Gate keeping systems Phil Madden, EASPD February 2008, Belgrade

Gate Keeping “The system of decision making that guides effective and efficient targeting and services for people with disabilities” Bilson / Gotestam*1 (see references file (2.A.6), document no.1)

How to define effective and efficient Effective Quality of life Being part of the mainstream Equal participation Equal citizenship Applies to all agencies Efficient Reliable Cost Best value

Micro services - How to meet the needs of individual people with disabilities? Macro services - How to link them to the needs of all people with disabilities? - Creative tension between categorisation and personalisation - How to plan forward?

Key Technical Components Micro Referral - How do people say they need support? Assessment - How is the need for support measured and prioritised? Entitlement - How is it decided people will get a service?

Design - How is it decided what type of service people will get? Delivery (Purchasing / Contracting) - How is the service to be provided? Review - How will the service be evaluated and regulated? Appeal - How can people challenge decisions? How can they change the type of service they receive?

Key Technical Components MACRO The aggregation of individual needs –how to do so? Identification of trends and changes in need and best practice The strategic allocation of resources –short term and long term.

Technical components do not exist in isolation They must be linked to: The value base Evidence based practice The political / economic context

UK Context Legal framework: Sets out Overall entitlements -2 overarching laws -Some detailed processes National Government sets policy and allocates resources

Social care / education / housing provided by different local authorities Elected members Usually free if entitled Health services provided via regional / local agencies Not elected Free, but can pay to go privately and be seen quicker

All agencies set local priorities Social care services increasingly contracted to private and voluntary organisations – the market Services independently regulated by Quangos.

Lessons from UK experience The battle never ends – many people still get no services You need networks, you need friends Success brings new challenges – for example older people with disability

1. The importance of a value base UK inclusion agenda Our Health, Our Care, Our Say *2 Disability Discrimination Act *3 In Control *4 Improving Life Chances *5

The UN Convention *6 Human Rights Legislation *7 The EU Disability Action Plan *8 The Council of Europe Disability Plan *9

-National action plans -Away from institutions / medical model - to individual / inclusive services. - mainstreaming - equal citizenship

2. Quality Issues Political rhetoric / blandness “Holiday brochure” market forces Vested interests Roles of personality Retreat into numbers

Expediency - short term funding Friday afternoon decisions Excessive reorganisation Personalities drive policy - EGO Should be more emphasis on outcomes More links to evidence base (Mansell report) and IASSID Including what we DON’T know

3. Quantity issues Many people get no services Social care population increasing Eligibility criteria tightening Services “unaffordable” (Getting to Grips with the Money) These issues apply across Europe

4. Self directed support Disabled people manage and design individual services Aim to have individual budgets by 2012! Cheaper and better? Also in Belgium, Holland, Sweden and others

BUT not for everyone – a lot of work 1 Cost driven Cost fears *11 Annual renegotiation 2 - Zealot driven 3 - Workforce issues

General direction towards Person Centred Services Exciting stories Natural approach All agencies Healthy communities for all