Between the NHS and the Local Authority – On Being Seconded

I’ve been a local government employee for a good number of years but however much I try to ensure that I am fully linked into the policies that trickle down to us via my own employing council, I can’t help but feel an increasingly sense of separation on the basis of my ‘secondment’. Don’t get me wrong, I think the advantages of the secondment outweigh the negatives but it’s something I tend to just take for granted.

It isn’t uncommon for mental health social workers to be seconded to mental health trusts. It is the case in most of the mental health teams I know. While my colleagues whom I sit alongside are employed on NHS contracts, only the social workers in the team are local authority employees.

The background to this is mostly historical. Before community mental health teams were interdisciplinary in the way they are now, social workers within the local authority worked generically and so when these new teams emerged, some of those generic social workers were moved out and seconded into the new teams in the NHS. Legally, there was also a provision in the 1983 Mental Health Act that specified that Approved Social Workers should be employed by the responsible local authority.  A change in the legislation with the passage of the 2007 amendments to the 1983 Mental Health Act mean that the employment is no longer specified and there are some noises about some of the social workers being employed directly by the NHS but I feel relatively confident in saying that my position of being seconded to work in the NHS by the local authority is likely to be the majority position for Mental Health Social Workers in England at the moment.

I moved into this team  from a local authority social work team and without doubt there is an increased feeling of isolation and detachment from our local authority employers when I compare the experience to that when I worked in the local LA office.

On a very basic level, we are frozen out of the intranet and the local authority IT system. It wasn’t always like this and isn’t supposed to be like this but increased security both on the Local Authority IT systems and the NHS systems mean it is impossible to run both networks on the same physical PCs.  Whisper it quietly but I haven’t checked my local authority email address for about three months and only get around to it when I visit other offices and can borrow someone else’s PC that is ‘on the network’.

The difficulty in this is that some people in our communication department, despise being told again and again and again, refuse to believe us and persist in sending all relevant information to our local authority email addresses.

Some people in other departments repeatedly try to contact me via the LA email address and although I have an ‘out of office’ response on it, I always find things that I should have seen much earlier when I check it. I know, it’s my own fault but they don’t make things easy for us!

It also means the ‘wonderfully efficient’ e-tools that the local authority has in place on its intranet to do all your appraisals online and to book annual leave and training online remain barren and unused and we are using scraps of paper to log our annual leave because HR wants to charge us for paper versions of the old ‘cardboard ‘real’ Annual Leave cards’.

It also explains why, apart from safeguarding training, I receive almost all my annual quota of training from the NHS Trust rather than accessing the local authority training schedules.

Recently, I did find myself in a meeting over in the local authority offices and  I was actually staggered by the amount of policies I hadn’t been aware of, training I haven’t heard of and ways of working that had completely passed me by.  Of course, none of it makes a massive difference to practice (which makes you wonder about the people who sit in offices and write reams of policies)  but sometimes you feel almost as if you have a duel identity working in an NHS team as a local authority employee with neither ‘employer’ wanting to take overall responsibility. Mind, I’m still a bit bitter about the lack of our involvement in the development of personal budgets. I genuinely believe we could have created a far better system if we had been consulted about the way that process had been rolled out and piloted.

But the positives outweigh the negatives. Apart from the annoyances that emerge when trying to claim any kind of expenses back for travelling which involve begging a ‘friendly’ local authority team to let us please use their budget for our ‘permit to travel’. Fortunately having previously worked in the social services office, I have some contacts to lean on at the requisite moments but it is not something that is made particularly easy for us.

The main positive is the sense of independence for a start. We are slightly detached from the rest of the CMHT having different employers and can sometimes take a step back. Personally, I think it allows a greater freedom to challenge ‘from the outside’ as one thing that can definitely be said about the NHS is that it is a hierarchical organisation. By remaining slightly outside as seconded employees and being ‘representatives’ of the local authority within CMHTs gives it a slightly different hue and sphere of influence.  The role of the Mental Health Social Worker in a team has to be about advocacy and promoting involvement and bringing the importance of social issues into the scene when looking at helping someone holistically.

