ࡱ> ` ެbjbjss .%T888899d4Yh :":"D:D:D:D:D:D:XXXXXXX$Zh]pX?D:D:??XD:D:XBBB?pD:D:XB?XBBU[WD:: .L8a@<7VXY04YKVt]At]([Wt][WXD:H;Bv<2=D:D:D:XXOBpD:D:D:4Y????"88$  Response prepared by the British Institute of Learning Disabilities to the Green Paper Independence, well-being and choice 28th July 2005 Keith Smith, Chief Executive, BILD Registered Office, Green Street, Campion House, Kidderminster, Worcs. DY10 1JL Telephone: 01562 723024 28th July 2005 Paul Richardson, Adult Social Care Green Paper Consultation Unit, Department of Health, Wellington House, 133-155 Waterloo Road, London. SE1 5UG Dear Mr. Richardson, BILDs Response to the Adult Social Care Green Paper Independence, Well-being and Choice The British Institute of Learning Disabilities (BILD) welcomes the opportunity to respond to the Green Paper and its proposals for the future direction of social care for all adults in England. Our response has been developed in consultation with our many stakeholders, including BILDs Council. We anticipate that this consultation will be the start of a process which will enable adult social care services to become truly person centred and inclusive. The vision for social care BILD fully supports the new vision for adult social care outlined in the Green Paper and based on the principle that everyone in society has a positive contribution to make and that they should have a right to control their own lives. We welcome the emphasis upon partnership working between local authorities, primary care trusts and the independent/voluntary sectors to make the best use of available resources. It will be important to ensure that more creative ways of offering holistic support are developed so that real choice is possible for all individuals as opposed to the traditional menu of services. We are pleased to see the emphasis upon inclusion and involvement and a recognition that the way to sustain an individuals independence is by building networks and coalitions of individuals, families, carers, friends, supports and community capacity. Inclusion of all sections of the wider community is vital. There is considerable work to be done to ensure that citizenship and automatic access to opportunities in the community is available to people with learning disabilities. Currently, this can be particularly difficult for people with profound and multiple disabilities, sensory impairments or people with learning disabilities from black and minority ethnic communities. The values and vision expressed in the Green Paper reflect many of the initiatives in services for people with learning disabilities over recent years. In particular, it reinforces the 2001 White Paper Valuing People with its four principles of civil rights, independence, choice and inclusion. However, the lessons learnt from the implementation of Valuing People suggest that large scale change in social care approaches and values take time to become embedded in the culture of services and support. It will be important to ensure that the changes already in progress linked to Valuing People knit together with the proposals in the Green Paper and the new 20 year disability strategy Improving the Life Choices of Disabled People. A unified strategy is required that clearly ties these strands together and builds upon the progress already made as a result of Valuing People. The Green Paper emphasises that the voices of people receiving social care should be heard at all times. We would emphasise the paramount importance that the views and opinions of people with a learning disability and their families and carers must be at the centre of the delivery of this social care vision. This echoes the Valuing People commitment of nothing about us without us. However, it must be recognised that communication and involvement can be difficult to achieve and must be worked at creatively. Offering individuals choice in relation to their support and life decisions will require the time to get to know each person and their preferred methods of communication. In particular, people with profound and multiple disabilities or anyone who cannot communicate verbally will require additional time and support for them to benefit from the approaches outlined in the Green Paper. Allied to this must be recognition of the important role of advocacy in its many forms to support individuals in making their views and opinions known. Despite the widespread recognition of the importance of independent advocacy, there is little sustained funding for its delivery across the country. It will be important that there are clear links between childrens and adult services. The holistic approach as outlined in Every Child Matters should be reflected in adult services otherwise, there is a danger that the ongoing difficulties at transition will continue. Any future structure in social care must actively encourage working across Government departments and joint working with local authorities. This is particularly important in relation to health. 2. Setting Clear Outcomes We believe that the seven outcomes are very positive and empowering. For people requiring support, there is a positive move from merely being able to survive to the recognition that an improved quality of life is the aim. An approach which focusses upon outcomes rather than inputs is to be welcomed. However, it will always be much more difficult to assess the qualitative impact of social care interventions. We would wish to raise the importance of addressing issues of communication and the need to ensure a range of ways of finding out information from people who do not express their views and choices verbally. One of the areas that is missing in relation to the outcomes is friendships, companionships, relationships and intimacy. We know that many people with learning disabilities only have opportunities to spend time with either their family, their peers or people who are paid to be with them. Many people who have been resettled from the long stay hospitals or who have moved through a variety of residential placements have not been supported to maintain contact with friends or people they have lived with in the past. In moving to an inclusive approach, the issue of how to widen peoples opportunities for friendships and relationships in the community should be included as an outcome. Further work will be required to provide practical ways to achieve the outcomes that are both deliverable and measurable. This will require partnership working across all central and local governmental and community agencies and not just social care. For example, freedom from discrimination, access to transport and improved health will depend on an approach that addresses the wider inclusion agenda. 