Change that leads to better lives

A Personal Tribute to Jim Mansell

Professor Jim Mansell, architect of significant elements of learning disability policy in England, founder of the Tizard Centre at Kent University and champion of individualised, evidence based services for people with the most complex needs, lost his battle with cancer on March 13th.

Rob web

I first met Jim Mansell in the summer of 1987. I was the newly appointed General Manager of mental handicap services (as they were then called) for Lewisham and North Southwark Health Authority. Three days in, I was at the Regional Health Authority Steering Group for the closure of Darenth Park Hospital – the first big mental handicap institution to close its doors. The meeting had its tensions, with a divide between those authorities committed to ordinary housing and support and those that were developing what were later called campuses for people with the more complex needs.

After a while I became aware that whenever contentious issues arose, the Chair of the meeting - the indomitable Regional Nurse (now Baroness) Audrey Emerton - was quietly checking things out with a man sitting off to one side. He said little, but when he did it seemed to make eminent sense and was on the side of the progressive approaches. That man was Jim Mansell and this vignette illustrates three important things I was to learn over the following years about how Jim operated. He didn’t seek the limelight, he understood the importance of influencing those with power and he had clear views, based upon evidence, of what were and were not the right things to be doing.

For the following five years, I was one of the many managers in the South East Thames region that called upon Jim, and the ‘Special Development Team’ that he set up, to help ensure that the new community services were fit for purpose when it came to people who were labeled as challenging services. From him I learnt the importance of planned, individualised service design, the need to spend money up front on people with the greatest support needs in order to get good outcomes whilst saving money in the long run and perhaps most importantly, a belief that you should never, ever, assume that an individual could not achieve great things in their life because of the label that services had put on them. Several people left Darenth to live better lives in Lewisham and Southwark because of the vision provided by Jim.

Jim’s national profile grew with what became known as the Mansell Report – the first clearly evidence based policy around how to support people with learning disabilities who challenge services. Its publication in 1993 was sadly marked by the DH doing its best to bury it. Perceived as being too expensive, it challenged too many vested interests. Yet Jim, with the support of others, kept on reminding people that the evidence showed this was the way to do things and unlike most other Government policy statements it was never forgotten.

Some of us slipped a re-commitment to the Mansell Report into Valuing People. (If we’re being honest, most of the DH officials at the time didn’t know or realise its implications.) Then, around 2006, Jim was asked to produce an update. In a memorable exchange, we expected to receive academic sized timeframes and bills for doing it, only for Jim to say it would only take a day and cost almost nothing. The reason, he said, was simple. All that was needed was to type “I was right fifteen years ago, and I’m right now. Get on and do it”. This betrayed another Jim tendency that his colleagues will recognise – when supported by evidence, he was clear and adamant about how things should be done.

However this was linked with a highly perceptive strategic brain. He could see and recognise the importance of ‘playing the long game’ and was skilled at working out who to influence and how to do that. This is one reason why he was so respected by major national figures. He didn’t shout and throw his toys out of the pram when thwarted – he reflected, regrouped and built a new case for change. My last contact from Jim was just over three weeks before he died. Whilst no doubt in great pain, his concern about the implications of some DH actions linked to the post-Winterbourne View work had led him to write and send me a detailed and brilliantly cogent analysis of what needed to be done to maximize the likelihood of the DH being encouraged to ‘do the right thing’.

Which leads to the question of how we can best mark Jim’s contribution to the lives of people with learning disabilities. Jim started on this journey of working for better lives for people with learning disabilities by supporting residents of Ely Hospital to go to the cinema. For those who do not know, Ely turned into one of the first great scandals that kick-started the de-institutionalisation programme. Back in the autumn, Jim and I were discussing his role advising the DH on its response to the Winterbourne View abuse. He knew his cancer had returned but still believed he could fight and defeat it. He said; “I came into this with Ely, and I want to go out of it by seeing the end of the last institutional provision”.

The cancer stopped him reaching that marker. So our tribute to Jim should be to collectively ensure that his vision comes to fruition. Whatever comes out as Government statements in the coming weeks and months needs to not only say the right words, but also commit to resourcing and supporting actions that will mean no person with a learning disability is ever again consigned to rights denying, poor outcome generating, soul destroying, institutional care. If it doesn’t, we should collectively challenge it until the right things are done. Why? Because that is what Jim Mansell would have done.

Rob Greig

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