Staff anxious about integration

The NHS take-over of mental health services in the London
Borough of Westminster has raised much concern among social
workers. Phil Cohen investigates

Robin Hanau, aged 52, has a history of mental health problems
and homelessness and now lives in a hostel owned by the London
Borough of West-minster.

In August 1994, the staff at the hostel stopped being employed
by the social services department and transferred to the Riverside
Mental Health NHS Trust, which won the contract to provide social
care services for people with a mental illness across the whole of

Did Hanau notice the difference? ‘It’s the same staff who are
now employed by the trust. Things haven’t changed much, the hostel
is about the same and there is not a lot of intervention in the way
it is run,’ he said.

For social care staff and users the jury is still out on whether
the reorganisation – the first time an NHS trust has taken over a
complete social services function – will improve services rather
than simply change titles on office doors.

Despite examples of successful joint commissioning of mental
health services in Northern Ireland and Wales, the evaluation of
the first year of the five-year Riverside contract, carried out by
the Sainsbury Centre for Mental Health, reveals staff anxious about
the threat to their social care skills and suspicious of the
internal health market.

Mental health services had previously been provided by
Westminster’s Community Support and Rehabilitation Services. This
unit jointly bid for the contract with Riverside and when
successful, its staff transferred to NHS contracts, although some
approved social workers preferred to stay and re-train as care
managers who still play a key assessment role.

Lesley Warner of the Sainsbury Centre says CSRS staff were given
a warm welcome by Riverside but only about half of those she spoke
to felt they were part of the trust. They keenly felt the loss of
approved social worker status and the tension of deferring to
Westminster care managers who had until recently been their close

Signs of the corporate culture, like shoulder pads and glossy
documents, left them suspicious, and feeling like market forces
fragment services, not integrate them.

Warner said the gains from integration between CSRS and
Riverside had to be set against loss of ties with social services
and housing departments and the ‘loss of choice for service

But Chris Heginbotham, chief executive of the Riverside Mental
Health NHS Trust, said the change has brought an increased number
of care packages for users, extended opening hours into weekends
and better client access to health services.

‘Perhaps no service is completely seamless, but we can make the
seams invisible.

‘What we meant by integration was not some managerial or
technocratic integration but integration at the level of delivery
of care packages for users. It is important that if there is going
to be a joint approach from two organisations from two cultural
backgrounds, the organisational aspects have to be given high
priority,’ he said.

Ann Windiate, director of Westminster social services, said the
driving force for the contract came from the wish of council
members to become a slim, enabling authority by shedding direct
provision. She admitted it was process-dominated and said there was
a lot of unhappiness among social workers, with some leaving and
‘that is a great regret that we were not able to keep everyone on

Gill Newsome, CSRS director who played a key role in the change,
said it was traumatic because some social workers felt that moving
into a providing unit would damage their careers as specialist

There was staff and user anxiety but those who moved over
handled these fears ‘incredibly well,’ she said.

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