3. Putting People in Control We support the Green Papers aim to move to a system where adults can take greater control of their lives. For many people with learning disabilities, the quality of support available is patchy and inconsistent. There remains a postcode lottery where service development varies depending upon where people live. Eligibility criteria developed as a result of Fair Access to Care often means that little or no preventative support is available. Overall, there can seem to be little flexibility or creativity in the narrow menu of services and support available to people with learning disabilities and their families and carers. This is particularly true in relation to people from black and minority ethnic communities. Therefore, we support the approaches outlined in the Green Paper that seek to diversify the ways that people can receive their support and increase individual choice. However, we recommend that further work is undertaken to investigate potential options for services required by minority ethnic communities. (a) Managing Risk We believe that people with learning disabilities should be able to take the same risks as anyone else, providing that they have been given sufficient information to allow them to make an informed decision about the risk they face. Care services have become extremely risk averse and are often more worried about protecting their own back than supporting people to take more control over their choices and lives. Similarly, commissioners and regulators can be risk averse and create the situation where service providers are unable to support people creatively and with a common sense approach to risk. With more people with learning disabilities living in their own homes and tenancies, and with an anticipated increase in the use of direct payments and individual budgets, there will be an inevitable increase in the risks facing individuals with learning disabilities living in the community. We are keen that the discussion about risk results in common sense approaches. It is unlikely in any situation that all the risks of harm can be totally ruled out. However, positive and flexible support should be about enabling individuals to lead their own lives successfully. The starting point should be to identify the important things in peoples lives through a person centred planning process which includes a process of identifying and managing risk through options such as: Altering the physical environment Supporting the individual in a different way Providing training for staff offering the support Helping the individual make new choices and explore different opportunities If people with learning disabilities and their families are to be provided with information to enable them to make choices in relation to risk, then this will need to be done in a variety of accessible ways. There is a role for advocacy in this process. There is a balance to be achieved between allowing individual choice and the need to offer protection for vulnerable people. Risk inevitably means that mistakes can be made and that things could go wrong. Risk assessment will continue to be required but should start from the premise that the risk can be managed rather than protecting the agency and staff. It will be vital to enable risk with the appropriate support and information and ensure adequate protection for those who need it. (b) Providing better information and signposting We support the provision of better information about support and services as this will enable people to have more control over their lives. People with learning disabilities and their carers consistently criticise the lack of information available and can be greatly frustrated by being passed from person to person or from department to department. It can feel that the lack of local information acts as a gate keeping function and there is an inevitable appeal towards information being provided independently and not linked to service provision or commissioning. Information must be available that is easily understandable and relates to peoples individual circumstances and situation. Choice is worthless unless it is informed and people with learning disabilities and their carers need to know and understand what is happening and what their options and choice could be. If people with learning disabilities are to have the same chances as everyone else, then they must have the right information in the right format at the right time and with the right support to understand and use it. Additional support will be required to ensure that people with profound and multiple disabilities, people with learning disabilities and sensory impairments, and their carers have access to information. Information providers will need to invest time and resources to ensure that they can respond to the different requirements of people with learning disabilities if real empowerment is to take place. It is very important that each local area and community identify the range of approaches and networks that can pass on information. For example, information that can be passed on by word of mouth may be a positive source