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Leaving the building (well not really)

Sorry for a slightly self-indulgent and very long piece today but I hope I can be forgiven as it is my last week as manager of the Think Local Act Personal (TLAP) programme.

If you had said to me in Jan 2002, when I joined the Valuing People Support Team (VPST), that my next 11 years would be working with government and national partnerships I would have laughed out loud, that being so far from my sense of myself and my purpose (working class kid - founder of Bury Young Socialists).

That is what happened though, first for the VPST, then leading self-directed support for the Care Services Improvement Partnership (CSIP), managing the Putting People First Delivery Team and latterly the TLAP team.  This has been a time of big developments in social care and wider public policy so I thought I'd offer a few of my reflections.

In late 2001, after 20 years working with local government and the third sector, I sat in an Italian restaurant in Oldham with Julie Stansfield and took advice on my next move. We decided I should go for the opportunity to work with the VPST which was just being set up to help deliver the first White Paper for learning disability in 30 years.  The thought was that I could take into policy implementation our practical learning from the previous ten years or so about person centred approaches and shifting power to people.

We also thought that ideally I should only do it for a couple of years and then return to the real world. I could act as a kind of fifth columnist.  Staying beyond that, we worried, might lead me to forget what I was there for (yes I know what some might suggest here…). We agreed that one way of avoiding this would be to make sure I spent regular time with disabled peopleand families telling me how things really are and I've tried to do that.An important mentor of mine - John O'Brien, warned methat it would be hard to quitnational roles as there would always be something else that came along where I would be tempted to say "I really should just stay and do this". And so it proved. ..

Leading on person centred approaches for the VPST alongside the wonderful Helen Sanderson and with the support of Rob Greig and great VPST colleagues, gave the opportunity to help build a community of allies and body of work and learning which has been an important underpinning of personalisation.

Linking person centred approaches and direct payments experience to thinking about how to respond to the deficiencies of care management led to the development of In Control in 2003. This was initially set up as a partnership between VPST and Mencap. We were very lucky then to be able to call on the special brain of Simon Duffy and the practical and personal experiences and skills of Helen, Caroline Tomlinson, Julie Stansfield,  John Waters, Andrew Tyson and others.  The early headquarters was Helen's kitchen. Steve Jones, then CEO of Wigan Council and Jo Williams then Mencap Chief Executive gave us the platform to launch self-directed support and what became personal budgets, on a bigger scale.

This was a time when the Blair government were looking for big ideas for public service reform, social care and other public policy areas were developing their next stage agendas and we were well placed to offer ideas and influence development. I remember being at Blackpool Pontins on a very windy day when a civil servant rang from the Prime Minister's Strategy Unit called to ask us to come and talk to them about In Control.

A chance meeting with Jenny Morris in the SCIE offices also led to an important  linkwith the Improving the Life Chances of Disabled People policy. We were always very conscious that the heavy lifting done by the disabled people's movement in their development of the social model, independent living and then direct payments needed an answering echo from the service system - that was what we were aiming at.  Planning with Joe Tomlinson (first person to get a PB) at Caroline's house, we said we needed to connect Caroline's front room to the council chamber and the Cabinet room.  This was about working out how Joe could get a good life, then what the council and the government could do so that people like Joe could self-direct public resources alongside personal ones.

Though of course it is exciting to be influencing policywe were always aware of the dangers and down sides of taking an early stage, counter-cultural innovation like self-directed support into the maelstrom of government and in engaging with politicians and senior civil servants. When one of the eager beaver kids from the Strategy Unit said if the Prime Minister likes this we will make it happen fast for all, we put our head in our hands and begged him - no! But perfect choices don't exist and power is dispersed in government.  This meant thatpersonal budgets came to policy prominence via the Individual Budgets (IB) Pilot Programme, but also that we were only able to influence implementation strategies to a limited extent.

