Helsedirektoratet

Veileder om tjenester til utviklingshemmede

Helsedirektoratet har sendt utkast til veileder om tjenestene til utviklingshemmede på høring. Tillitsvalgte bør jobbe for at kommunale råd, bruker råd og andre relevante instanser avgir høringsuttalelser. Utkastet til veileder er skrevet i de beste hensikter av folk med innsikt, men vær klar over at flaskehalsen ikke er mangel på veiledere eller rundskriv.

Vi må benytte de anledningene som kommer. Helsedirektoratets høring er en slik anledning. Veilederen om tjenestene til mennesker med utviklingshemming kommer i kjølvannet av det nasjonale tilsynet med tjenestene til utviklingshemming i 2016. Når veilederen før eller senere blir ferdigstilt, så vil den neppe gjøre noen skade. Veilederen kan gi argumentasjon for bedre tjenester som kan benyttes både av tjenesteytere og tjenestemottakere.

Symbolpolitikken

Det å utarbeide veiledere er ofte den enkleste løsningen når departementet må gjøre noe og ikke vil gjøre noe av betydning. Symbolpolitikk koster lite, på den annen side er virkningen også begrenset.

«Ny kommunelov § 2–2, 3. ledd og Grunnloven § 49, 2. ledd fastslår at staten bare kan styre kommunen med hjemmel i lov. Det innebærer at rundskriv, veiledere og statlige tolkningsuttalelser ikke binder kommunene.» (Direktør for KS Advokatene, Tor Allstrin, og advokat Øyvind Renslo, KS Advokatene.)

Mangelfull informasjon kan nok være årsaken til flere av ulovlighetene som bla avdekket under det nasjonale tilsynet i 2016, men andre forhold kan være vel så begrensende. Her kommer et lite knippe eksempler på ulovligheter som ble avdekket.

–Ved gjennomgang av brukernes vedtak, turnus og bemanningsplan fant vi at innvilgede timer i brukernes vedtak ikke samsvarer med samlede årsverk som disponeres til å yte tjenestene. Dette innebærer at innvilgede tjenester ikke gjennomføres, noe som også ble bekreftet gjennom intervjuer. (rapport fra Spydberg kommune)

–Vedtakene legger opp til at brukerne skal ha felles aktiviteter. Aktivitetene tilpasses ikke den enkelte (rapport fra Kragerø kommune)

–Det er ikke tilstrekkelig bemanning i helg og kveld i ukedager (rapport fra Oppegård kommune)

–Det er lite spor av brukerens ønsker, behov og mål i planleggingen og utformingen av tjenestene (rapport fra Midtre Gauldal kommune)

–Det fremkommer at grunnbemanningen i flere av boligene er lav, særlig på helg (rapport fra Trondheim kommune)

–Det er fellesaktivitetar for brukarane, ikkje aktivitetar tilpassa dei enkelte brukarane. Dei som ikkje vil vere med på fellesaktivitetar får ikkje avgjere at dei skal bli igjen heime eller gjere noe anna (rapport fra Seljord kommune)

–Enkelte brukarar har svært mange ulike tenesteytarar (rapport fra Haram kommune)

–Vedtakene framstår som standardisert, uten reelle individuelle vurderinger. Ytelsene blir tildelt i «sekkeposter» uten nærmere spesifisering av tidsbruken som er tiltenkt hver enkelt tjeneste (rapport fra Inderøy kommune)

–Gjennom journalgjennomgang og intervju er det dokumentert at 5 brukere som har vedtak på støttekontakt ikke mottar denne tjenesten (rapport fra Lenvik kommune)

Forhold som påpekt over, finnes det mange av. Skal det bli orden på slike forhold, så kreves nok langt mer hensiktsmessige tiltak enn en veileder.

God dag, mann! - Økseskaft!

I oppsummeringsrapporten fra det nasjonale tilsynet i 2016 stilles et svært kritisk spørsmål, blant annet:

«De alvorlige forholdene som dette tilsynet har avdekket gir grunn til å stille spørsmål om dagens rammer og ressurser for kommunenes tjenestetilbud er tilstrekkelige til å sikre gode og trygge tjenester til alle brukerne. Har kommunene nødvendige forutsetninger for å etablere og drifte forsvarlige tilbud – også til brukere med store og komplekse tjenestebehov? Gir staten tydelige nok krav, føringer og faglig støtte til kommunenes oppgaveløsning? Prioriterer spesialisthelsetjenesten bistanden til kommunene høyt nok? » (Det gjelder livet. Oppsummering av landsomfattende tilsyn i 2016 med kommunale helse- og omsorgstjenester til personer med utviklingshemming. Rapport fra Helsetilsynet 4/2017, side 26.)

Til nå har staten ikke svart på disse spørsmålene. Hvis veiledern skulle være en vesentlig del av svaret, slik som tildligere eldre- og folkehelseminister Åse Michaelsen antydet, så er det av typen God dag, mann – økseskaft!

Jens Petter Gitlesen

22 august 2020

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