of advice for some black and minority ethnic communities, backed up by written material as required. In addition, ICT and the internet has become a very significant way in which information is now transmitted. People with learning disabilities will need to have access to computers in order to access a wide range of information and communication. There is a need to establish the wider use of ICT in social care, as it can have considerable positive impacts for all people with learning disabilities, people with high support needs, and profound and multiple disabilities. BILD are aware of some excellent work being developed in this area by H.F.T. (c) Assessments We welcome the acknowledgement that social work assessments have been perceived as rationing or gate-keeping services and resources. The role of care manager has all too often mixed the assessment and budget allocation process in ways that have been unhelpful to people with learning disabilities. The link between identifying the support that people require and rationing must be broken. We would welcome the possibility of people being able to self assess, but would recognise the danger of individuals or their carers under assessing. Clearly the success of any self assessment would be the simplicity of the system the current care management approach is both confusing and too bureaucratic and limits funding to what is identified in the care plan. Individuals themselves are the experts on what they need and our experience is that they are realistic in their expectations. However, people with learning disabilities would have to be given the right support from advocacy, peer support and help lines to help them make their own decisions. We would welcome an assessment process that streamlines assessments between agencies, not only between local authorities and the Department for Work and Pensions but also including health and education. The experience of many people with learning disabilities is that they are continually assessed at regular intervals but that outcomes are often not achieved. Person centred planning offers a holistic and ongoing approach to identifying the most important things in a persons life and how to enable them to be full and active citizens in the community. This approach does not focus upon dependence and what people cannot do, unlike the current benefit system. Instead, it focuses upon individual wishes and ambitions and looks for ways to achieve them. This approach is not an assessment process and we would want to avoid the person centred planning process being subsumed into a single assessment process or the care programme approach. However, person centred approaches will assist in improving the ways that the support requirements for people with complex needs are identified. The Green Paper acknowledges the complexity of the current system and proposes individuals with roles such as person-centred planning facilitator, care manager, care navigator and care broker. We believe that this will lead to confusion and would suggest that individuals requiring support would be able to determine who provides the help needed to understand and get through the system. This may be a professional such as a social worker or community nurse, it could be an advocate or a broker, it could be a circle of friends, or a family relative or whoever was most appropriate. The key is ensuring that there are a variety of choices to enable people to identify their support needs and to move forward in planning. (d) Direct payments and individual budgets We believe that the use of direct payments and individual budgets is the key to delivering the vision contained in the Green Paper. However, there has been a low take up of Direct Payments for people with a learning disability. This appears to be due to issues such as complicated paperwork; individuals and carers not wanting to employ and manage staff; difficulties in staff recruitment and retention; and the failure of some local authorities to actively encourage the take-up of direct payments. We believe that the benefits of direct payments should be extended to those currently excluded on the grounds that they lack the capacity to consent or are unable to manage the process with consistency. The use of an agent to manage the direct payment on the individuals behalf would help to increase the number of people who could benefit from this option. It will be important to include on the menu of options the opportunity not to have a direct payment or an individualised budget. One of the negative aspects of direct payments is the bureaucracy and monitoring that takes place to ensure that the money is being used for the purpose agreed. There is a danger that people assessing direct payments can be subjected to more stringent monitoring than in traditional support without any evidence to suggest that there are any greater risks of fraud than in normal services. We believe that the introduction of individualised budgets offers a creative and person centred way for adults with learning disabilities and their families to have greater control over the services they need. BILD has been impressed by the In Control pilots on which the concept of individual budgets outlined in the Green Paper is based. It offers the opportunity for people with learning disabilities and their families to find out what money they are entitled to from the social care system and plan to use it in the way they want. This could include the ability to choose to have a direct payment; or to have services purchased for them by the local authority; or to have their money managed by a representative, a trust, a broker or a service provider. The opportunity to pay family and friends to provide the support and to access community supports such as neighbours will open up many more opportunities for people to be in control of what happens in their life. In relation to individual budgets, BILD supports