Terms and conditions are generally (although this is arguable) better in the local authorities. None of the social workers want to switch over to NHS contracts (because yes, it has been discussed many times and is something that seems to be perpetually ‘in the pipeline’ since the change in the 1983 Mental Health Act).

I think the feeling of difference is remarkably important and it gives the local authority a physical presence in the team which is particularly important as care management and support planning is a massive part of our role in older adults services. The introduction of personal budgets to all our service users has meant that more information and documentation is channelled between the teams but I can’t help the nagging feeling that we are sometimes the  ‘forgotten’ employees. This is not always a bad thing.

As well as the intranet and the lovely sparkly new HR systems that we can’t use, on a far more fundamental and basic level, we can’t use any of the local authority databases. Their attempts to move everyone to paperless working mean many battles trying to explain to whichever service it is that we can’t get onto the intranet to make referrals online seems to be a constant.

In my dream world, the local authority would issue some kind of communal email to everyone in the council telling them that not everyone who works for the council can actually access the intranet. I think that would come as news to them on account of the amount of times I’ve tried explaining this to baffled looks of astonishment.

But generally, I’m happy where I am.  Taking a step back and looking at the situation in the broader context, I think I have and am continuing to learn incredibly useful lessons about the ways that organisations develop and grow and work or don’t work.

Sometimes there are frustrations but if everything worked perfectly, it would just be more boring and standing between both the Local Authority and the NHS allows for a more critical reflection of the ways that both operate and are managed in a way that I couldn’t have if I were entirely placed in either one or the other.

Ginger

My duty as an AMHP (Approved Mental Health Professional) is fundamentally to co-ordinate and carry out assessments according to the Mental Health Act (1983 – as amended 2007).

So in the case of a community assessment, I will request the doctor’s attendance – if a warrant is required for entry, I will attend the local magistrate’s court and request police assistance if needed.

I book the ambulance and although the Mental Health Act Code of Practice is clear in vesting the responsibility for bed finding to the doctors involved, our current practice where I work would mean that I would alert our Trust ‘bed manager’ of the impending assessment who would then inform me of the bed that I can use.

I am obliged to accompany the patient to the ward if they are admitted under section (compulsion) to ensure that the admission papers travel with the person themselves – although this can be delegated, I have never done so – and even if it were, it would remain my responsibility as the AMHP.

Once on the ward, I hand the papers to the member of staff whose role is to ‘accept papers’ who will then check everything is correct. I will, if I can, stay to see the patient settled but one of the other matters that I am tasked with is to under Section 48 of the National Assistance Act (1948) which explains

(1)Where a person—

(a)is admitted as a patient to any hospital, or

(b)is admitted to accommodation provided under Part III of this Act, or

(c)is removed to any other place under an order made under subsection (3) of the last foregoing section,

and it appears to the council that there is danger of loss of, or damage to, any movable property of his by reason of his temporary or permanent inability to protect or deal with the property, and that no other suitable arrangements have been or are being made for the purposes of this subsection, it shall be the duty of the council to take reasonable steps to prevent or mitigate the loss or damage.

(2)For the purpose of discharging the said duty, the council shall have power at all reasonable times to enter any premises which immediately before the person was admitted or removed as aforesaid were his place of residence or usual place of residence, and to deal with any movable property of his in any way which is reasonably necessary to prevent or mitigate loss thereof or damage thereto.

Put briefly, I have to ensure the property is secure. This is usually done by enlisting a locksmith to attend the assessment so that if the lock does have to be broken it can be replaced immediately.

‘Moveable property’ though, also ensures that any pets are taken care of and I have a legal responsibility to ensure the well-being of any pets left behind in a property.

And so it was that I learnt of the existence of a device called a ‘cat trap’ (obviously one of those humane traps!).

image AmbHain at Flickr

I had carried out an assessment a couple of days ago. It was relatively fraught, as is often the case. Mr Y though had a very timid cat. After he had been admitted I called our animal warden to see if we could arrange a cattery for the cat in question (as that is invariably what we do).

