The Department of Health has never claimed that it has a just and equitable policy for the delivery of services for people with a mental handicap. Anyone who thought that there would be any change in this deplorable state of affairs when the 1990s policy document, Shaping the future, was published must be sorely disappointed, especially as equity was meant to be one of its underlying principles. We were led to believe that with the implementation of the strategy set out in that document real steps to ensure fairness would be taken. An important part of this strategy in the field of mental handicap was to be the abolition of the direct funding of fourteen agencies, a system which was becoming more and more indefensible. We looked to its implementation with some optimism. Scandalous contrasts in levels of service and levels of funding based on no more than the degree of influence which some service providers were able to exert when negotiating their annual global allocations with the Department must surely be coming to an end.
The implementation of this particular part of the strategy required long talks by a working group culminating in the report Enhancing the partnership. For the life of me I cannot see why. Nothing of any importance has changed. The direct-funded agencies will take their funding with them, considerably topped up in the last decade or so in preparation for the rough world which they might be expected to meet in close encounters with the health boards. In future, we are told, the funds will pass through the health boards to these agencies, untouched and intact. Hardly a significant restructuring. It is certainly unlikely to change the fortunes of all those people with a mental handicap who were unjustly treated before the partnership was enhanced. Any decisions about policy which do not provide the means for their implementation usually prove irrelevant in the long run.
There is nothing in the new agreement which ties funding to need. The service agreements are not new arrangements which might be expected to give priority to people in need. They will simply describe the service that the service provider is currently giving. Future service agreements will indicate the service which the service provider is willing to give. The funding will stay in place, in time unrelated to the needs of their clients. Not only will the funding stay in place but the hitherto direct-funded agencies are assured of increases in this funding as the costs of their clients are reviewed ever upward. Even when the costs might be judged to be less, the money will not leave the agency; some other area within the aegis of the agency will then benefit. Meanwhile, the difficult person with a mental handicap whose lack of an appropriate service involves cruel hardship for his family, as well as for himself, falls to the care of the health board, to join the other unselected and underfunded people in the statutory services. The working party which produced this document sets great store by ‘the transparency in relation to funding and service developments between the voluntary and health board developments sectors’.
Does the working party mean that when the agencies in the voluntary sector discover the disgraceful inequalities in the two sectors, they will immediately take steps to even things up a bit? This would certainly get the Department of Health and Children off the hook. Unfortunately it is most unlikely. The primary responsibility for the delivery of an equitable service rests with the Department, and in this respect Enhancing the partnership offers no improvement. The sad thing is that this deficiency is unlikely to be noticed by many, for what we have here is the manifestation of an attitude of mind which may be a hangover from the days of the Poor Laws when so many of the services provided by health boards were funded by the rates. The rates were abolished in 1977, but the attitude of minimum provision for the ‘poor’ still persists.
The absurdity of a two-tier service, where both tiers are fully funded from central funds provided by the taxpayer, is lost on the general public. Until comparatively recently very few were aware that their taxes paid for these ‘voluntary’ services. It is not a subject of general interest. But to find the attitude alive and well and flourishing in the minds of our policy-makers is deeply disquieting. One suspects that one of the reasons why otherwise intelligent and fair-minded people think in this way is that they do not regard the person with a mental handicap as a citizen with equal rights to any other person. They are not primarily concerned with the person. They are concerned with the institution. They prefer private institutions to public institutions, to the point where they indulge in discriminatory funding. Until the policy-makers identify this flaw in their thinking, unjust policies will continue to emanate from the Department of Health, underpinned by documents such as Enhancing the partnership.