MENCAPs response to the Green Paper as detailed below: We welcome the Governments plans to extend the remit of individual budget pilots to different social care groups and to explore the integration of different funding streams such as DLA, Access to Work or the Disabled Facilities Grant. We feel it will be essential that the specific needs of different groups are not ignored or lost in the development of much larger pilots. It will also be vital that other Departments, most notably the Department for Work and Pensions, are closely involved and fully support this new approach. All stakeholders will need to be bought into the development process early to identify and overcome problems. Finally, all individual budgets will need to be easy to use, transparent and flexible to be effective. We believe that future pilots will need to explore the following areas: An assessment process that takes into consideration the full needs of an individual, including health, housing, employment and support needs. A system for resource allocation that is transparent and realistic. A system that ensures that there is adequate funding for support and brokerage. An exploration of the different brokerage systems for recipients of individual budgets involving families and carers when appropriate. Guidelines for local authorities to ensure that commissioning is creative and flexible. A clear plan for introducing individual budgets to younger people who are entering the transition phase from childrens to adult services. Ongoing dialogue with local stakeholders including mainstream services, voluntary organisations, local authority commissioners and Learning Disability Partnership Board to ensure that appropriate services are being developed and promoted locally. Methods for informing and explaining individual budgets in an accessible way to all users of social care services, and their families and carers where appropriate. Effective monitoring to ensure that service users are getting the support they require and that harder to reach groups are being targeted. Investigation into the specific needs of people with profound and multiple learning disabilities and their carers, who have highest support, needs, and need to access the most expensive care packages. An agreed and enforceable system of safeguards to help protect against potential risk and fraud. Mencaps National Assembly were particularly aware of the importance of trust in this system. A framework for developing external support structures, such as well-resourced advocacy services, Centres for Independent Living and peer support networks. (Mencaps submission to the Green Paper consultation) It is apparent that if individualised budgets are to address the health needs of individuals, then access to health budgets will be required. We would encourage individualised budgets being extended to children with disabilities and their families. Not only would this better enable the change in culture required to change the supports available, but it could well address many of the difficulties associated with transition. Children and young people could develop flexible, individualised support systems which are person centred and could adapt and change into adulthood, rather than relying upon fitting into a small menu of existing adult services. The implications and impact of individualised budgets must be evaluated and monitored to ensure that the positive outcomes currently being seen by the In Control project can be generalised. In addition, the cultural change required for individualised budgets to be successful will have implications for leadership, workforce, commissioning and the quality and range of provision. 4. The Role of the Wider Community Families and Carers We support the Green Papers appreciation of the role that families and carers play in supporting people with learning disabilities. It is vital that families and carers are empowered to be involved in the assessment and planning processes of their relatives. Given that 60% of adults with learning disabilities continue to live in the family home, planning for the present and future is dependent upon the active participation of carers. This is particularly true in relation to sons or daughters with profound and multiple learning disabilities whose care is very intensive and carers must be seen as the experts in terms of ensuring person centred approaches. There has been some positive progress in recent years, ranging from legislation such as the Carer (Equal Opportunities) Act 2004, the involvement of parents and carers in Partnership Boards and the development of initiatives such as The National Family Carer Network. However, many families and carers feel isolated and alone with the expectation that they sustain their caring role on an ongoing basis. The ever increasing numbers of older carers in their seventies and eighties is a real cause for concern. The postcode lottery means that there is no consistent pattern of support for families and carers, be that respite care, skilled support workers or short breaks. Without effective guaranteed support, families and carers may be reluctant to embrace new opportunities such as direct payments or individualised services. The provision of traditional day centres does provide a daily break for carers and may be more attractive than proposed community based initiatives that are less certain or guaranteed. A holistic person centred approach to planning support must address the needs of carers and families and not view people with learning disabilities in isolation. The lack of take up of traditional services from families from black and minority ethnic communities would suggest a failure of understanding in identifying the best ways to provide support. Additional pressure upon families and carers can be the result of trying to support a son or daughter with challenging behaviour. It is of real concern that schools