Zoe Porter (an amazingly talented and values driven woman) joined me from the VPST to run the Care Services Improvement Partnership (CSIP)self-directed support programme. This was at the invitation of Richard Humphries the head of CSIP and included the IBpilot delivery team - a great group.  It was clear to us from the start that there was little chance of the proper integration of funding streams within IBs at that point as there was too much institutional resistance and too little political will. Some of the early meetings were almost unbelievably surreal - you felt like putting your hands over your ears and running away fast. We took the view, however, that we did have a chance and therefore a responsibility, to introduce the key elements of self-directed support into policy via the pilots. We hoped that the learning about linking funding would be helpful as policy moved on in succeeding years. The current Right to Control pilots emerged from this unfinished business.  Despite the 2005 White Paper saying personal budgets wouldn't be extended to health, the experience of the IB pilots led to Lord Darzi agreeing later to pilot personal health budgets. Several members of my team, led by Zoe, then took on the delivery support to the PHB programme.

This was both an exciting and frustrating period . We agonised about the dilemma of top-down introduction of such a challenging innovation and did what we could to encourage wider real world experimentation and buy in (In Control played a key role here via the efforts of Simon and Julie). We tried to encourage a shift from personal budgets and personalisation being developed in isolation from other key policy developments - includingfor older people and people with learning disabilities and mental health needs.  It is pretty well understood that across government and even within departments, it is difficult to get good joined up development and we had limited success with this. This was partly I think because we didn't have enough clout, partly because what we were proposing was very challenging to other policy areas and partly due to the intense politics and complexityof government. This environment is hard to fully appreciate unless you have seen it up close.  Some blame specific players or groups for this but I think that often misunderstands the complex realities.

The social care minister for two key years of this period was Ivan Lewis. It was unusual to get a minister for two years - they were usually re-shuffled or sacked after one. I think we had eight during my time.  Indeed it was fascinating watching the dance between different ministers - with their agendas and personalities - and the civil servants.  A former volunteer, third sector CEO and chair of a council social services committee Ivan brought experience and passion to the role. His determination, political skills and connectedness was sometimes underestimated. He was the main driver behind the development of what became Putting People First and indeed wrote major sections of it himself. Some high calibrecivil servants also played very important roles at this time in seeing this policy development through. David Behan - challenging, toughMr B,has a big heart and gets personalisation. He looked out for me and mine in the DH at some tricky times during this period.

Putting People First, launched by Andy Burnham on Dec 10th 2007 at the Kings Fund, took people by surprise.  It demanded a really big shift in social care, focused on universal services, prevention, social capital, choice and control (my team celebrated with a long karaoke session in Manchester). However, though there had been some work in government and councils in previous years to build and test some elements of this prescription- for example the work done on re-ablement, supported by the Care Services Efficiency Delivery Programme (CSED), they were at very early stages. Inside government and out in the field, personalisation had not gotten into the bloodstream.  In addition,  there wasn't a strong alignment of the levers which government can use to support policy delivery with this major new agenda, or even very good awareness in key parts of the system. At an event in London that we organised with Geoff Mulgan and Charlie Leadbeater bringing together policy and sector leaders to consider best ways to manage this change, it was clear that not enough people were ready for it or, in the case of some, even in agreement with it.

It's easy to say 'I told you so' (and of course manyhave been quick to do so) but our recommendations were for a somewhat slower pace. We wanted  more phasing and developing and sharing learning to build understanding and supportive coalitions for change. We wanted an investment in the "demand side" - helping people, families and their organisations to grasp the potential of personalisation and demand it from councils.  Ideally  the transformation grant would have been used in a more targeted, conditional way, supporting pioneers and rewarding progress. We weren't successful in these suggestions for a different strategy - the politics of the situation didn't allow (maybe one for the memoirs!). In such a situation you can bleat, blame,leave, or see what you can do to influence as positively as possible. That's what myself and a group of us decided to do for a while.

Putting People First came with a transformation grant, an architecture of support, a national and local government leadership consortium and a Director of Social Care Transformation. There were milestones of progress and ADASS surveys against those milestones.  The results of this investment were inevitably markedly uneven. Underdeveloped innovations and top down expectations placed on an unprepared, somewhat resistant field are unlikely to achieve the desired effect. Throwing significant funds at the task is also not likely to be the perfect solution as these will inevitably  not be as well targeted as you would wish for in such a context.

