This edition of Frontline has a broad perspective; two articles examine what happens when the person with an intellectual disability comes up against the criminal justice system. It is a surprising fact that a large minority of the population of our prisons is composed of people with an intellectual disability. This minority is much larger than appears to be the case in other countries and the reasons for this need to be examined and understood so that more appropriate arrangements can be made for the therapeutic management of people with an intellectual disability who fall foul (offend against?) of the law. This is fundamentally a human rights issue, but it also a function of good governance. We live in an era of an ever-expanding prison populations, which may not be surprising since? and this is not surprising if prisons are to some extent operating as residential holding centres for people with intellectual disability.? It makes little sense to provide an inappropriate service for people who require focused, tailored intervention approaches that can?may impact favourably? on their lives in the medium to long term. Although it may be that a small forensic intellectual disability service needs to be maintained for a minority, for the majority this unfortunate state of affairs needs to be addressed by government (prison management?) both for the sake of the prisoners and also for the health of society as a whole.
Paul Horan’s article on the collision between the salaries of Health Care Assistants (HCAs) and those of Registered Mental Handicap Nurses highlights another area in which a complex problem has been ‘solved’ by a short-term solution, at the expense of a balance in the system. The problem of low pay for care staff in the intellectual disability sector has been one that long required a solution and it is welcome that the government has addressed the matter. The government has, however, only addressed part of the problem, as it is clearly a ridiculous situation where in some circumstances Health Care Assistants are receiving a higher salary than the nurses to whom they report. It is a testament to the dedication of the nursing profession that they are willing to accept this situation in the short term; (but if the situation persists—or is allowed to continue?—the role … it is not a situation that can last because the role of nurses in the field will be greatly eroded. The recent positive evaluation of the pilot Health Care Assistants course (Department of Health and Children 2003) recommends that the course be delivered and administered by the Centres for Nursing Education. T this suggestion highlights a long-term inter-dependent relationship between HCAs and nurses. This relationship can only flourish if both groups are content with the structures at which they interface; if one group is chronically dissatisfied, the main fallout is likely to be (a deleterious effect on?? care standards. Now is surely a prime opportunity for the government to look at salaries in the disability sector to ensure that all those working in the sector receive appropriate remuneration.
However it is not only salaries that need to be examined; the roles of all professionals in the sector are more fluid these days. The review should examine the interface of all professionals in the intellectual disability field with a view to enhancing care standards as well as bringing about better cooperation and coordination within services.
These two topics reported on in this edition of Frontline highlight the challenges for the governmental policy-makers to readjust the balance as a means of improving service standards.