and services can use exclusion yet then expect families to cope for twenty four hours each day. BILD is aware that many families struggle on a daily basis to support sons or daughters who present physical aggression to their carers. There is an urgent need to provide active support including training for carers in this position. We need to move to a position where families receive consistent and ongoing support that is both guaranteed and flexible to meet the needs of each individual situation. As a nation, we are dependent upon families to continue caring and the delivery of independence, well-being and choice for adults with learning disabilities is dependent upon addressing the support needs of families. There are also significant numbers of people with learning disabilities who have no family contact or support. In many day to day situations, these people are totally reliant upon paid staff or advocates to speak up on their behalf. New policy developments in relation to individualised budgets and the other plans in the Green Paper should ensure that this group of people are included. Therefore, such options and choices should be fully assessed as to how they could work for people who have no family or friends to support them in accessing new types of services and funding. (b) Using community resources The Green Papers vision for its outcomes is dependent upon using the wider resources of the community. We believe that a critical part of the new role of Director of Adult Social Services will be to mobilise and stimulate the involvement of Local Authorities, Health Services, Local Strategic Partnership and the local voluntary and community sector. The feedback we receive from self advocacy groups suggests that issues such as access to leisure activities, transport, bullying and harassment are daily barriers in peoples lives. These can only be addressed by the wider inclusion and social regeneration agenda. If people with learning disabilities are to be able to become part of their local community, then there will need to be active support from the local community infrastructure for capacity building. Sustainable communities: people, places and prosperity (Office of the Deputy Prime Minister 2005), defines communities as places that offer people: A decent home they can afford A community in which they want to live and work The chance to develop skills and interests Access to jobs and excellent services The chance to get engaged in their community and to make a difference We believe that communities should offer these opportunities to adults with learning disabilities and that universal and mainstream services should be accessible to everyone in the community. It is important that people with learning disabilities have a chance to contribute to the communities in which they live. The Green Paper lacks an emphasis upon employment as a strategic approach to addressing social care needs. Improving access to paid work will encourage independence, well being and choice and would also provide a focussed approach to the modernisation of day services. We believe that an emphasis upon supported employment and job matching would be a positive start, as would local authority, health services and government departments acting as role models in increasing the number of work opportunities and social enterprises available for adults with learning disabilities. In addition, a wide range of volunteering opportunities will also enable individuals to contribute. In conclusion, any barriers to access to mainstream services should be tackled in a two-pronged approach at a national and local level. 5. The Prevention Agenda We support the recognition that the focus of social care has become providing services to fewer individuals at increasing costs, concentrating on those with greatest needs. However, it remains important to ensure that individuals who require considerable support continue to receive it. We believe that support could be provided in ways that maximise better use of wider community resources but would express caution about assuming that funding savings could be achieved in this way. We would have serious concerns about reducing resources from those with the most complex needs including people with profound and multiple learning disabilities. BILD is convinced that developing local specialist services will prevent people being sent away from local communities. This requires the development of staff with specific skills and local providers able to respond flexibly and appropriately with services to meet individual needs. We are very supportive of the emphasis to be placed upon prevention and better targeted early interventions. We believe that Fair Access to Care has produced a concentration on those in crisis, leaving people with lower level needs to struggle and deteriorate until they qualify for services. The Green Papers vision that concentrates on promoting a quality of life and wellbeing cannot be fulfilled without the prevention agenda. Many people with learning disabilities live in the community with access to little or no support. Investment in low level practical support which focuses upon signposting to ordinary community supports and initiatives would be invaluable in preventing people being potential vulnerable victims or part of the criminal justice system. Investment in advocacy initiatives appears to us to be an extremely cost effective way of addressing this issue. The availability of access to social contact and friendship will help to avoid loneliness. It is important to recognise that people with learning disabilities may require services throughout their lives and in particular at key transition stages. 