Having made these very critical points - essentially about inadequate strategy, you might be surprised to hear me say that on balance I am relatively pleased with the results! This is because I think a rational policy model is not an appropriate way to judge these developments. In such a model a clear and agreed policy is complemented by an implementation strategy carefully constructed to impact on a set of actors able to deliver on the expectations and provided with the power and resources to do so. In reality it is so not like that. Self-directed support is powerfully counter-cultural to public services and to at least the perceived interests of many of those holding power and resources within them. Additionally, even if people wanted to do it, there were significant technical and practical challenges to overcome. In the late great Gerry Smale's term, it is an almost "unadoptable" innovation. There is no way that such an innovation could diffuse quickly or simply across the system.

Some have argued powerfully that government championing of personalisation has crushed the organically growing, local maturing of co-productive relationships between people using public services, professionals and service providers. If only these were left to grow, before long they would flower without external pressure or assistance. To me that is as much Pollyanna as the idea that government can simply mandate rapidly changed relationships and behaviour.  For me, neither top down or bottom up can be a wholly successful strategy but something was needed to shake the situation up, to strengthen the arm of people wanting to shift and share power in public services. The instrument we had was the messy, confused but in some respects impactful hand of government.

So we have had the inevitable messy initial period of personalisation delivery, with its successes, failures and unintended consequences. Toomany places have implemented superficially and not according to the true principles of self-directed support. It is tragic that soon after the policy was declared the economy melted down and we entered the period of unprecedented public service cuts. But we also have successes, developments and learning that we can build upon going forward.The simple truth for me is that personalisation - as one part of a broader shift towards a fair society -  is right. People should have much more control over the supports they receive, money power is sometimes an important route to that, and co-production is in everyone's interest. This being the case we should focus all our efforts on building from where we are with personalisation to where we want to be.

From 2007-10 our PPF team worked hard to help those working to deliver personalisation at national and local levels. The communication challenge for personalisation was enormous and greatly underestimated. We were therefore really lucky to have the very talented Jaimee Lewis lead on a strategy that took an age to get agreed but was later recognised by the National Audit Office as highly effective in very unpromising circumstances.

At this point I was concerned that we should say and do more about "social capital". It felt that this massively important part of the agenda for change had been almost totally neglected.  Having gotten the go ahead to do something we decided that rather than simply develop and issue guidance, we should work directly with local councils and their community partners - identifying and supporting promising approaches and then sharing these. We uncovered a gem to work on this - Catherine Wilton- and received wise advice and assistance from people like Clive Miller, David Towell and Richard Brazil. Departmental interest in this work went through the roof soon after the 2010 election, as everyone tried to understand what the Big Society might mean in practice!We took this Building Community Capacity initiative forward into TLAP.

In 2010 we got a new, coalition government. A fascinating period - very few in government could remember coalition or how it was supposed to work in practice. Departments normally prepare two briefs, red for a Labour win, blue for a Conservative victory. In this case a veritable rainbow of briefs was needed! For us personalisation obsessives the big question was would the de-facto political consensus on personalisation hold. We were very relieved, therefore that the Coalition Agreement confirmed direction of travel and the new social care minister Paul Burstow, confirmed his enthusiasm for the agenda in both social care and health. This was a strange time - my team were able to have influence over the Vision for Adult Social Care and the associated guidance (though I certainly don't take responsibility for the 100% personal budgets target!). At the same time new rules meant it was very difficult to spend any money on supporting delivery and just when we really needed to explain about personalisation, communication activity was almost forbidden across government. This was the time of the seven "P"s - can anyone remember them all? Erm - Personalisation…Prevention…Plurality (what's that?) - but direction of travel was good.

By this time the writing was firmly on the wall for those of us who had been brought in from the sector to help interpret and support delivery of policy - this activity was to be ended and the DH return to its more traditional policy development functions. I'm really proud of my team, who all worked really hard right to the end to leave a strong legacy while knowing their jobs were going. Perhaps ironically, given the timing, this was greatly helped by senior civil servants keen to use our knowledge and skills  (they don't like to be named - but they will know who I mean!).

