Tuesday, 10 November 2015

We don't need no consultation

Lately, I find myself turning more and more to the Devil’s Dictionary by Ambrose Bierce (a late 19th century American rabble rousing journalist and writer) – see http://www.thedevilsdictionary.com/  for an online version. On the day the Department of Health published its response to their consultation “No voice unheard, no right ignored”, I found this Devil’s Dictionary entry:

Consult, v.i. To seek another’s approval of a course already decided on

The sad thing this, applying this to the Department of Health consultation response feels like a bit of a compliment, unless ‘the course of action already decided on’ includes ‘doing as little as possible’. This blogpost won’t be a comprehensive look at the consultation response (can I call it NVUNRI, which any fan of Shooting Stars will know how to pronounce) – others are better placed than me to do this well and it has been handily summarised by @AndyMcNicoll…

Instead, this blogpost will contain some random reflections, in particular doing a bit of good ol’ comparing and contrasting (those student essays burn deep…) with the consultation process and response for Valuing People Now. Valuing People Now (VAPENOW?), let’s remember, is only six years old, and has never to my knowledge been officially superseded by any overarching policy for (with?) people with learning disabilities since.

A declaration of interest here – at Lancaster University we analysed the responses to the Valuing People Now consultation – although my beef isn’t largely with the way the NVUNRI has been analysed and reported (this was also done by an independent agency, The Evidence Centre). Instead my beef is with the half-hearted way in which the Department of Health ‘promoted’ the consultation, and the political uses to which the consultation has been put.

The Valuing People Now consultation (see here for the report analysing what people said http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_093362.pdf ) gained in total 2,009 useable responses, including: 730 from people with learning disabilities; 407 from family members; 375 from professionals; and 375 from ‘others’. The report analysing the NVUNRI consultation (see here https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/475153/summary_of_responses_acc.pdf ) gained 468 responses, of which ‘half’ were from people with learning disabilities and families, which a maximum of 389 responses to any individual question. Clearly, the Department of Health didn’t put nearly as much effort into encouraging people to give their opinions this time around.

The numbers of people responding to the NVUNRI consultation start to look perilously small, particularly when they are broken down into the views of different groups of people who may have different perspectives (people with learning disabilities vs large voluntary sector organisations, for example). Only the consultation analysis, and DH’s consultation response, doesn’t do this. Although we could have done a much better job of the Valuing People Now consultation analysis, particularly in terms of including people with learning disabilities and family members in the analysis, we did feel it was crucial to represent the views of people with learning disabilities, family members, and professionals separately.

Instead, throughout the DH response there is a general air of ‘some people said this, other people said that’, which is used to justify inaction or a bit more pondering. Well, which people said this and which people said that? Who is more important to listen to? What about doing what’s right?

Whatever our collectively jaundiced views on government rhetoric, the shrinkage of ambition from Valuing People Now (see http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_093375.pdf ) to NVUNRI (see https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/475155/Gvt_Resp_Acc.pdf ) is striking, even in the ministerial forewords - always a good indicator of whether the civil service machinery is signed up to a policy. Words are cheap (a lesson I know well!) but compare and contrast these snippets from the forewords – (1) is from Valuing People Now and (2) is from NVUNRI:

1)      People with learning disabilities are entitled to the same aspirations and life chances as other people.
2)      Our vision of a civilised society is one in which we take more responsibility for ourselves and our neighbours as part of thriving communities working together, and with less dependence on remote bureaucracies.

1)      But although we have made real progress, there is still a lot to do – and that is why we are restating our commitment to leading change to transform people’s lives and opportunities.
2)      One area where we are still not making enough progress to realise our vision is for those with learning disabilities, autism and mental ill health.

1)      This Government is determined to deliver equality and independent living for all disabled people.
2)      Our aim is that people lead as fulfilling and independent lives as they can, and that they have the support to live independently when possible.

