Learning Lessons From Freda

I’m sure this is the same for everyone, both in their lives and their careers, but I've found that there are certain events that stay with you for some unknown reason. On these rare occasions you are left with an indelible mark that stays with you, which from time to time you find yourself glancing at again. One such event from several years ago is the story of Freda. I recently heard news about her death so I suppose it's inevitable that my mind turns once again to her. It’s a brutally sad story, which is perhaps why it affected me – and continues to do so – but more than that I feel that the story crosses well into tragedy if the lessons are not learned from what happened.

I don’t think that Freda's is necessarily a simplistic story about the innate dangers of cutting social budgets. Nor do I think it’s a story about apportioning blame. It’s possibly more of a story about a shift that I would like to see (potentially enabled by the Big Society) towards a point where organisations share their unique view of a situation to build up a more omniscient view that potentially could prevent such things from happening. Perhaps it makes an eloquent case for housing always to be a required presence on the new Health and Social Care Boards being established round the country. Perhaps it’s just a sad story.

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Two women had lived as neighbours in the same block of flats for a decade. One was in her eighties and was open, gregarious, well-liked and respected for her community work. The other, Freda, was in her sixties and had been described by her doctor as “being a bit odd”. Her neighbours shared that view, as they regularly faced some challenging behaviour from her and some unpleasant odours from what was a poorly managed tenancy. Whilst this behaviour was for the most part tolerated, comments were occasionally made to Freda about the fact that she was disruptive and smelly.

Now the older woman lies dead. Some hours earlier, Freda had used an empty plastic bottle to hit her on the back of her head. Initial injury was slight, but a heart attack came swiftly afterwards, from which she never recovered. The post-mortem shows no direct causal relationship between the assault and the heart attack, so no murder; just an assault with terrible, tragic consequences.

As always at times of crisis, the full forces of the caring professions were mobilised. Housing staff, police, social workers, psychiatrists, district nurses, community psychiatric nurses all working in partnership to make the best of a messy situation. Over the initial few days, hours of professional time was consumed, the value of which inevitably ran into thousands of pounds.

Freda showed no remorse for her actions “I’d do it again… she had it coming…she was the ringleader of them against me,” she said. She showed no understanding of her bail condition which prevented her from returning to her flat, threatening suicide if she wasn’t allowed to go back. She flatly refused to engage with any of the support that was offered to her.

After one night in emergency accommodation, the psychiatrist didn’t consider that she could be detained under mental health legislation and so the professional team as a whole had no power to prevent her returning to her old flat. Fortunately, an assessment bed was found at a residential care home and Freda spent her second night there. But she was distressed about being unable to return to her own flat, aggressive towards those who were trying to help her and the danger of disruption in her new setting remained ever-present.

Had anyone seen it coming? Was it inevitable or could anything have been done to prevent it?

Her doctor had known her for twenty years and attached the label of “personality disorder” to her behaviour – something that MIND labels as a “dustbin diagnosis”; a catch-all with little real meaning or value. But did his long-standing relationship with her mean that he been unable to see her deteriorating ability to look after herself? The District Nurse who visited every day was satisfied that she was self-medicating adequately, including for her insulin dependency. But were the worsening condition of her flat and Freda’s increasing frailty on her radar?

The community psychiatric team had assessed her more than once and despite her erratic behaviour and the impact it was having on others, had not felt her to be in need of intervention. The housing staff, sympathetic to the vulnerability that Freda so clearly displayed, were reluctant to take action to enforce (through taking her home away if necessary) the tenancy conditions which she was required to comply with.

All the individual pieces of Freda’s jigsaw were there but through no one’s fault there was no system to put them together and see the bigger picture. Each professional dutifully looked at their specific part of the picture. They did nothing wrong, but had anyone stood far enough back to look at the big picture, they would have seen a vulnerable woman who was simply not able to live an independent life without a well-thought out bespoke care plan. They would have seen someone who was not getting the help she needed and was potentially a threat to herself and, as it so tragically turned out, to others too.

Freda’s story illustrates a much wider problem with social care across the country where public service budgets – for domiciliary support, mental health interventions – are stretched and continue to be pulled tauter still. It is fanciful to expect that those budgets will be increased in order to prevent further tragedies like this. If “community care” has failed both Freda and her victim, the answer is not to return to the institutional incarceration of the mental hospital.

It’s potentially not more money that we need to improve the millions of other situations and lives like Freda’s that are balanced on a knife’s edge. Maybe what is needed is to develop our understanding of the broader picture, so we can all listen and respond to the concerns of our fellow professionals. Perhaps we need to develop new skills and systems for sharing our knowledge about vulnerable people across organisational boundaries. Above all, we need to recognise that resources invested in prevention save on those required at times of crisis and potentially save people’s lives too.

The Importance Of Breakfast

When I was writing about my highlights of last year I mentioned that the breakfasts I had were a particular highlight. While you can’t help but agree with nutritionists that the meal itself is a valuable part of the day, I was actually referring to the breakfast meetings that I held with staff over the year. These meetings ended up shaping a huge part of my year and have started an annual trend that I intend to continue. To give you an idea of what a significant part they played here’s a photo of my office wall, which is covered in the drawings the staff did in preparation for the breakfast meetings. 