Knowing that the PPF programme was ending and most funding for the support for personalisation delivery was to cease, some of us started exploring how we could build a post PPF sector partnership for personalisation. Jeff Jerome played an important role at this time through his strong relationships with provider leaders. This was a chance to go well beyond the previous central/local government consortium and build one that had co-production at its heart. Shahana Ramsden had built and co-ordinated a really inclusive and effective co-production advisory group to influence DH policy and implementation and this group was well-placed to play a big role in what became TLAP.

After many drafts (can you imagine getting everyone into the big tent!) and with strong leadership from the first chair, Richard Jones, we emerged with the Think Local Act Personal manifesto and developed the Partnership's membership, purpose, funding  and working methods. The week I left DH I published a piece in the Guardian which ended with the words:

The Think Local, Act Personal Partnership is launched this week, a coalition of more than 30 organisations working in social care…..At times like this we mustn't take our eyes off the prize for which people have fought for so hard and so long. Instead, let's work, argue, influence and fight for true personalisation.

In a nutshell I think that captures the purpose of TLAP reasonably well. We have been trying to support people to stay focussed on personalisation, influence the policy and implementation context and gather and share best learning on what works and doesn't. For myself I left the DH to go to work for In Control but was asked to stick with TLAP part time for a few months to help get it established. That few months turned into 2 years (yes you can see a pattern here - I've been married 25 years too!). TLAP is a strong, active partnership and we have done our best to have an impact according to our purpose and with the various forms of political and other capital we have. We don't kid ourselves though that we can in any way substitute for the on the ground hard work that needs to be done by people around the country in all sorts of groups and organisations - we just hope we can add some value to these efforts. The tiny but wonderful team of Jaimee, Shahana, Linda, Chelsea and Corrine work tirelessly and from a firm values base.

Making it Real has been an important development, launched this last May and developed primarily by the National Co-production Advisory Group, it offers a simple but strong set of markers for true personalisation. It's encouraging to see many people and organisations using it as something to rally around, focus efforts and support each other.

So now that I am finally standing down from the TLAP manager role I am so glad to be handing on to Sam Bennett.  Sam has been an important part of the personalisation journey over the past few years - working in a council on Individual Budgets and then doing some of the best practical work in the PPF team and for TLAP. Over these past two years he has also worked on the ground in organisations and councils, helping find great solutions to the practical challenges of delivering true personalisation.

I'm really pleased that, just as my tenure as TLAP manager is ending, we had the really positive results of the personal health budgets evaluation and Norman Lamb, another minister  enthusiastic about personalisation, was able to confirm their roll out.

For me, I hope to still work on some projects for TLAP that are close to my heart but I want now to spend more time myself alongside people working to make personalisation real. These are truly and unprecedentedly hard times for public services and those who use them. People who want a fair society and the personalisation of public services will respond in different ways - through resistance, careful engagement to positively influence or reduce damange, practical support to people and communities  - all these are valid and we should respect them all. I think I'll try and do some of each of them.

Told you it was a long one - if you are still with me Happy Christmas - stay strong and support each other

Love from me

Martin

9 comments for “Leaving the building (well not really)”

  1. Gravatar of Alan RosenbachAlan Rosenbach
    posted 14 December 2012 at 17:58:59

    A wonderful narrative of the journey. Good luck with the next phase of your work.

  2. Gravatar of Jane LivingstoneJane Livingstone
    posted 14 December 2012 at 21:32:04

    A really interesting insight Martin. Best wishes for the future.

  3. Gravatar of Steve RawSteve Raw
    posted 15 December 2012 at 18:35:51

    Thank you for the opportunity of reading your story and it is one I will share within our team and also our work. Also as a carer for my daughter with a Personal Budget it makes it so relevant

  4. Gravatar of maria terrasmaria terras
    posted 15 December 2012 at 21:13:32

    As a close relative of a young disabled man with severe learning and physical disabilities I see things differently. From the noble intentions of the early pioneers the landscape in the UK appears to have changed beyond recognition: person centre is no longer mentioned and its sine qua non, person centred active support never even got a look in; independence has come to mean independence of state and local government from their duties towards disabled people. The O'Brien values have been distorted and now visibility in the community is used as an excuse to offer only universal services - mostly never made accessible - and, at best, very restricted. Residential homes and daycentres are closing down, putting the responsibility for severely disabled people back on the shoulders of their parent carers. I dread to think of my elderly sister and middle age nephew's future as they have no family or support networks (I live in Australia and thus unable to lend a hand). What is there to celebrate??