1)      Moreover, we recognise that people with learning disabilities are among the groups most often excluded from society. That is why we have made it a priority across government to support more people with learning disabilities into real jobs and settled homes.
2)      For some people, being in employment will be a key indicator of success.

1)      The strategy and the delivery plan which is published alongside it set out the action we plan to take over the next three years, working with people with learning disabilities, their families and carers and with other partners.
2)      That is why you will find that this response is phased so that we can make progress urgently by building on existing momentum and implementing change quickly as well as setting out a longer term plan that will tackle some of the most difficult and complex challenges.

1)      The strategy focuses on what needs to be done at all levels to deliver the vision of equality and transformed lives for everyone.
2)      The package of proposals we set out here is intended to enable system-wide changes that make it easier to do the right thing for people and their families.

1)      If people with learning disabilities and their carers are to have the same opportunities as other people in society and to lead a fulfilling life, we need to improve their access to the whole range of public services.
2)      Many people and organisations at all levels have key parts to play in making our vision happen. At the local level, Health and Wellbeing Boards need to ensure they have good plans to tackle the challenges ahead.

1)      It means taking a human rights-based approach.
2)      As a country, a key measure of our success will be how we care for the weakest and most vulnerable in our communities.

To be honest, I feel a bit torn about presenting these comparisons – perhaps the replacement of overblown rhetoric with a bit of becoming modesty about doing practical, achievable stuff within a realistic timeframe is a good thing? Well, I’d be more convinced about this if there was a convincing, practical plan on the horizon. For all the consultation response’s grand talk about Implementation Phases 1, 2 and 3 (although they’re not sequential, you understand?):
·        Implementation Phase 1 seems to be mainly corralling stuff that is already happening (some of this is good stuff that’s worth doing, but timescales are not attached), although the DH should have learned from the Winterbourne View saga that ‘guidance’ rarely has the Cillit Bang effect on commissioners and services already under the cosh and past caring what the government tells them to do;
·        Implementation  Phase 2 is waiting to see whether any fiddling with the Mental Health Act will be recommended to the government from the Law Commission; and
·        Implementation Phase 3, “which explores more radical solutions to longer-term issues, as well as ongoing monitoring and review, and a commitment that the Government will intervene further, including through legislation if necessary, if the improvements sought continue not to be realised in practice.”

Implementation Phase 3 is curious, a kind of “You don’t feel well? Come back and see me when it’s developed into a full-blown health crisis and then we might do something” vibe. This doesn’t come close to understanding the reality of the lives of so many people with learning disabilities, how this is likely to be getting worse rather than better, and the urgency of doing something radical about it now (#LBBill anyone? https://lbbill.wordpress.com/ ).

It also doesn’t seem to realise that the information the government is collecting that could be used to ‘monitor’ the situation is getting worse rather than better in relation to people with learning disabilities (at least, the information that is made publicly available). For example, less information than in previous years can be specifically examined for people with learning disabilities regarding safeguarding referrals and their consequences and Deprivation of Liberty Safeguarding processes. There is no specific publicly available information about people with learning disabilities at all that I can find in DWP statistics (I would love to hear that I’m wrong on this). Significant numbers of commissioners and local authorities don’t bother to provide information on important policy priorities, such as the number of people with learning disabilities in inpatient services. People with learning disabilities are rapidly disappearing from official sight (and from a responsibility to be supported), both within education and adult social services (see http://chrishatton.blogspot.co.uk/2015/11/the-disappeared.html ). And the DH have not had the commitment to drive through mandatory reporting of deaths of people with learning disabilities in services, surely the most fundamental ‘monitoring’ indicator there is.

It just doesn’t feel enough.


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  2. The very next entry after CONSULT in the Devil’s Dictionary is:

    CONTEMPT, n. The feeling of a prudent man for an enemy who is too formidable safely to be opposed.

    I am certainly feeling it towards the bureaucrats massaging figures and watering down reports to hide suffering so that laws can be passed relieving the fortunate and well off of any moral duty.

    Keep blogging to redress it!

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