He was happy to agree it but we needed to find Ginger. Along with Mr Y’s daughter (whose own child was allergic to cats), we went to try and find him. And we couldn’t. He is a timid cat at the best of times but the uproar and noise of strangers padding in and out of his ‘den’ must have had some kind of impact.

That was when the warden suggested a trap. He explained that it wasn’t as scary as it sounded and just involved putting food inside a cage which would close down when kitty entered.

And the trap was left overnight. The next morning, sure enough, there was Ginger. Looking disshevelled but rather plumply satisfied and with the warden, we waved him on his way to his own ‘place of safety’ for a couple of weeks at least.

Sometimes you really never do know what the day will bring.

Positive Influences

I came across a tribute written by Clare Allen in the Guardian, to her own Social Worker, Bernadette, who is retiring this week. Allen writes about the positive influence that her social worker and the relationship between them has resulted in.

I could quote whole swathes of the article but honestly, it is better to go there and read it in its entireity as says a great deal about the way in which a good social worker practises and how it is perceived and interpreted from the view of the recipient of the service.

Just a couple of points though, first is that Allen had the same social worker allocated for 11 years and, she writes, as far as she remembers, Bernadette has never had a sick day.

I honestly can’t imagine many people being able to write that about support staff. I wonder if it is about conditions, working environments and management structures.

It is a great tribute but it is also an indication, in more general terms, of the work that can be done in Community Mental Health teams by social workers and why it is important to retain their skill-base in teams that seem to be ebbing ever more to a Health-based paradigm and away from Social care.

Yesterday I was at a meeting where one of the discussions revolved about the apparent marginalisation of social workers in CMHTs as we move towards multi-disciplinary working and the need for social workers specifically has been loosened with the changing of the ASW (Approved Social Worker) role to the AMHP (Approved Mental Health Professional) which can be taken up by other professionals. Of course, it won’t happen for a while, but it is clearly a worry. There is though, a substantial role for social work to carve a niche and to have a positive effect.

Back to Bernadette though, who does sound like a great practitioner. I have learnt myself from Allen’s piece about things that are important that I think will have an effect on the way I practise.

I trust she will have a well-deserved, restful retirement!

According to the testimony of Bernadette Soubi...

Image via Wikipedia

Training

It’s a fairly busy month in the Mental Health teams with the impeding (3rd November) changes in the Mental Health legislation in England and Wales.

Having attended my ASW (Approved Social Worker) to AMHP (Approved Mental Health Professional) conversion course, a mere 3 months after receiving my warrant, I have somehow (actually, I believe it’s related to the above!) become involved in the training of other members of our service in the changes that are coming in with the new legislation.

k.susuki at flickr

k.susuki at flickr

I ran (with a colleague) the first of the training sessions yesterday. It was a lot more positive than I had feared it would be. I was concerned that either there would be some ‘information overload’ or that I had pared too finely the ‘essential information’ needed. Too much reliance on PowerPoint too. That was a genuine worry

It was the first time I’d delivered training, as such. I have given presentations but they have tended to be much shorter – of up to an hour. I spent a couple of years teaching English as a Second Language, mostly overseas and to a wide variety of age groups and levels but again, those sessions were much shorter. At least it had given me a lot of experience with ‘interesting’ activities and the importance of some element of interaction and group work.

But this was training. This was different. This was new.

We had drummed together a few activities related to the subject matter including a quick quiz on current legislation (with one .. um..  deliberate mistake)  and a couple of case studies with lots of discussion points.

We have another couple of general sessions to run as well as some more specialised ones on request. I think there’s a little bit of fine-tuning to be done before the next session.. maybe the ‘deliberate’ error was a little too subtle!

We made significant use of the materials provided on the Care Services Improvement Partnership site, which comes highly recommended.

They even have a  very handy (and brief) summary of all the changes here.

