Two of regular panellists offer advice on adult
“In common with many local authorities we have become
increasingly concerned about the financing arrangements for
residential accommodation charges for adults with support needs who
are subject to after care under section 117 of the Mental Health
Act 1983. Since the Bournewood Hospital case, social services
departments have been put under more pressure to meet these costs,
and this can create additional tensions between local authorities
and NHS Trusts, in particular with regard to funding issues. Yet
good joint working arrangements between social services, health,
housing and other agencies are essential if we are to meet clients’
needs. Can panelists suggest ways in which effective inter-agency
work can be pursued despite these funding pressures?”
Joshua Ashitey, senior projects and partnership officer, Newham
The Bournewood case is not, I think, relevant, because the
Lords’ judgement pretty much resolved the matter. However, the
court of appeal ruling last year that residential care must be
provided under section 117 after care is much more important. But
the question is really about good inter-agency working in a
pressured environment. Suggestions include:
– Joint assessments and joint care plans as part of the care
programme approach with social care engaged early, not just for
– A strategy to reduce use of residential care and increase the
spectrum of housing options with flexible support.
– Ensuring a comprehensive systems approach to mental health,
embracing housing, benefits and employment.
– Being clear what partnership is for – it is to deliver
mutually agreed goals for people with mental health problems.
Where to start depends on where you are at now. I like to adopt
a three-pronged approach to partnership working:
– Create a mechanism to discuss issues with all the key
– Within that have a much smaller action oriented project
– Influence the key players – take them out to lunch or meet
them in their office, not yours.
The revised government guidelines following the House of Lords’
ruling in the Bournewood Hospital case do confer the overall
responsibility of co-ordination and implementation of the care
programme approach (CPA) on approved social workers (ASWs).
The key must be the integration at the earliest stages of all
processes and involvement of partners, including health, housing,
independent sector, police, criminal justice agencies, service
users and carers. This is before any assessments – at the earlier
“future capacity” planning stages and in the development of a range
of community facilities. Examples of good practice and service
models can be found in the National Service Framework for Mental
Health: Modern Standards and Service Models.
The dialogue created by Supporting People will surely be a spur
to the creation of supported living options, including flexible
support around individuals with tenancies. It is vital that health
and our independent sector partners are included in these initial
discussions, building on the achievements of beacon authorities. A
guide for commissioning organisations is available from the
Department of Health.
Integrated processes such as the Dewsbury model, where a CPA
care manager is employed by social services, must be the key to
managing the inter-agency tensions and funnelling resources to
support after care and supervised discharge arrangements. Moves
towards pooled budgets will finally complete this integration and
should remove the funding tension totally from the process.
1 Department of Health, National Service Framework for Mental
Health: Modern Standards and Service Models, Stationery Office,
2 Department of Health, Building Bridges: Arrangements for
Inter-Agency Working for the Care and Protection of Severely
Mentally Ill People, (HSG (95) 56, DoH, 1995