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Unofficial social policy

Nearly 30 years ago I wrote a paper later published as my first book chapter.* In it I argued that official social policy – White Papers, legislation etc – had largely failed to bring about improvements in the lives of people with learning disabilities, whereas what I termed ‘unofficial’ social policy had helped steer service provision in the right direction.

The examples of unofficial social policy that I cited included Wolfensberger’s concept of Normalisation, O’Brien’s Five Accomplishments and Towell’s Ordinary Life principle. These radical ideas were picked up by brave and innovative leaders, and the rank and file as well. But it was an uphill struggle and those of us engaged at the time were in a minority. I recall hearing Professor Nick Bosanquet, a champion of people’s rights and a radical himself, speaking at a conference in the late 1980s describing the radicals campaigning for better lives for people with learning disabilities as ‘partisans moving from one safe house to another.’

Starting in the mid-1970s and throughout the 1980s there was fervour, a sense of urgency. People were demanding change. Hospitals started to close and community-based supports were being developed. A reforming zeal spread through the grass roots. Supporting people with learning disabilities to leave institutions was more than merely a job, it was a just cause.

"There are still 3000 people with learning disabilities in ATUs and private hospitals. No change at all."

The creation of Choice Support is an example of unofficial social policy forcing progress and change in the face of inert official social policy. In 1984 a small group of activists held a conference in South London and decided to do something to support the closure of Darenth Park Hospital, in Kent, the first large long stay institution in England to close. The result was the formation of Southwark Consortium, later to become Choice Support.

Have things got better since the early 1990s when I was bemoaning the ineffectiveness of official social policy? No. They have got considerably worse. The policy of successive governments (Labour, Lib Dem/Conservative coalition and Conservative) first worked against the interests of people with learning disabilities, was then less exciting than a damp squib and now is even less effective than when I started to challenge it. Let me give you three examples:

  • In 1993 when my book chapter was published the second part of the 1990 NHS and Community Care Act was being implemented. It was heralded as the beginning of a new and positive era for social care. It introduced care management, a commissioner/provider split and the dreaded competitive tendering, where people’s lives are auctioned off wholesale to the lowest bidder. Once the lid was lifted from that particular Pandora’s box there would be no going back.

  • In 2001 the White Paper Valuing People was published, greeted with enthusiasm and excitement by most stakeholders. However, part of the enthusiasm was probably because there had not been a learning disability White Paper since 1971. Whilst one could not fault anything said in Valuing People there were no great revelations. For me it did no more than legitimise and validate the best practice of the previous decade. I suppose we should be grateful for the government finally telling us that what progressive organisations were already doing by their own initiative was the right thing to do. And as in the case of the previous White Paper, Better Services for the Mentally Handicapped, published thirty years before, the government set out targets for hospital closure with no clear strategy. The history of official social policy repeated itself when hospital closure targets were not met.

  • Another and most disturbing example of official social policy failure and history repeating itself took place in 2011. Starting in the 1960s and continuing into the 1990s there were abuse scandals of epic proportions in learning disability institutions. Official policy was impotent when it came to stopping this abuse. The only solution was to close those institutions. However, by just over a decade into the 21st century there had been three major national abuse scandals. The most recent was at Winterbourne View, a private hospital near Bristol, owned and operated by a company called Castlebeck. It took a Panorama investigation broadcast in May 2011 to expose the physical and psychological abuse suffered by people with learning disabilities at the hospital. In the aftermath the government woke up to the fact that although the doors had finally and belatedly closed at the last NHS learning disability institution in England in 2010, there remained around 3000 people with learning disabilities in NHS Assessment and Treatment Units (ATUs) or private hospitals like Winterbourne View.

    The official social policy response – the DH Winterbourne View Review Concordat: Programme of Action (2012), Winterbourne View – Time for Change (2014) and Transforming Care for People with Learning Disabilities – Next Steps (2015) – must go down as the greatest social policy failure in the field of learning disability ever. There are still 3000 people with learning disabilities in ATUs and private hospitals. No change at all. 

Where does that leave us? With the exception of the failing Transforming Care programme there is very little official social policy relating directly to people with learning disabilities around at the moment. So we have choices. We can do nothing and let the inertia that is already setting in stifle innovation and progress whilst we wait (maybe for a long time) for new official social policy. That, history tells us, will be ineffective anyway. Or we can take matters into our own hands and take action. This is what we are doing at Choice Support – pioneering new ways of thinking and new ways of working relying largely on unofficial social policy. 

There is a compelling need for change, but I don’t think it will come through official social policy. Rather, it will come through passionate, committed and creative leadership, willing to test boundaries and ask difficult questions. Leadership that creates new unofficial social policy that can inspire this generation, just as radicals like Wolfensberger and O’Brien inspired a generation 30 years ago.

Steven Rose, Chief Executive 

* Rose, S.J. (1993). Social Policy: A perspective on Service Developments and Inter-Agency working. In Brigdon, P., & Todd, M. (eds): Concepts in Community Care for People with a Learning Difficulty. Macmillan Publishing, Basingstoke.

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