The Process of Change

Author: Sam Sly

A version of this article was first published in Learning Disability Today.

I was honoured recently to be asked to speak at the Challenging Behaviour Foundation Board Meeting about the Beyond Limits project, and the highs and lows we have experienced trying to get people out of Specialist Hospital and into a life. 

The Foundation was started by an amazing parent/carer Viv Cooper. The Foundation has supported some of our parent/carers who have felt powerless and not heard by professionals to have a voice and influence change for their relatives. 

Of the speakers at the meeting, the person whose story impacted the most was the parent of one of the people abused at Winterbourne View. For the matter of an extra few hundred pounds to their support package (which was significantly less than a Hospital Placement) this person was not allowed to stay where he wanted to with extra support, but instead was moved to Winterbourne View where he was systematically abused and his life and that of his family were destroyed. The complete senselessness of this situation simply beggars belief. 

Also speaking on the day was Chris Bull the Learning Disability Improvement Programme Lead tasked with moving forward from Winterbourne View. Whilst he spoke at the meeting I reflected on the sheer scale of the task ahead which will be without doubt, if done properly, one of the biggest whole systems changes, services for people with learning disabilities, have seen in a long time as it will impact on everyone and everything. 

Having been involved in smaller scale change programmes in Cornwall (Budock Hospital) and Bournemouth (NHS Campus Closure), I reflect that the reason that these similar systems changes got seen through to a conclusion (not always perfectly but concluded all the same) was because of a number of factors, that need to be considered by the post Winterbourne project team. 

The factors were a tight non-negotiable timescale, massive downward pressure (and monetary investment) from the DH, CQC and the media, increased family and self-advocate involvement and good Leadership. Each of these points had pros and cons but they are worth bearing in mind. 

Tight timescales hone people’s thinking and make action happen. There is a tendency if timescales are too far advanced, or too loose that action gets left till the deadline is looming as there is always something more pressing to get on with. However, what I have also observed with tight timescales is that action becomes reactionary; people get desperate and don’t give the right amount of time to plan and to think things through. This can have a catastrophic effect on people’s long term lives when half-baked, ill-planned solutions lead to the necessity for further change and upset when things don’t work out. 

If we cast our minds back to the closure of the original long stay Hospitals and the setting up of ‘community’ placements, which were in essence four or five bedded residential homes, some twenty years ago, most of those people no longer live where they first moved to because they did not choose who they lived with or where they lived and it did not work for the long term. Many people had to move several times before the right solution was found, and some have experienced abuse on the way as with those people involved in the Budock Hospital scandal. 

The timescales for the implementation of the post Winterbourne recommendations are ill-thought out. The timescale, set so that all reviews for people in Specialist Hospital will be completed by May 2013, is definitely not workable if good planning is to take place. 

I am sure reviews will take place, and I have already heard professionals saying reviews have been done, but they are talking about Care Programme Approach Reviews that do little to plan positively for people’s futures by building on their gifts, talents, hopes and dreams and tailoring a service to the person; and instead dwell on the negatives, behaviours and risks associated with living anywhere other than in a Hospital. Good planning is vital for getting it as right as possible first time. 

Pressure from those in power usually makes professionals get on with a task. The fact that in Cornwall we had the Secretary of State, DH, CQC and many legal firms breathing down our necks made us get the job done. I am still not clear as to what real high power pressure there is on this project, although there is much talk about it. The other thing that helped in the past was enough money to be creative in planning. An example in Cornwall was with housing, where if we had not been able to use health money to support the start-up of Shared Ownership many people would not have got the tailored housing that they needed which rooted them in their communities. 

Family and self-advocate involvement, in fact family and self-advocate leadership was the key contributor to change both in Cornwall and Bournemouth and investing time so people were key project members made all the difference to getting things right in the longer term.

And finally there is the need for good Leadership within the project and of those on the ground as change cannot happen and be sustained if the fundamental principles and values of personalisation are not paramount and do not permeate from the top down. Great change has happened in the past and then floundered when the temporary change team has done the job and moved on. Change has to be delivered by those who will be around long term to continue the momentum. Any short term project team can kick start the process but big systems changes like the post Winterbourne project will need leaders able to stick in there long term and embed the cultural changes that will be the legacy of their work.

The publisher is The Centre for Welfare Reform.

The Process Of Change © Sam Sly 2013.

All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.