Chartering a vehicle for election success ?sx Diana Sutton looks back on this year's Parliamentary session and assesses the effects which the government's Citizen's Charter will have on community care .sx She believes that John Major has missed an opportunity .sx No one could describe this year in Parliament as dull .sx The historic resignation of the Prime Minster ; the abandoning of a fundamental pillar of Government policy -the community charge ; a rumoured November election ; and a glossy Citizen's Charter have certainly livened up recent months at Westminster .sx On the legislative front , Parliament has seen the Disability Bill , the Child Support Bill and the Criminal Justice Bill .sx For the disability lobby , the disability living allowance is a far cry from a comprehensive disability income scheme , failing to address the fundamental fault with the system - that people with identical disabilities and costs receive largely differing benefits depending on age , cause of disability , sex , race and national insurance contributions .sx One significant victory came from an embarrassing defeat in the Lords and resulted in a U-turn on the Independent Living Fund , guaranteeing payments at least for existing claimants .sx However , those who become disabled after 1993 will have to take what their local authority will provide - thus introducing a two tier system .sx The Child Support Bill makes long overdue reforms in the system of child maintenance by setting up the Child Support Agency to pursue absent fathers for maintenance .sx Public debate has centred on whether the woman should have to name the father of her child .sx The most significant victory has been the widening of the exemption from the obligation to co-operate , to include situations where the woman or her children would fear undue harm or distress by naming .sx However , coupled with this has been the introduction of one of the most punitive sanctions in the benefit system - a deduction from income support for 18 months ( 20 per cent in the first six months , followed by 10 per cent in the last twelve) .sx This session has also seen John Major's Citizen's Charter .sx Its section on social services is simply a restatement of the government's community care reforms .sx The performance indicators suggested for the Social Security Benefits Agency include standard times for callers to be seen .sx For hospitals , guaranteed maximum waiting times for in-patient or day care treatment are suggested .sx However no indicators are suggested for community care , nor is there any concrete indication of exactly how an individual's views will be central in assessment or of rights to assessment or to services .sx It is a missed opportunity to put performance standards for assessment and service delivery in place and to ensure greater accountability to disabled people .sx Currently , the duty to assess and provide disabled people with services under Section 2 of the Chronically Sick and Disabled Persons Act 1970 is supposed to provide a watertight guarantee of assessment .sx In practice , many disabled people find themselves put on a waiting list either for assessment or for services , with some being told that it will be 18 months before an assessment can be made or a year before services become available .sx Attempts to enforce the 1970 Act revealed that in some local authorities services were only provided as resources become available , for example when another disabled person no longer needed them .sx There was no real redress for the citizen , except by using the Secretary of State's default powers , pointing out that a local authority was in default of its statutory duties .sx This was done by one organisation on behalf of several disabled people and two authorities waived their waiting list for telephones for disabled people almost overnight .sx Although the new complaints procedures will hopefully improve this , it must be coupled with acceptable times for assessment and service delivery .sx Although the Citizen's Charter states that individuals have rights to advocacy where necessary , this sits uneasily with the Government's recent decision not to implement sections 1 and 2 of the Disabled Persons Act 1986 .sx Similarly Labour's charter although mentioning the Act merely commits Labour to discussing it with the local authority associations , despite the fact that its full implementation is Labour Party Policy .sx A charter for community care also needs to include performance indicators to show levels of user control and satisfaction with services .sx Labour's charter states that everyone depending on community care will be covered by a service contract tailored to meet their particular situation , giving both the users and carers clearly defined rights as to the quality of help they can rely on .sx As a statement of principle , this is not dissimilar to the Government's " individual care plan reflecting the individuals sic !sx wishes as far as possible saying what services will be available " .sx However , neither charter shows a commitment to empower community care users to control service delivery .sx Nothing , for instance , is said about whether direct payments could be made to enable disabled people to buy in their own community care services , so that they are not dependent on services when and how the local authority chooses to provide them , a system which could ensure real user choice .sx Similarly , neither charter deals with the situation where the carer's and the disabled person's needs and rights are in conflict .sx For instance where a carer wants the disabled person to go into residential care but the disabled person wants to remain in their own home ; or where the carer is no longer able , or does not want to be , the main provider of care , but the local authority cannot afford to provide support services .sx It goes without saying that a charter for community care would need to be fully resourced and policed , the latter function could be carried out by a committee of service users .sx Until some performance standards are introduced , the Citizen's Charter philosophy of instant redress will seem an anathema to many disabled people who are reluctant to criticise the service they get in case it is withdrawn altogether .sx Compulsory or by consent ?sx Controversy over the use of sedatives to control the behaviour of young people in psychiatric care is gathering pace .sx Mark Ivory reports .sx Pin-down