« Previous | Contents | Next »
Listen
A Scottish Executive Review of Speech and Language Therapy, Physiotherapy and Occupational Therapy for Children and Speech and Language Therapy for Adults with Learning Disabilities and Autistic Spectrum Disorder
Part 3 Theory, Policy and Practice Developments
1. The following chapter briefly outlines some key theory, policy and practice developments that are of relevance to the review.
DISABILITY THEORY
2. There have been two key developments in disability theory which have had a significant influence on health and social care practice.
13 The first, the Social Model of Disability, was developed by disabled people and has had the greatest impact on the way services for people with physical and sensory impairment are organised and delivered. The second, normalisation theory has had the greatest impact on services for people with learning disabilities.
3. The Social Model of Disability was developed by disabled people. It challenges the Medical Model of Disability's emphasis on 'fixing' or 'curing' the person and instead directs its efforts towards the identification and removal of social and economic barriers faced by disabled people. The adoption of the Social Model of Disability has gained pace in recent years and has led to a number of practice developments including disability-led services and the purchasing of care services by individual disabled people through Direct Payments.
4. Normalisation
14 is synonymous with the term 'ordinary living' and has been a catalyst for the development of community-based services and the inclusion of people with learning disabilities in mainstream settings. The emphasis has moved from treatment and training to quality of life. Many services now sign up to the framework for achieving quality in services developed by John O'Brien, the 'five service accomplishments'.
15
5. Both the Social Model of Disability and Normalisation are having an impact on the way disability is defined by therapists, that is, whether the 'problem' is located with the individual or located within society. This, in turn, has an impact on the goals or desired outcomes of interventions. In addition these theories have influenced the settings in which services are delivered.
INCLUSIVE EDUCATION POLICY AND PRACTICE
6. The Scottish Executive is leading the way with a number of initiatives supporting the advancement of inclusive education. Recent legislation has placed new duties on Local Authorities in this respect. Section 15 of the Standards in Scotland's Schools etc. Act 2000
12 requires that the education of all children should be provided in mainstream schools, unless certain specified exceptions apply.
7. Guidance to Local Authorities
16 states that the legislation 'is based on the premise that there is benefit to all children when the inclusion of pupils with special educational needs with their peers is properly prepared, well-supported and takes place in mainstream schools within a positive ethos. Such inclusion helps schools to develop an ethos to the benefit of all children, and of society generally'.
8. The Scottish Executive has also brought forward new legislation through the Education (Disability Strategies and Pupils' Educational Records)(Scotland) Act,
17 which was passed by the Scottish Parliament in March 2002. This legislation will require Local Authorities and independent, grant-aided and self-governing schools to prepare and implement accessibility strategies to improve over time access to education for pupils with disabilities. In addition, from 1 September 2002 the provisions of the Disability Discrimination Act have been extended making it unlawful for education and training providers and other related services to discriminate against disabled people.
18
9. A review of the assessment and recording arrangements (the Record of Needs system) for children with special educational needs is also well underway.
19,20 Developments in inclusion have been supported through the Excellence Fund and the SEN Innovations Grants Programme and there have been a number of initiatives funded which aim to improve the transition of young people from school to post school education and training or employment following the recommendations made in the Beattie Committee Report.
21
10. The increasing emphasis on mainstream education for disabled children has obvious implications for the planning and delivery of therapy. These changes will be challenging for therapists, service planners and managers as well as other key stakeholders such as families and education colleagues. However, they also offer exciting opportunities to develop new models and approaches to support children to be included in schools and in society more generally.
IMPLEMENTATION OF '
THE SAME AS YOU?'
11. The Scottish Executive published
The same as you?,
2 the Learning Disability Strategy for Scotland, in 2000, and the following year Valuing People
22 was published in England. The number of people living in long-stay hospitals for people with learning disabilities in Scotland has fallen from 7,000 in 1965
23 to 1,221 in 2002.
24The same as you?2 states that long-stay hospitals should close by 2005. It also recommends the role of day centres should change, operating increasingly as resource centres offering some in-house activities and support. They should also use community facilities more and support people into education, jobs and sports and leisure activities. This has obvious implications for the delivery of Speech and Language Therapy which is also increasingly likely to be delivered in community settings.
12.The same as you?2 makes a number of additional recommendations. These include:
The development of 'Partnership in Practice' agreements between Local Authorities and
Health Boards
The establishment of Local Area Co-ordinators
The widespread availability of Personal Life Plans.
13. These have the potential to provide mechanisms to ensure that the needs of people with learning disabilities, including their communication needs, are more effectively identified and met. In addition, Speech and Language Therapists have a key role to play in ensuring that the commitment made in
The same as you?2 to fully involve people with learning disabilities in decisions about their lives is achieved.
JOINT MANAGEMENT AND RESOURCING OF SERVICES
14. A recurring theme in recent policy documents is the Joint Future agenda, the key parts of which are joint resourcing and joint management of services and single shared assessment.
Our National Health made a commitment to introduce both. Joint resourcing and joint management of community care services starts with older people's services from April 2003. The Joint Future agenda has been strengthened by the provisions in the Community Care and Health (Scotland) Act on delegating functions and pooling budgets. Single Shared Assessment for all community care groups is planned to start in April 2003. Within primary care, joint management and joint working issues are found in the March 2002 report of the Primary Care Modernisation Group 'Making the Connections'.
15. Similar advances are being made on children's services. The Scottish Executive report
For Scotland's Children7 highlighted the importance of an integrated approach to service delivery. A Cabinet Sub-Committee on Children's Services, chaired by the First Minister, is driving forward this agenda. The Changing Children's Services Fund has provided Local Authorities, the NHS, the voluntary sector and other interested parties with resources to re-orient their services in a more integrated way and guidance on more integrated planning for children's services has been issued. Other developments include work to try to build up more integrated approaches to assessment, enabling those from different professions to share information and jointly decide upon action, and studies of workforce issues.
« Previous | Contents | Next »