Sam Sly has worked in social care and helped improve services for people with learning disabilities and mental health needs. He developed an approach called "Hands Off Its My Home" to promote citizenship. Currently he is directing a 3-year project using individual budgets and service design to create personalized support for 20 people in hospital placements to transition them back to their local communities. Research shows personalized community support can save money compared to out-of-area institutional placements. The project aims to give people control over their lives rather than isolating them in large, distant facilities that cannot meet individuals' needs.

1. Sam Sly
Beyond Limits (Plymouth)

2.  Social Worker for people with learning
disabilities and mental health needs
 CSCI (CQC)
 Change Team Cornwall (changing housing
and support that had gone badly wrong)
 Cornwall PCT continued to improve quality
 Bournemouth Campus re-provision
 United Response improving quality
 Developed ‘Hands Off Its My Home – a path
to Citizenship’
 Director for Beyond Limits with Doreen
Kelly
 Columnist for Learning Disability Today

3. 3 year project with NHS Plymouth
Personalising Commissioning
 Using Individual Service Funds
 Using Service Design & Working Policy
 20 people currently in Hospital placements
 20 people with big reputations
 20 people who will get a tailor made service
 20 people who will get a life that makes
sense to them

4. ‘People often end up in expensive out of area
placements because local systems have not the
flexibility to develop suitable personalised responses.
This leads to people being over-supported and cut off
from their own communities. There are currently
10,000 people with mental health problems supported
in out of area placements and research suggests at
least 5,000 of these are without significant clinical
justification. The use of individual budgets as part of
intentional programme to bring people back to their
own communities with personalised support could save
£100 million a year.
Vidhya Alkeson & Simon Duffy ‘Health Efficiencies - the possible impact of
personalisation in Healthcare ‘ 2011

5.  Individualised, local solutions providing good quality of life
not those too large to provide individualised support, too
far from their homes, and providing good quality of life in
the home and as part of the local community.
 Direct payments and individual budgets should always be
considered and be more widely available.
 Closer co-ordination between the commissioners paying for
services, the managers providing services and the
professional specialist advising on the support people need
to ensure advice is both practicable and acted on.
 Commissioners should allocate a budget to be used to fund
a much wider variety of interventions as an alternative to
placement in a special unit.
Jim Mansell ‘Services for people with learning disabilities and challenging
behaviour or mental health needs’ 2007

6.  All have been abused
 Have moved between 6-25 Institutions
 Youngest 26 Oldest 56
 First admission to an Institution aged 14-22
 All on MHA Section for between 5-14 years
 Most have moved to more and more secure
accommodation as they have fought the system
 All families have felt loss of control, marginalised
and physically unable to stay in touch
 All people have the same hopes and dreams as all
of us

7. Citizenship and
Personalisation

8.  Key 6 – Giving something back (Community
Life)
 What needs to be achieved?
 It is by giving back to our community that we
can help other people understand our worth.
This means working, learning and enjoying
leisure pursuits with other fellow citizens whilst
making friends along the way.
 Why is it important?
 To overcome prejudice
 To make a contribution to the community
 To make relationships and friendships
Simon Duffy (2006) Keys to Citizenship

9.  The resources to enable people with learning
disabilities to achieve a good life.
 Strengths – skills, gifts and abilities
 Connections (relationships) – family,
friends, community networks and
organisations
 Community (Access) – information,
emotional and physical support
 Control (Assets) – income, property,
savings, benefits
Pippa Murray, Simon Duffy, Nic Crosby (2008)

10. Service Design (Partners for Inclusion/Beyond
Limits)
‘Every service is designed, from scratch, with
only the person in mind, and modified in
the light of experience and as things
change. Individual service design in rooted
in the organisation’s commitment to help
everyone achieve citizenship for
themselves’.
Personalised Support – Julia Fitzpatrick (2010) Published by the Centre for
Welfare Reform

11. A good facilitator
The person
Family and
significant people in
their life
People who know
and care about the
person
People with strong
relationship with
person

12.  Planning and pre-
move transition is
funded (one off
payment clawed back
through reductions
from years 2 onward)
 Post move transition
is funded
 On-going budget
flexible in first year
 Greatest reductions
after year two and
three

13.  Take time getting to know person and
significant others
 In a comfortable environment
 Telling their story
 Being in control
 Direction
 Money
 Home
 Support
 Contribution (Giving something back)

14.  What does the
person do with
their time now
(routines)?
 What should we
keep doing?
 What should stop
happening?
 What should they
start doing?
 What should we
start doing?

15.  What hours of paid support do they need?
 What will happen in those hours?
 What support could help the person become
more independent or develop more natural
support?
 What do we need to do to keep them and
others safe?
(risk mapping and enabling is a natural by-
product of service design)

16.  Who worked well in
the past and who
didn’t and why?
 What kind of person –
quiet, busy and lively?
 What knowledge, skills
and experience?
 What contracts are
needed?
 Leadership skills
needed?
 What hobbies interests
should they have?
 Man or woman?
 Age?

17.  Being seen as a fellow citizen by others
 Controlled by the person
 Provided by who you choose
 Enables you to do what you want and does
not control what you do
 Invisible
Simon Duffy (2006)

18.  It enhances the person’s dignity and respect
in the community
 It helps the person be present in the
community
 It helps the person participate in community
life
 It helps the person develop and learn new
skills
 It gives the person choice and control

19.  Many great plans are made and fall down
because they are not followed up by a
detailed ‘how to’ bit.
 It is fundamentally important that once a
service is designed a ‘how to’ plan is written.
Partners for Inclusion and Beyond Limits call
this a Working Policy.
 Involves the person (if they wish), present
and past professionals and family

20.  Aged 28
 25 different placements furthest was 349
miles away from home
 Went through Criminal Justice System
 Sectioned for 6 years
 Physical Intervention from aged 17
 Family seen as a problem
 She was seen as a big problem
 Always wanted to come home to be part of
family

21.  Part of the family (highs and lows!)
 Has own home
 Interviews for her team
 Health problems stable
 Been to Bristol to visit friends twice
 Tickets for Peter Andre!
 Ice skating lessons
 Been Clubbing twice (first times in 11 years!)
 Says she never wants to go back to Hospital

22.  Hospital doesn’t work
long or medium term
 Being away from family
and community is
destructive
 Planning for a normal
life has to start from
day one
 Matching teams makes
the difference
 Individual flexible
budgets
 Cultural change is
required
 People want lives

23.  Hospitals
 Hostels and
Campuses
 Residential Care
Homes
 Don’t let
‘supported living’
be the next
institutions
 People want to live
in their own homes
just like you and
me

24. Sam Sly
Beyond Limits
sam@beyondlimits-uk.org
sam.sly@enoughisenough.org.uk
07900 424144
www.beyondlimits-uk.org