caused a furore because young people were put in solitary confinement for long periods in what was described by Allan Levy , who helped investigate the regime , as a " fundamental abuse of human rights " .sx Since then , other young people have alleged similar treatment , mostly in psychiatric rather than local authority care .sx In addition to 'exclusion' , or solitary confinement , psychiatry has an even more powerful method at its disposal - sedation .sx Hill End adolescent psychiatric unit in St Albans , Hertfordshire , has recently been accused of excessive use of sedatives , following similar allegations against Langton House , a mental nursing home for children in Dorset , and St Charles Youth Treatment Centre in Essex ( News , 13 , 27 June and 25 July) .sx All of these institutions took referrals from local authorities unable to look after the young people in council care homes because they were too disturbed or too troublesome .sx Some were suicidal , others violent .sx According to Mary Moss , spokeswoman for the National Association of Young People in Care , the care system has failed these young people .sx Psychiatric care has , she says , become the " dumping ground " for society's most abused children .sx She claims that four-fifths of adolescents sent to psychiatric units would be better off in local authority children's homes , if only they were properly resourced and supported by trained staff .sx " The way sedatives are used in psychiatric units is completely out of order , " Moss says .sx " They literally dose up young people to keep them under control .sx " .sx Langton House was earmarked for closure soon after Community Care revealed the allegations and St Charles YTC is being shaken up by the DoH , but Moss says the use of sedatives as a means of restraint remains widespread .sx Elaine Murphy , vice-chairwoman of the Mental Health Act Commission , believes the use of drugs like Largactil and Haloperidol - both anti-psychotic drugs with a sedative effect - to control behaviour in non-psychotic patients is an " extremely dubious " practice .sx " I can't imagine prescribing something of that potency to control impulsive behaviour , " said Murphy , who is a consultant psychiatrist at Guy's Hospital in London .sx The crucial question arises over how often these drugs are administered without consent .sx No consent is needed if the young person has been sectioned under the Mental Health Act .sx But many of those referred by local authorities are in psychiatric care voluntarily and consent is normally required .sx There are two principal exceptions to this rule :sx when the life of the patient or a member of staff is in danger and when the patient is deemed mentally incompetent to give consent .sx Concern is growing that some consultant psychiatrists may be using these escape clauses too readily .sx Bill McIntyre , priority services manager in charge of Hill End , says there are strict procedures for the use of sedation and exclusion .sx " The unit makes it very clear to the parents and the referring local authority that exclusion or sedation can be used if that's the only way the situation can be managed , " McIntyre says .sx " Sedation is used for behaviour control if it's required as a last resort .sx " .sx McIntyre , who describes Hill End as a " breath of fresh air " in psychiatric care , says the unit seeks verbal consent for these measures before the young person arrives .sx " When a child goes crazy and kicks a nurse , doctors can't ask them permission to give a sedative injection , " he says .sx However , the alleged over-use of sedatives to control behaviour , rather than as part of a structured treatment programme , has led the father of a 15-year-old boy to contemplate legal action against Hill End and Bedfordshire SSD , the referring authority .sx The boy's allegations , which included prolonged exclusion , are being investigated by the Health Advisory Service .sx Bedfordshire social services director Tim Hulbert is concerned about allegations that sedatives are used for restraint .sx " It might be legitimate in some circumstances but our anxiety is what safeguards there are , " he says .sx Hulbert denied that Hill End had given him full information about administration of sedatives , saying that he had agreed to their use for treatment and not restraint .sx Both Hulbert and Murphy say there should be a clearer framework of regulations and inspection to govern psychiatric units which look after children .sx There are indications that some establishments , and even the courts , are giving short shrift to the Mental Health Act code of practice .sx The code spells out the rules governing consent but the ready use of escape clauses by some psychiatric units appeared to win support from a decision last month by the Court of Appeal .sx Subject to dramatic mood swings , a 15-year-old girl in an adolescent unit had refused sedative drugs during one of her lucid and rational periods .sx Despite the code's unequivocal assertion that an individual's capacity to give consent can vary over time , the Appeal Court clearly took a different view .sx It would be dangerous , said Lord Justice Farquharson , for the court to refuse to authorise medication on the basis that a patient was lucid on a particular day .sx Mental health charity MIND accused the judges of moving the goalposts .sx MIND solicitor Adina Halpern said :sx " It now appears that even though a young person is capable of giving consent , it's still possible that a court can decide against his or her wishes to order treatment .sx " .sx As the judges appear to back the view of some psychiatrists , young people look increasingly beleaguered .sx Their only hope may be regulations with sharper teeth than a mere code of practice .sx New family training pack aims to disperse power .sx BY CATRIONA MARCHANT .sx New training materials to help social workers follow Children Act principles of working in partnership with families has been launched by the Family Rights Group .sx .sx Jo Tunnard , FRG's director , said the pack , which has been commissioned by the DoH , was the first of its kind .sx She said the training programme's case studies and problem-solving tasks would help social workers to recognise the experience of families .sx " The knowledge and expertise of families is not the same as professionals but it is terribly important to complete the jigsaw of getting the best outcome for the child , " she said .sx