6. Funding The Green Paper proposals will require a massive change in the culture of the provision of social and health care. BILD remains totally unconvinced that these changes will be able to be met from the existing funding. In fact, there is a real danger that the Green Paper will lose all credibility by being developed on a cost-neutral basis. To deliver the new approaches such as individualised budgets may create some cost savings over time but we believe that this will require initial investment. Although savings can be made in the care management and assessment system, it must be recognised that the traditional menu of services for people with learning disabilities currently absorb the bulk of the committed expenditure. These include group homes, day centres and specialist units where people are sent, often away from their local community. It remains difficult to provide individualised support in all of these three types of settings. The implementation of the Green Paper will require additional resourcing and an emphasis on investing to save. The change management approach to deliver the vision will need to include funding for workforce development, leadership and investment in the voluntary and community sector. In addition, there will need to be development in infrastructures to ensure the involvement and empowerment of disabled people and organisations of disabled people. Future funding will need to be much more flexible and able to move with the person. It makes no sense to continue to focus resources in particular services when they must be able to address an individuals own wishes, lifestyles and preferences. This is the challenge that the vision expressed in the Green Paper offers. 7. Strategic commissioning, service improvement and delivery We believe that the commissioning process is fundamental to ensuring that the right services are delivered by the right people at the right time. The key to improving the process is to ensure that commissioners work in partnership with people with learning disabilities and their carers, health commissioners and providers, the wider community and the voluntary and independent sector. It is critical that the assessment / person centred planning process identify what supports are required and how to creatively provide them. It will be important to think out of the box and to maximise the opportunities that can be achieved in the community and via neighbourhood supports, not just by segregated specialist services. Commissioners will require specific learning and development opportunities and should be encouraged to develop entrepreneurial approaches to delivering the support required. It will be vital to have clear strategic approaches linking children and adult services. We believe that it is unacceptable that transition remains a period of disappointment, uncertainty and stress for many young people and their families. Commissioners will have to ensure that services are developed by a range of providers drawn largely from the independent, voluntary and independent sectors. Without this, the ability to choose will not be available for people requiring services and their families. Specific emphasis will be required to address the needs of black and minority ethnic communities. In addition, individuals with high support needs or profound and multiple disabilities will require local solutions to prevent them having to move into specialist provision far away from their local area. An important part of the strategic commissioning process will be to stop providing services that do not match the vision of the Green Paper. Changes in service provision will only be acceptable if new provision is of a better quality and is more person centred and consistently available. 8. Regulation and Performance Management We support the recognition that social care regulation requires modernising to reflect a person-centred focus and the integration of social care and health boundaries. It has always been easier to measure inputs and the quantifiable aspects of social care delivery. However, a new focus on outcomes and the qualitative aspects of choice, responsiveness and the quality of life will be significantly harder to evaluate. This will have to involve people with learning disabilities and their families sharing their experiences of service delivery. Inevitably, this will mean considerable emphasis upon communication issues, particularly for people with profound and multiple disabilities. We welcome the recognition that a holistic approach will require the development of shared performance indicators for local authorities, primary care trusts and health service providers. We believe that it is very important that the proposed merger of the Healthcare Commission and the Commission for Social Care Inspection (CSCI) does not lead to any diminishing in the social care model but leads to the benefits of shared practice. We have been impressed by CSCIs current proposed changes to their inspection processes which are person centred. They have placed great emphasis upon the involvement of people with learning disabilities and their carers in their consultations. We would welcome opportunities for people with learning disabilities and carers to be included in inspecting and regulating services. Our own experiences of evaluating services alongside carers and people with learning disabilities as part of the Quality Network has been very powerful and has led to significant changes in service delivery. We would anticipate further work being necessary to evaluate how regulation addresses the anticipated rise in individual arrangements taking advantage of direct payments and individualised budgets. We welcome the control that these arrangements provide people with disabilities but recognise the tensions of evaluating the quality of support and protection issues. 