  5. Gravatar of MartinMartin
    posted 16 December 2012 at 11:41:58

    I totally recognise much of what you say Maria. In some ways I'd go further because as I say in the blog personalisation and person centred approaches remain pretty counter to the culture of services. They always have been so the early experiences you describe were only available to tiny numbers of people. We are now in a situation where 30% of govt grants are being taken from councils.

    However,we have learned a lot over the past few years about what leads to better lives and the evidence shows consistently that personalisation works. The really hard but really important job ahead is to make this a reality for the many in very hard times

  6. Gravatar of Nick DrummondNick Drummond
    posted 17 December 2012 at 20:39:59

    The truth is that 'personalisation' was first rushed into by politicians eager to roll out new policy initiatives without taking the time to consider the impact of this type of top down approach on many of the vulnerable people it was supposed to empower.

    Where is the evidence that 'shows consistently that personalisation works'?

    It seems likely that those people for whom 'personalisation' resulted in improved outcomes and control in terms of how their care was delivered were the most able to cope with the responsibility - those with physical disabilities or with mild cognitive impairments, and possibly some with more severe learning difficulties whose carers were sufficiently skilled to facilitate the process for their loved ones. For them 'personalisation' may have worked - but what about he rest?

    How does the balance sheet of 'failures and unintended consequences' against 'successes' really look?

    Now that adult social care budgets are being savagely cut the 'messy initial period of personalisation delivery' has morphed into the perfect smokescreen to implement budget savings - a device to close and sell off day centres against the wishes of people with learning difficulties and their carers in the name of better care choices and new models of service delivery.

    Many of the people now being force fed 'personalisation' are vulnerable adults approaching middle age whose carers are their elderly parents or relatives, and are quite unable to access mainstream community services in the way envisaged. For them the reality of 'personalisation' is not just messy - it's a disaster.

    These people are leaving the building against their will, with nowhere to go.

    Outside it's cold - and getting colder by the day.

  7. Gravatar of Martin Martin
    posted 17 December 2012 at 21:17:18

    Hi Nick,
    I share many of your frustrations of course. There is now a lot of strong evidence that done reasonably well personalisation benefits people, not just the groups you mention. The National Personal Budgets Survey asks people and their families to report on their outcomes and experiences. Its being repeated at the moment so we will know soon if the positive findings of last year are repeated. What we do know is that, as with everything, you can do things well or badly. Its really important to seperate out cuts from personalisation. I'm sure you don't think that even without the policy of personalisation, cuts of 30% in central grants imposed on councils would leave the services you value safe. At its heart personalisation is just saying things should be designed around you with you having a big say in what is done and how. I'm sure we can agree that is right?

  8. Gravatar of HelenHelen
    posted 17 December 2012 at 21:29:30

    I was reading an email from David Towell tonight who said, about your blog, that "this kind of contribution is rare and much appreciated."
    I agree. One of the things I have learned from you Martin is how to play a weak hand in a strong way. I admire the way that you have continually looked for opportunities to create positive change, in whatever context you have been in. Yes, there has been lots of learning (as there should be), yes, the cuts have had a huge, and awful impact on peoples lives, yes, there were things that could have been done differently...and your contribution has still made a positive difference to peoples lives.

  9. Gravatar of SamSam
    posted 18 December 2012 at 09:14:48

    Thanks Martin for your incredibly valuable contribution. The importance of this work cannot be overstated. At a time when the challenges of keeping the spirit and practical drive for personalisation alive have never been greater, it is important that we use any and all means available to keep the show on the road. TLAP is a great legacy built on the good will and commitment (not to mention time and resource sacrifices) of its Partners across the sector, and the drive and guidance of the National Coproduction Advisory Group. I'm not aware of another Partnership like it - so what we've been striving to build must be worth the effort! Glad you're not actually leaving the building as we have so much more to do. Sam

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Last Updated : 18 December 2012. Page Author: Pam Schreier.