Change agents: councils’ critical friends

Anabel Unity Sale spends a day with one of the Care Services Improvement Partnership’s change agents to find out about their work supporting councils to improve adult services

Chickens and cows threatened to change the course of adult social services in the West Midlands. This is not a reference to an outbreak of bird flu or BSE, but an alternative career for Robin Cowen (pictured), West Midlands regional change agent for the Care Services Improvement Partnership (Csip). Cowen considered becoming a farmer like his father before starting his social care career 36 years ago – a choice that would not have seen him appointed to Csip 10 months ago.

Csip was formed in 2005 through the merger of several Department of Health agencies and programmes. Csip incorporates seven programmes including the National Institute for Mental Health in England (Nimhe) and the Valuing People Support Team, and has an annual budget of £42m. Its aim is to help improve adult services particularly through the promotion of independent living, and improve integrated working between social care and health.

Former social services director Julia Ross leads Csip’s social care programme, and nine change agents – including Cowen – help deliver the programmes across England’s regions.

But Csip’s feathers have been ruffled. There have been whispers it may split its health and social care functions (news, page 6, 22 February). According to a source close to Csip, the proposed split is at least in part down to the DH’s health and social care elements both wanting to get their hands on the £40m tied up in the partnership. All that is known for certain is that a review of Csip is about to start and will report back in December, with firm plans for the future expected by April 2008.

Last autumn a Community Care survey suggested that only one quarter of practitioners had heard of the agency. But the good news was that most of those who had heard of it knew what it did.

Cowen recognises Csip’s low profile because, although it works with local authorities, NHS trusts, primary care trusts and the voluntary sector, its role is to support individual managers. He adds: “I recognise how hard-pressed lots of strategic managers are and I relish the opportunity to give them support.”

When he started the job he had to tackle the lack of recognition locally. “Csip wasn’t known as a social care organisation and we had to build it up in the West Midlands so people saw us as valuable.”

His remit covers 14 councils in the West Midlands, four of which the DH has decreed need extra help. His priorities for all of the regions’ councils are to address issues connected with commissioning, the workforce, health and social care leadership and the modernisation of learning difficulty services.

It was this emphasis on improving ­services that inspired Cowen to apply for the two-year post, as it was something he felt his previous role as service inspector for the Social Services Inspectorate and then the Commission for Social Care Inspection lacked. “I like the fact I have a real focus on improvement because that’s what floats my boat. I’m allowed to be creative and can use my skills and expertise to get the job done.” Having qualified as a community psychiatric nurse in 1974, and with a CQWS in 1980, Cowen spent most of his career in services for older people.

As for the future of Csip, Cowen will not be drawn on the likelihood of a split. However, he is adamant that, whatever happens, the DH will want a social care presence in the regions.

Community Care spent a day with Cowen to see what a change agent does.


Makes a start on scaling the south face of Paperwork Mountain.


Csip’s West Midlands branch is based in the picturesque Uffculme Centre in Moseley, Birmingham. The building belonged to Cadbury until 1906, having been built as a family home for Richard Cadbury. Cowen hot desks as Csip’s space within the building is limited.

After travelling by train from his Bristol home, Cowen’s first meeting is with Sue Williams, an independent consultant working with him on self-directed care. She also works with the Association of Directors of Social Services’ West Midlands branch on developing service access for older people.

The pair discuss organising a second workshop on direct payments aimed at managers. The first session they ran identified the tools councils needed to go ahead with direct payments and the next session will look at how they progress from here.


A call to Stephanie Canham, head of adult services at Herefordshire Council, one of the authorities Cowen works with. The council has one star and “uncertain prospects” and Cowen is supporting Canham to improve overall performance.

For Canham, the advantages of having a change agent on hand as a peer mentor are clear: “It’s enormously helpful to have someone who has this level of experience and stature. Csip isn’t judging us and it’s very helpful to run ideas past Robin and tell him this is an area where we are struggling.

“Change agents are critical friends and what they do is reflect back to you where you are.” The only downside, she says, is that Cowen is spread thinly across the region and is very busy.

Next is a quick call to Tracey Sparkes, another independent consultant Cowen is working with. They discuss the work they are doing on sub-regional commissioning and how they can pull the region together on the issue. Their work coincides with Csip’s second priority for the locality: improving the commissioning skills of staff. Sparkes wrote a model for commissioning, using different services as examples, and has e-mailed it to Cowen.


Cowen and Williams take a taxi to check on progress at the site of one of Birmingham Council’s four new care centres for older people with dementia. They are met by Jon Tomlinson, Birmingham Council’s service director for older people, Brigid Doherty, project support officer in Birmingham’s adult and ­communities directorate, and Shah Shahnavaz, project manager for construction contractor Wates, which is building the centre.

After donning hard hats, wellies and high-visibility tops, the group go on a tour of the centre, which will provide a mixture of intermediate, respite and long-stay accommodation for 64 residents. It will also have a gym which the local community can use, and other facilities for its residents. Each centre costs £11m to build and this location is due to open in October.


Tomlinson joins Cowen, Williams and Ian McPherson, director of Csip West Midlands for lunch at the Matchbox Café, a social co-operative run by Birmingham Council that employs 11 workers with learning difficulties and five support staff.

As they tuck in to lunch they discuss Birmingham’s plans for intermediate care. The council has been supported by Cowen since December 2006 to address its improvement of intermediate care, building upon work the Health and Social Care Change Agent Team did several years before with Birmingham East and North Primary Care Trust. Cowen and colleagues support Birmingham’s goal to identify areas of good practice in its PCTs and disseminate the information city-wide.


After a bumpy journey on the bus back to the office, Cowen and Williams meet Liz French, an organisational development manager at Herefordshire Council. French is assisting Csip and the ADSS with developing commissioning skills in the region. She hopes to carry out this task through an informal secondment to Csip one day a week. This work fits in with one of Csip’s aims for the area: to improve its workforce development. Cowen suggests French establish what information already exists on the subject and they plan a consultation and event with interested parties.


Cowen’s working day ends and he goes to the railway station. When he gets home he’ll tend to the chickens in his garden. He didn’t totally abandon the idea of becoming a farmer after all.

Further information
Information on change agents

This article appeared in the 29 March issue under the headline “Your critical friends”




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