A little extra

Even if it is known that a service is in decline, plans for change can set the nerves jangling, with anger placed on standby. What you have may not be perfect, but at least you know where you stand.

In 2002 Tower Hamlets Council in east London formed a partnership with the housing charity Epic Trust to replace a residential care home for older people with 40 self-contained extra-care flats with on-site care and support. It was the first scheme of its kind in the borough.

The charity recruited Nancy Nelson, who had overseen closures in another London borough, to manage the service transition.

“There was a fair amount of scepticism from staff in Tower Hamlets about whether this was going to work,” she says. Having worked exclusively in day and residential settings, Nelson admits she shared the scepticism at first.
“I thought people in residential care wouldn’t be able to manage in their own homes. But, with careful assessment and placement planning, it can and does work. It’s about well-being and, to use a good, old-fashioned social work word, empowerment. People have control.”

While recognising that older people would still have to leave their home to move into the scheme, Nelson believes it is still “home”. She says: “They can keep all the things that matter to them – their furniture, photographs and so on.

They have their own front door, bathroom and loo. And they have the ability to tell someone when they come to the door: ‘Bugger off, I don’t want to see you today.’ And that is crucial. We also insisted on the front doors being different colours, which helps people with memory loss.”

A challenge for Nelson was to convince other professionals that the scheme could work even though she had no evidence that it would. “But I believed if we could work in partnership – and that’s the really important thing – we could achieve something.”

She adds: “Before the building opened we had a furnished show flat so that professionals as well as potential service users could come in and have a look around. For professionals it was about talking about the assessment process, how we could meet people’s needs and how we could adapt a support plan if something wasn’t working or if their needs changed.”

The demolition of the care home also sparked local outrage. “It made some people angry,” says Nelson. “But that meant I had to get out there and talk face-to-face with people and hold meetings with teams. It was all about selling the service.”

An important aspect was the approach to staff recruitment. “We used local job centres. Some people we recruited hadn’t worked for a while and some didn’t have professional experience of caring for older people but had a relative or neighbour whom they knew and had cared for. But we recruited locally. We had local people supporting local people. So, if an older person wants to reminisce about Roman Road market or Bethnal Green the member of staff that is working with them is from the area so will know about it and will have seen the changes.”

Similarly, Nelson’s social work background was drawn on to purchase credibility. “People could see that I knew what I was on about and I hope what they also saw was my energy and enthusiasm,” she says. “I’ve never lost my commitment to older people. Even after I got my CQSW I was one of the few qualified social workers who chose to remain working with older people, particularly in the residential field.”

Everything, it seemed, fell into place with only one unsuccessful placement. Since the first scheme opened, two more have followed equally successfully. The policy to replace popular care homes seemed controversial at first, but four years on it’s clearly as safe as houses.

Curriculum Vitae

Name: Nancy Nelson.
Job: Now semi-retired, providing induction and training for a care staff agency.
Qualification: CQSW.
Last job: Service manager, Epic Trust.
First job: Assistant matron, older people’s home.


  • Always be honest and realistic and listen to people.
  • Make sure your objectives link in with partner agencies.
  • Ensure staff development is meaningful and stimulating.


  • New brooms must always sweep clean – change everything.
  • Always presume with staff on board that they are working to the same objectives.
  • If things aren’t working out – persevere: you’re right, they’re wrong.

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