent link to this document: http://dx.doi.org/10.1108/13595474199900004 Downloaded on: 22-05-2012 To copy this document: [email protected] This document has been downloaded 136 times. Access to this document was granted through an Emerald subscription provided by For Authors: If you would like to write for this, or any other Emerald publication, then please use our Emerald for Authors service. Information about how to choose which publication to write for and submission guidelines are available for all. Additional help for authors is available for Emerald subscribers. Please visit www.emeraldinsight.com/authors for more information. About Emerald www.emeraldinsight.com With over forty years' experience, Emerald Group Publishing is a leading independent publisher of global research with impact in business, society, public policy and education. In total, Emerald publishes over 275 journals and more than 130 book series, as well as an extensive range of online products and services. Emerald is both COUNTER 3 and TRANSFER compliant. The organization is a partner of the Committee on Publication Ethics (COPE) and also works with Portico and the LOCKSS initiative for digital archive preservation. *Related content and download information correct at time of download. •••SERVICE FEATURE Deinstitutionalisation and Community Services in Greater Glasgow ABSTRACT Knowledge of what makes for quality in adult learning disabilities services does not cascade directly down into grassroots practice. It is instead severely filtered and variously diluted through layers of national policy, local strategy and administrative complexity. In the current difficult climate, quality is not obtained without exposure to the strains and stresses inherent in the dynamics of the health and welfare bureaucracies and their attempts at partnership. Following a largely chronological and descriptive account of attempts to change and develop services in the Greater Glasgow area in the mid-1990s, consideration is given to the effect of these ‘filters’ in the context of the Greater Glasgow Joint Learning Disability Project. John Dalrymple plans to reduce significantly the number of their SUPPORT FOR ORDINARY LIVING, MOTHERWELL (FORMERLY long-stay hospital beds. The second was the PROJECT MANAGER, GREATER GLASGOW JOINT LEARNING introduction of the NHS and Community Care Act, DISABILITY PROJECT) with its double emphasis on the development of community-based social and health care services which enable people to live in their own homes, and INTRODUCTION the transfer from long-stay hospitals of people whose needs can best be met in a community care setting. While there has been a consistent United Kingdom Strategies for the development of a new style of emphasis on the need to shift learning disability learning disability service began to emerge in various services away from policies of segregation and health parts of Scotland, typically proposing significant care dominance towards a model of ordinary living resettlement programmes for hospitals such as: in community settings with the emphasis on social G Royal Scottish National Hospital, Larbert care, there has in Scotland been a much more (in the Forth Valley Health Board area) conservative and slower-moving interpretation of this trend. During the 1980s, when plans were being G Gogarburn Hospital, Edinburgh (Lothian made to phase out, almost totally, hospital provision Health Board area) for adults with learning disability in England and G Lynbank Hospital, Dunfermline (Fife Health Wales, new learning disability hospitals were actually Board area) being opened in Scotland, and the speed of retraction G Merchiston Hospital, Renfrewshire (Argyll in existing Scottish hospitals has been much slower. & Clyde Health Board area) Nonetheless, in the early 1990s things began to G Birkwood Hospital, Lesmahagaow (Lanarkshire change, for two reasons. The first was a short period Health Board area) when the Scottish Office threatened with monetary G Arrol Park and Strathlea Hospitals (Ayrshire penalties those health boards which did not produce and Arran Health Board area) Tizard Learning Disability Review VOLUME 4 ISSUE 1 JANUARY 1999 © Pavilion Publishing (Brighton) Limited 13 SERVICE FEATURE: DEINSTITUTIONALISATION AND COMMUNITY SERVICES IN GREATER GLASGOW G Crighton Hospital, Dumfries (Dumfries and work department, health board and NHS trust. This Galloway Health Board area). reported to an inter-agency project management group (a sub-group of the Greater Glasgow Joint The plans developed in Greater Glasgow (with Planning Group) comprising officers of the regional implications for Lennox Castle Hospital) formed council, the health board, the NHS trust, Scottish part of this larger national picture. Homes, Glasgow City Housing and Strathkelvin In addition to developing these strategies with District Council. local authorities through joint community care plans, The structure of the project was that the health boards were encouraged by the Scottish assessment team focused on individuals in hospital, Office to submit bridging finance applications to working with them and with ward staff to identify assist with their implementation. Lothian Health their needs, while the commissioning team found Board had been successful at an earlier stage in suitable community services. Once services were set securing bridging finance and the permission of the up, it was envisaged that they would be supported, Secretary of State to close Gogarburn Hospital, and to the extent necessary, by specialist community Fife Health Board had made similar progress in health staff. The project team handled inter-agency relation to Lynbank Hospital. Beyond that point, relations as well as project planning. however, it was only the Greater Glasgow plan As a result of training and consultancy work which was to receive this type of financial support arranged for the assessment team, some of the from the Scottish Office, resulting in considerable assessment tools which had been in use were uncertainty over the future of services in other areas, abandoned in favour of a person-centred approach whose applications had in effect been rejected. to individual assessment and service planning known as Essential Lifestyles Planning. In addition to being THE GREATER GLASGOW JOINT a significant development in the policy and practice of the team, this had the effect of providing an LEARNING DISABILITY PROJECT important team-building exercise, giving all members In the summer of 1995, Greater Glasgow Health of the team a shared sense of the task and its Board, the social work department of Strathclyde importance in shaping the future of the people Regional Council and the Greater Glasgow they were working with. This developmental work Community and Mental Health NHS Trust agreed also resulted in increased speed and volume of to collaborate in the creation of a joint learning completed assessment work. disability project. The joint community care plan The major initial task of the commissioning proposed a very significant shift in the balance of team was to develop the range of social care agencies care, the health board had made formal application able and willing to participate in the project and to for the closure of Lennox Castle Hospital, and provide the types of service required. Following application had also been made for bridging advertisement in the national press in May 1995 finance. The project had as its aim the creation seeking enquiries from agencies interested in partici- of comprehensive, competent and locally-based pating in the programme, team members undertook community services for adults with learning visits to agencies in various parts of Britain, seeking disability in the Greater Glasgow area. to evaluate the quality of service such agencies might A project manager was appointed in 1995 in be able to bring to the development of community the social work department of Strathclyde Regional learning disability services in the Greater Glasgow Council to manage the project. An assessment team area. The team arranged a providers conference already existed at Lennox Castle, and to this a which took place in Glasgow in September 1995. commissioning team was added. The project This was important in attracting more providers to manager chaired a joint learning disability project the local area and in engaging some of the existing team made up of middle-level managers in the social local providers in a new way. It was accompanied, 14 Tizard Learning Disability Review VOLUME 4 ISSUE 1 JANUARY 1999 © Pavilion Publishing (Brighton) Limited SERVICE FEATURE: DEINSTITUTIONALISATION AND COMMUNITY SERVICES IN GREATER GLASGOW however, by negative and mischievously-inspired meant, in effect, that the decision on the future of media attention (focusing on hospital closure) which the hospital had been postponed; it did not mean seriously hampered the work of the project in many that the hospital would close, or that the hospital ways over the following months. would not, in the longer run, close. The effect of the Those agencies which sustained an interest announcement was to release sufficient funding for in participating in the project submitted