As for the training, well, it isn’t over yet. I enjoyed it though. I definitely see it as an area that I would like to develop in my own work. My not-so-secret ambition has always been to move towards teaching when I do just get too tired to continue with the front line work. Management of a team doesn’t interest me and I’ve harboured the wish to move into a more pedagogical role for many years. All these experiences are good then in the long term planning.

Guardianship – Making decisions

From my earlier posts about the possible use of Guardianship and the interrelation with powers under the  Mental Capacity Act in the context of a current decision that needs to be made at work, it seemed that in general, the Mental Capacity Act offers a similar authority to the Mental Health Act.

It allows for some restraint to be applied (Mental Capacity Act 2005 s 6) if it is a proportional response.

So what guidance is there about the differences? I am curious now as to whether I was asked to prepare a Guardianship application because the people doing the asking weren’t perhaps as aware of the scope of the Mental Capacity Act as I had assumed (this is not meant as a disservice it’s just that quite a lot of people are still unsure of the scope of the new legislation).  It seems to be a least restrictive option.

image piccadillywilson at Flickr

I’ll try and sum up so as not to turn this into an essay!

The issue that we need to address is not able compelling A to stay in one place (her residential home – where she has stated that she is happy to stay) but more about how to prevent her from leaving and going to her ex-husband (not necessarily to prevent her from seeing him)  and what can be done to ensure that she returns when she does go.

The Mental Health Act Code of Practice currently (because it changes in November!) says that

21.4 A person absent without leave while under guardianship may be taken into custody by any officer on the staff of the local social services authority, or by any person authorised in writing by the guardian or the local social services authority.

and to me, this is the main difference between the usage of the two acts. There are some (bluntish) teeth to the powers of Guardianship regarding ensuring that someone who leaves their place of residence can return. The Mental Capacity Act allows for some form of restraint to prevent a person from leaving in the first place (assuming it is proportional) but no powers to compel A to return – (I don’t think.. ).

We are needing to look at the powers to bring someone back to a particular place if A does go back to her (potentially abusive) ex-husband.

The principle of maintaining the path of least restrictive practice remains crucial.

Can we honestly imagine that forcibly trying to remove A from her ex-husband’s house would be feasible? It’s a question I did actually ask to which I had a positive response.

What would his response be? Would the legal force be enough to ‘scare’ him into not allowing his ex-wife to enter? In which case, would the appointment of a deputy serve exactly the same purpose if no ‘power’ were needed?

A new Code of Practice has been published which will come into force in November. A quick glance foresees some of the interplay between the Mental Health Act and the Mental Capacity Act and there is an explicit statement 26.12 that the Mental Health Act (namely Guardianship)  should be used where

• there is a particular need to have explicit statutory authority for the patient to be returned to the place where the patient is to live should they go absent;

In this case, the particular need would be the potential abusive situation.

The Mental Capacity Act Code of Practice 13.20 says that

Decision-makers must never consider guardianship as a way to avoid applying the MCA

But I’m not sure that is the case in this situation. Guardianship could be considered if it were the best for A and not as a way of avoiding applying the Mental Capacity Act – indeed, in many ways, the Mental Capacity Act would be favourable.

There is also the issue of potential deprivation of liberties under the Human Rights Act (1998) (Article 5). This will, no doubt, be picked up over the next few months with additional provisions being added to the Mental Health Act – but now, today, I am working in a situation prior to those provisions being enforced.

While the Mental Capacity Act allows for some kind of restraint, it does not seem (to me, anyway, although I am happy to be corrected) there are any powers to return A to her home if she has already left.

So where am I with this? Still looking at the Mental Health Act to be honest. The care coordinator who knows A thinks that the sanctions available to guardians are necessary and that she will respond to them. Sometimes when we know that there is a situation of (potential) abuse and a vulnerable adult, we are obliged to take action at the firmest level.

Would the deputyship be a better case scenario? – possibly in some circumstances – it is definitely worth consideration –  but it looks for the moment that the Guardianship will be favoured. I am taking the two options to the multi-disciplinary meeting though.

Now I need to plough through the local authority procedures – but don’t worry, I won’t share those!