Earlier last year, the breakfast meetings didn’t require any kind of artwork at all. In the earlier incarnation of these breakfast meetings, every Tuesday morning I would get up extra early knowing that at 8.30 I was meeting a random selection of 10 or so staff. Those meetings were interesting in that we had a mix of staff – so it might be a support worker with a joiner and an accountant, and we’d get together and I’d listen to their concerns. Being honest, they were only partially successful. Some were positive, some were negative; some turned up, some didn’t; some revealed things that we could work on, some were like pulling teeth! On top of that although I don’t exactly get up late, the extra pressure to be in early made it all the more taxing.

So we took a Summer break, had a think about the format and completely changed them around. This time I had the meetings in teams, with no managers, just the workers. The rationale was that the organisation had been through a huge change and each different team had been affected in different ways. So what I asked the various teams to do before the meetings, was to draw me one picture that showed what it was like to be in Trafford Housing Trust, in that team, at that point in time. Over the course of a seven week period I threw my diary out of the window and met with 26 teams who presented and explained their pictures to me.

The result was those pictures you can see on the wall – and almost down to the last one they were fantastic. As a manager I was interested in the outcome of the picture and what it would show me needed to be done, but what I hadn’t appreciated was the sense of teamwork that would be built by asking a group of people to draw a picture. There were some incredibly detailed and clever pictures which had obviously taken a lot of thought – not only about what the issues were, but in how to present them. I’ll give you an example.

This one came from our Voids team – so all the plumbers, electrician and builders. They were doing this at the time of the Chilean miners rescue and in comparing themselves to the miners they were saying that they felt they had been by-passed by all of these things that had happened to the organisation. They were aware of them, but that somehow their experience of them had been at one step removed. Fortunately, their new manager, Stuart, was doing a fantastic job of pulling them up to “safety”. You can probably see how useful this picture is as an overview to give an instant impression about how the team felt and to show us what needed to be done.

I really had no idea that people would go for the idea as much as they did. I came away with a feeling that I knew the places in the organisation that were absolutely motoring and the are the ones that needed help. It was immediately before a strategy session with the board, so I got an overall sense of how prepared we were for the next step as an organisation. Some quite detailed points came out of the pictures that we’ve got to address before we start doing them again. After all, if we’re going to ask staff to tell us something, we need to be responsive to what they say. If they’re going to be open then we have to respond to that, and I guess that means some more early mornings and the occasional missed breakfast.

How Does It Feel To Be A Times Top 100 Company?

We’ve been sitting on some excellent news recently and in this digital age when all it takes to announce something to the world is a quick tweet or a speedy blog post, it’s been difficult to keep it to ourselves. The news? Well, Trafford Housing Trust was recently named as the 22nd Best Public Sector Company To Work For according to The Sunday Times Top 100 list for 2011. Last year we were ranked 65^th, so it’s genuinely delighting that we’ve made such progress in a year.

The official handover

One of the real values of this award is that it’s based on questionnaires sent privately from an organisation called Best Companies to our staff who then return it directly to Best Companies, so we have nothing at all to do with it. We were graded as a Two Star Organisation (up from One Star last year) and we were ranked a very laudable 22nd. Perhaps most impressively of all our managerial team ranked as the third best managerial team overall.

So aside from the fact that it makes nice reading, why is this news that brings a smile to the face you see above? Two main reasons.

The first thing is that the organisation views its managers so positively. There is lots of evidence, including decisions I have made during my own career, that staff leave managers, not organisations. If you want to keep hold of your best staff then you need people to love, and be loved by, their manager. From what our people told us this time, it seems we’ve got that situation and that gives us a fantastic chance of keeping our most talented individuals. And resources are tight at the moment, I know it’s not that managers have been making staff happy by giving out big pay-rises, it shows that they’ve succeeded by doing the right things, day in and day out to motivate their teams.  

The second reason it makes me delighted is that there is such a huge congruence between the criteria used by Best Companies to assess organisations and our organisation’s values. Our values are the key to everything we do at Trafford and this result gives me huge confidence that putting values first and everything else second is not only the right thing to do, but that it's working. When new staff first start at Trafford Housing Trust they get a card with our values printed on them. I also meet them and tell them that the card should be next to their bed so it’s the first thing they see in the morning and the last thing they see at night. Usually people laugh nervously and wonder what on earth I'm on about! But they soon see that we really do take the values seriously. I’ll give a more concrete example of this in a future post.

As is right and proper we celebrated at the awards which were made at a dinner with over 1,300 people present. We met up with a number of other housing associations and I really enjoyed raising a glass (or perhaps two!) with a team from the Trust who had all worked to achieve the success. All of us are under no illusion that this means our work is done and we can sit back and relax for the rest of our careers - I'm sure 2011 still has plenty of challenges, but it was nice to have one night dedicated to celebrating their excellent work and achievements.

As a final thought, the amusing Bill Turnbull from BBC Breakfast was hosting the event and talking about how as part of the BBC’s relocation to Manchester he might be looking for rooms soon, have a look Bill and let’s talk.