Shaping Public Policy

In 2025 we lost John O'Brien. Those who knew John knew him as wonderful friend and source of love and wisdom. Others will have been influenced by John, perhaps without even knowing. because John played a critical role in developing many of the most important innovations in policy and practice of our time. 

For Citizen Network he was the primary source of inspiration for everything we have done over the past 16 years. John was also our first Fellow and he continued to support our work until the very end of his life. 

To honour him and his contribution to creating a world where everyone matters we are publishing a series of articles that reveal different dimensions of his work.

Author: Debra Moore

When English policy makers speak today about inclusion, choice, ordinary lives and citizenship in the context of provision for people with learning disabilities or people with mental health needs, they rarely mention John O’Brien. Yet, few individuals have shaped the moral direction and practical meaning of these ideas more profoundly.

John was not a minister, a civil servant or policy lead but nonetheless by changing what people believed was possible and over time, those beliefs found their way into White Papers, strategies and guidance. He changed how many people thought about what a ‘good life’ looks like and in turn, what services ought to be for and how they should behave.

John began with a truth that should not be radical, but too often is, that people, regardless of what label we have attached to them, such as ‘disabled’ or ‘mentally ill’, are not problems to be solved or services to be managed. They are citizens, neighbours, friends, workers, spouses, sons and daughters, whose lives should be measured by the same hopes and possibilities as anyone else.

Inclusion was never just about closing institutions or opening new buildings in the community, it was about being known, being valued and being missed when you are not there. It was about having something meaningful to do in the day, people who rely on you and places where you belong.

He often spoke about presence, participation, contribution and respect, not as abstract principles but as practical tests. If we have a system that cannot enable people to be present in ordinary places, participate in ordinary life, contribute in ordinary ways and be treated with dignity, then it’s not working.

This cut sharply against the prevailing culture that shaped disability and mental health services for much of the twentieth century, where success was often measured by beds filled, risks managed, and routines maintained. John asked a harder question: does this help someone to build a life that makes sense for them and amongst people who care about them?

A new strategy for the 21st Century: Valuing People

Valuing People was published in 2001, the first learning disability White Paper in 30 years. It marked a turning point: for the first time in a generation, national learning disability policy spoke plainly about rights, independence, choice and inclusion. Its language was striking, it did not primarily describe service models or professional roles, instead in placed emphasis on people’s lives. It spoke of people being part of their local communities, having real choice and control, forming relationships, having jobs and homes and being treated with dignity and respect. Valuing People’s emphasis on community presence closely reflected John’s thinking. Long before the White Paper, he had argued that segregation of some people in congregate, institutional settings was not just a technical failure but an ethical one.

I was honoured to meet John in person around this time in my role as a member of the government's Valuing People Team. I remember him as a master storyteller, someone who could bring into sharp focus the consequences of othering and treating people as ‘less than’. He had long argued that systems are skilled at absorbing new ideas while continuing old habits. They learn the language of reform quicker than how they learn to let go of control.

In many ways, Valuing People gave official voice to ideas that John had been testing in practice for a long time such as person-centred planning, and whilst this was a visible method, behind it sat a deeper influence; a redefinition of what ‘good support’ looks like.

A long reach into policy

John’s influence on Valuing People and subsequent policy and guidance did not come through formal consultation papers or ministerial advisory roles. It came through decades of work alongside people, families, frontline staff and reformers who were trying, often again, to build ordinary lives in systems designed for containment.

Over more recent years, I believe that John’s ideas have exposed something uncomfortable in other spaces, such as how we support people with severe mental illness. For me, they continue to hold a mirror to the situation of too many people stuck in hospitals, often far from home, sometimes for years and with no clear way out. Whilst it may a different group of people, different labels and different legislation, the themes of othering and exclusion are threaded through their experiences. Segregation may solve organisational problems, and institutional routines may create the illusion of control but neither of these create belonging.

Having a family member who lived with a severe mental illness, and working in mental health services, I value evidence-based treatments and do not seek to reject them. However, I often find myself thinking of John when trying to remind people that treatment, when required, is within a life rather than the point of it.

Today we talk more about neighbourhood care, integrated teams and supporting people close to home. Often this is framed technically, flow, capacity, demand, productivity. But underneath lies something older and more human: lives are built in streets not pathways, through relationships not referrals. John understood this decades ago. And this is not just about learning disability or mental health, it is about everyone whose citizenship is fragile or conditional; people who are homeless, leaving prison, living with addiction, seeking asylum, growing old in institutional services. In different ways, they may be subject to othering and facing the same basic question “are you someone who belongs or someone to be managed”.

A personal note

I think about John often in my current work at national level within the NHS.... supporting the development of neighbourhood mental health centres. Many involved in this space may not have heard of John nor describe themselves as following his tradition. And yet the principles that underpin this work such as trusted relationships, continuity, co-production, echo what he spent 40 years trying to teach us.

We know that transformational change is hard, and the same tensions keep surfacing; the pull towards control, the comfort of distance and the temptation to design services that function smoothly even if lives remain small. 

John offered no blueprint. I believe he offered something more valuable, a moral compass. 

He reminded us to look for who is far from home, who is alone, who has become invisible behind a diagnosis or placement type. He reminded us that safety without belonging is a thin kind of success.

John O’Brien did not influence English policy by writing it, he changed it by insisting, patiently, relentlessly, that the purpose of all this work is not better systems but better lives, recognisable human lives. That remains his challenge to us and quietly, it remains his gift.

You can also read more about John O'Brien and his work here.

The publisher is Citizen Network. Shaping Public Policy © Debra Moore 2026.