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Councils split on integration of mental health social workers in NHS

Local authorities appear divided over whether to sign formal agreements to fully integrate their mental health social workers in NHS teams, data obtained under the Freedom of Information (FOI) Act reveals.

Data returned by 108 of the 148 councils in England showed that 55 per cent currently integrate their social workers in NHS mental health services via official ‘section 75′ agreements, while 45 per cent do not. The partnership agreements allow for social workers to be placed under NHS management.

Twelve local authorities (16 per cent of those who had ever had a section 75 agreement) said they had terminated or not renewed the partnerships in recent years. Reasons for the withdrawals included fears that placing social workers in the NHS had led to “a loss of social work focus”, service restructures, and poor progress on personalisation (a concern also highlighted in research findings earlier this year). Social work leaders said that financial pressures had also put extra pressures on partnership agreements.

In its FOI response, Medway council said it had terminated a contract to second its staff to a mental health provider in 2012 due to issues around “poor social care outcomes” and “social care focus” not being resolved.

Wolverhampton city council did not renew a deal for the integration of its mental health social workers in February 2012 after feeling that “social care needed a stronger profile within the mental health service to focus on personalisation that would give an equal balance of health and social care.”

Bristol city council withdrew its mental health social work teams from an NHS trust in 2011. The council attributed various reasons to its decision, including a desire to ensure “social work skills and social care perspectives were not lost” as “was becoming the case”.

A number of local authorities without section 75 agreements said they had informal arrangements to co-locate social workers in NHS teams. But one social worker with experience of working in both set ups said co-location by itself did not always amount to integration.

“We were fully integrated but now co-located and I know when someone rings up they will now be asked if they want a health or social care duty officer. They will be subject to multiple assessments by different staff. We’re getting back to a situation where social workers only do assessments for residential care and the likes.”

The British Association of Social Workers (BASW) said it had heard from members at several other local authorities that had not provided data who had been pulled out of integrated teams in recent years.

Joe Godden, professional officer at BASW, said that section 75 partnerships could bring a lot of benefits to patients and staff when they were “done well”.

Godden said:

“A big question is, if section 75 partnerships are being ended what are they being replaced by? Some social workers tell us that when they have been pulled out of trusts they have basically been used as an additional pair of hands to undertake general adult care management”

“However if they have been pulled back to a well-articulated community mental health strategy and service that uses the strengths and knowledge of social workers and social care staff and has a clear strategy for on-going communication with health about service users then there is some chance of success.”

Ruth Allen, chair of The College of Social Work’s (TCSW) mental health faculty, said that regular review of section 75 agreements was essential for “healthy, functional services”. While some partnerships have “lost their way”, the data returned by local authorities suggested that an appreciation of the importance of integrated care “is holding most arrangements together”, she added.

Allen said that financial pressures on local authorities and NHS trusts had been an “important factor” putting strain on partnership agreements in recent years.

Allen said:

“Many cash strapped local authorities have asked pointedly whether they are getting their priorities met from trust-hosted social care staff, and some NHS trusts have also wondered whether their organisations benefit from trying to operate in integrated ways.

“In London, there was quite a healthy blow up over a year ago between NHS trust CEOs and adult social services directors about the problems of social care and social work delivery in mental health trusts. This has led to a coordinated effort to develop a new, robust section 75 assurance framework for local authorities and NHS trusts. TCSW’s recent consultation on the role of mental health social work (which will report in November) will also inform this.”

More on the integration of mental health social workers:

About Andy McNicoll

Andy is community editor at Community Care, with a focus on reporting on mental health. He has previously worked for titles focusing on the NHS and substance misuse sectors. You can contact him at andy.mcnicoll@rbi.co.uk

One Response to Councils split on integration of mental health social workers in NHS

  1. michael 25 September , 2013 at 11:11 pm #

    i worked in a so called integrated cmht in and it was a complete disaster the manager was health focused there was no senior experienced social worker to provide ‘supervision the whole service was medicalised and health staff were precious about there workload instigared tension within the group treated patients poorly and work colleaguues the main problem was the manager was a paperpusher lookig to climb the ladder had no interest in integrated social care just the medical ethos which dominated to the detriment of patients receiving ‘social input’ not just medical intervention hated the place and some colleagues