9. Building Capacity and Workforce The most fundamental element in delivering the vision of the Green Paper will be the ability to recruit and retain a dynamic, reliable, trained, resourced, valued and motivated workforce. We believe that additional thinking and planning will be required to address the capacity and workforce issues. It should be recognised that the welcome shift to supported living, direct payments and individualised budgets does increase the responsibility and requirements of the workforce. The cultural shift away from support always being provided by professionals and the move to self directed support that transfers power to disabled people is profound. The Green Paper fails to address these issues in any significant way. Structural reform will only take effect if a skilled workforce is developed. This should address: the need for workers who have a strong link with the community to develop opportunities; workers needing to develop active listening and communication skills and commitment to positively support individuals with high support needs; learning and development opportunities to enable workers to deliver the relevant skills and competencies (we believe that aligning the Learning Disabilities Awards Framework with National Vocational Qualifications will assist); the diversity of the workforce which should represent the community served. Employing workers with the knowledge of diverse communities and the necessary language skills will improve access and support; recruitment difficulties, particularly how to recruit from outside the traditional professional roles and from a wider range of cultures and backgrounds; equipping mainstream services and supports with the necessary information and awareness to open opportunities without becoming simply social care providers. We would welcome an evaluation of the impact on the social care workforce of increases in the use of direct payments and individualised budgets. This should explore how staff are both recruited and retained as well as how the human resources role is undertaken. We believe that there will be an increase in the variety of roles available for support staff and that additional emphasis will need to be placed upon staff support, supervision, development and management. We welcome the recognition in the Green Paper of the value of the social care workforce. However, we remain sceptical in relation to raising the status of the workforce if this is not approached in a structured way. The efforts taken to improve the status and value of nurses and teachers required a national approach and considerable investment in increasing salaries. We believe that positive words will need to be matched with increased investment in the social care workforce for the delivery of the Green Paper vision. It is likely that there will be an increased requirement for different types of staff including personal assistants, advocates and community bridge builders. A workforce development strategy will be required to draw these various strands together to ensure that delivery is not simply dependent upon local initiatives. We would actively support the involvement of people with learning disabilities in the training and development of staff as co-trainers. 10. Working with the voluntary and community sectors We welcome the increased role for the voluntary and community sectors in delivering the vision of the Green Paper as we believe that the required creativity and cultural change are present in this sector. However, it must be recognised that the real benefits of working with the voluntary sector will only be realised if true partnership working is achieved. The contract culture and its regulation has often left voluntary organisations providing services which mirror traditional models. Commissioners will need to work in partnership with people with learning disabilities, families and the voluntary and community sector to deliver person centred, individualised services. Good providers will need nurturing with the offer of longer contracts so that the quality of the service can be focused upon instead of concerns about future funding. Many successful Partnership Boards are already developing positive links and approaches with the voluntary and community sector. If new opportunities for community involvement are not maximised and created, then adults with learning disabilities will continue to have little or no control over their lives and have to continue to accept traditional options for support. A formal framework is required to enable the voluntary and community sectors to identify the necessary changes that they will need to make in future years. This will include the requirement for involvement in the development of new strategic commissioning plans locally and nationally. However, the anticipated fragmentation of the social care market as a result of increased take up of direct payments and individualised budgets should lead to provider services becoming more responsive and sensitive to the needs of people requiring services. 11. Implementation The Green Paper offers a real opportunity for a radical change in the way that social care develops in the future and this needs to be enforced. We welcome the approach in broad terms because the identified outcomes are ones that would significantly benefit the lives of people with learning disabilities and their carers. We welcome the announcement on 21st July 2005 that a joint White Paper will take this work forward with the aim of integrating the health and social care systems. Whilst this will be a challenging approach, we believe that a holistic person centred approach will only be achieved through such an integration. 12. Conclusion The British Institute of Learning Disabilities is pleased to provide this response as our contribution to the consultation on the Green Paper. We would welcome further opportunities to participate in the ongoing discussions which will take place over the future months. If you wish to discuss any of the issues raised above, the please do not hesitate to contact me on 01562 723024 or email  HYPERLINK "mailto:k.smith@bild.org.uk" k.smith@bild.org.uk. 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