Why a critic of institutional care is taking over from Southern Cross

By Janet Snell The Guardian,

Why has former learning disability 'tsar' Ann Williams accepted a key position on the board of a new company taking over 249 former Southern Cross homes? Janet Snell finds out

 Earlier this month, residents at a Darlington care home held a "good riddance to Southern Cross" party when they heard that the ownership of their home was passing from the collapsed care giant to a new company. It remains to be seen whether such celebrations will break out among those living in 249 other former Southern Cross homes that are being taken over by a newly launched operator called HC-One (the initials stand for healthcare).
The company is the brainchild of healthcare entrepreneur Chai Patel, who has pulled off something of a coup by recruiting Anne Williams as one of the key board members for the new venture. In contrast to Patel's private sector background, Williams is an ex-social worker with a strong public sector pedigree. Brought up in Scotland by churchgoing parents who believed in doing "good works", she rose up the ranks to become a director of social services and, most recently, learning disability "tsar" at the Department of Health (DH).
She held that role until this summer when the chancellor's spending axe cut short the government's Valuing People programme, which promoted inclusion for people with learning disabilities and had been due to run until next January. A cornerstone of the policy was getting people out of institutional settings and Williams was its ardent standard-bearer. So how has she ended up helping to run a private company that will be one of Britain's largest residential-care providers?
"The first thing to say is I wouldn't want to be associated with anything that wasn't driven by providing the best-quality care possible with the money that is available," says Williams. "And when it comes to driving up quality, you can commission and monitor all you like, but it's the provider that can really make the most difference to people. So moving to the provider side makes absolute sense to me."
But does it not strike a rather discordant note that part of the new HC-One empire will be a dozen residential homes for people with learning disabilities and mental health problems? After all, Williams spent much of her time at the DH berating local authorities for commissioning this sort of provision. 
Provider of choice
She acknowledges the point but is keen to stress that, at this moment, the most important thing for all the former Southern Cross residents, their families and the staff who work with them in 750 homes in all, is stability. "That doesn't mean 'no change'. But change is about focusing on quality and building up confidence to become a provider of choice. Then we can start looking at whether we have the right models of care for the future. But it is important not to frighten people, so we will not be rushing in there and saying, 'this is not the model'."
In May, a BBC Panorama investigation into the shocking abuse of learning disabled residents at the former Winterbourne View hospital near Bristol, run at the time by private operator Castlebeck, played out in graphic terms what can happen when the institutional model goes wrong. Could there be another Winterbourne View out there?
Williams hopes not, but makes the point that no one can say never. Among the homes that HC-One is inheriting from Southern Cross are up to 40 units that are half empty because of embargoes from local authorities, stemming from concern over standards of care. She is under no illusions about the scale of the task ahead of her and her colleagues when she starts her new role on 1 November, the day HC‑One formally takes over the homes.
In the meantime, Williams is busying herself as a member of the DH expert panel charged with the task of finding out what happened at Winterbourne View and how such horrors can be prevented in future. She is working with a dedicated team of civil servants, alongside Mencap chief executive Mark Goldring and Professor Jim Mansell, who has twice been commissioned by the government to write reports setting out good practice in the care of people with challenging behaviour.
The review team will be producing a major report for the health secretary, which will begin, yet again, with a study of what best practice should look like. But it will go further, she explains. "We will look at what happened around themes: for example, commissioning and issues for providers about governance. And, without wanting to prejudge the review, questions will have to be asked about the model of allowing people to be placed in homes often miles from where they come from, and mixing people with a variety of conditions in closed units where families never get beyond a visiting room. We know from history this is a risky way of doing things."
She describes the revelations of systematic abuse at Winterbourne View, which has since been closed, as "a dreadful wake-up call and a horrible reminder of what happened in earlier scandals". Since the Panorama programme was aired, two other Castlebeck homes have been shut following visits by the Care Quality Commission (CQC), which is currently carrying out inspections of 150 similar units, run by a variety of providers, to see how far the rot permeates.
The CQC findings, along with the results of investigations carried out by others, will feed into the DH review, but it is already clear that while some areas are getting it right, others are still getting it very wrong.
"I have always known that it's a very long haul to change the way that people think about vulnerable adults such as people with learning disabilities and elderly people with dementia," says Williams. "It boils down to whether we think people are worth it.
"And we can't ever sit back and think 'We have cracked it'. It's never-ending. It's about changing deep-seated attitudes and it needs total commitment from everyone in the health and social care business." 
'Walking the talk'
She describes her approach in the new role as that of a highly visible leader "walking the talk", imbuing staff with a culture that prompts them to ask the all-important question: "Is the service we provide good enough for a member of my family?"
"If the answer is no," she says, "then it's not good enough for anyone else either. We must instil that in everyone who works in this area, from top to bottom. That's the challenge for every board and every council in the land. And if a board does not start its meetings with the issue of quality at the top of the agenda, then they are missing the mark."
Under the new HC-One regime, extra cash is being made available to upgrade some homes. Williams wants to see improvements such as more independent advocacy for residents, better staff supervision, and local managers "empowered not pilloried" if they report up the line that there are problems.
As well as getting standards right, she is confident that HC-One has the right business model too. One of the reasons Southern Cross foundered was because its homes had been sold to separate landlords. When occupancy rates fell, the landlords would not (or could not) agree to a rent cut, in effect pulling the rug from under a provider struggling to fill its beds.
HC-One has been formed by bringing together landlord NHP and Patel's "care operator turnaround experts", Court Cavendish, into one entity. The 249 homes it is acquiring from Southern Cross have 15,000 staff and a total of 12,500 beds. There are no proposed home closures and the new company is currently recruiting for a range of posts including some highly paid managerial roles.
When Williams spoke to the Guardian, she said she did not yet know exactly what her financial package as a board member would be. "But I'm not in this for the money and I don't expect to be paid a silly amount for doing it. The cash available needs to go into the frontline."
When she left the DH, she says, she had no plans to move to a new role. "At first I thought, 'I've done my bit'. But then after reflecting I came to the conclusion, 'I'm not done yet'. I still think, with all my experience, I have a lot to give."
Williams has been quoted in the past as saying that her mantra at work has always been: "We can do better than this." Picking up the pieces from the Southern Cross fiasco, and following on the heels of the Winterbourne View scandal, she and her new colleagues at HC-One may feel that, after what's gone before, they could hardly do much worse.
Curriculum vitae
Age 'Let's just say I have my senior railcard.'
Lives Bramhall, Stockport
Status Married
Education Eastwood high school, Glasgow; Glasgow University (psychology); Manchester University (MA social administration and social work)
Career Newly appointed board member, HC One (2008-2011); national director for learning disabilities, Department of Health (2007-08); first president of Association of Directors of Adult Social Services (1979-2008); rising from social worker to strategic director of community health and social care, Salford council (1977-79); social worker, NSPCC (1973-77); unqualified social worker, Liverpool council and Manchester council (1972); trainee clinical psychologist, Clifton psychiatric hospital, York
Public life Non-executive director, Salford royal NHS foundation trust; CBE for services to local government (2009); honorary doctorate, Salford University (2008)
Interests Travel, opera, "gardening and chilling out" at her cottage in Scotland