A local authority considering pulling its mental health social workers out of integrated NHS teams believes the move could save cash and improve delivery of the Care Act.
Somerset County Council will propose scrapping a deal that has seen social workers integrated with Somerset Partnership NHS Trust since 1999.
The proposal, which impacts 60 staff, will be considered by the council’s cabinet at a meeting next month. If agreed, the social workers will be withdrawn from the NHS teams and returned to the local authority’s adult social services department in April.
The move is partly cost-driven. The pressure on local authority finances means the council wants to find £500,000 of savings from its mental health budget and has identified the management fee paid to Somerset Partnership as one option.
Community Care has learned the proposal has also been justified on the grounds it would improve compliance with the Care Act 2014. Some within the local authority feel the current integrated arrangement is failing to meet people’s social care needs early enough.
One source familiar with the situation expressed “shock” at the proposal given the push at national level to integrate health and social care provision.
‘Greater emphasis on prevention’
Asked how delivery on the Care Act would be improved by withdrawing social workers from the NHS trust, a Somerset County Council spokesperson said: “The proposals would enable us to ensure the positive work that has been underway regarding the council’s operating model fully includes mental health staff.
“It would enable greater emphasis on prevention, greater professional support and more direct supervision.”
Staff affected are aware of the plans, he added.
Somerset Partnership said it recognised adult social care services were facing “significant pressures” but insisted the trust remained “fully committed to integration” and hoped a solution could be found to maintain the arrangement.
The proposal follows months of talks between the two parties. Papers from a meeting of Somerset Partnership’s board in July 2015 reveal disputes over the potential for £500,000 of savings to be found from the mental health contract.
The council argued the trust should be able to achieve the savings through changes to back office functions. The trust disagreed, claiming that clinical staff already “carried out more social care activity than the trust was paid for” and warning “healthcare services will be forced to subsidise social care services” if the funding was cut.
At the time the trust said: “It was recognised the reduction in funding could have a detrimental impact on services which were already under considerable pressure. The delivery of integrated mental health services was key and every effort will be made to avoid the disintegration of mental health and social care services.”
Trust remains ‘committed to integration’
Today, Andy Heron, Somerset Partnership’s acting chief executive, said: “Our trust is aware that adult social care services in Somerset are facing significant pressures at present and that a number of options are being considered for their social workers in our mental health teams. As we understand it, there is no formal proposal as yet and we would hope that all options are considered.
“Our trust and Somerset County Council were amongst the pioneers of integrating mental health services during the 1990s and therefore integration between mental health and social care services is deeply embedded at many levels. If adult social care services do decide to withdraw their social workers from our community mental health teams, we are sure that colleagues from Somerset County Council will work with us to scope the likely impact of changes to these long standing arrangements and to do all we can to mitigate this.
“As we understand it, all options are still under consideration. The Trust’s position is very clear: we remain fully committed to integration and we would want to do all that we can to support the continuation of those arrangements wherever possible.”
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This proposal is an absolute disgrace. Social workers are a key part of mental health services and taking them out will do nothing but reduce the influence of social care/MCA/human rights and recovery based working for people in MH services.
Experience has shown us that when services return to social care they end up doing care management assessments and setting up financial packages. This is not what MH services need. This will increase organisational boundaries and reduce integrated working. The Govt needs to step in and prevent these decisions.
More importantly it needs to start funding LA’s to provide MH services rather than putting all of the money through the NHS.
I would be concerned that removal of social workers would water down and diminish the efficacy of the Care Act, and lead to more devicive practice between health and social care workers.
Brave and wise decision by Somerset. Although ‘Social Care’ is the Council’s responsibility ‘Social Work’ isn’t just the responsibility of the Council. It can be difficult to get Health Partners to understand this distinction.
That said I don’t think most Council’s fully understand the Coughlan Judgement: perhaps Somerset are showing signs of being among the first to do so.
Will be interesting to see how this evolves.
I work for an authority that pulled it’s social care staff out of NHS teams. It was the worst thing they did. We are deskilled and fragmented. We are not providing joined up service that mental health users need and we have seen a rise in serious incidents and vulnerable people slipping through the net, to disasterous consequences.
It is nothing to do with the care act or valuing social workers and amps, and nothing to do with improved service provision. It’s just a money saving exercise that will cost lives
Having worked in an integrated team that was ‘disaggregated’ I think that for social workers this is a double edged sword. In the integrated CMHT we were poorly managed and supervised and it sometimes felt like we were seen as there to supplement shortages of health staff. The social work role and local authority statutory responsibilities were poorly understood by health managers. Also, although we were in the same team there was no formal structure of joint working with health colleagues and this led to a lack of shared responsibility and expertise.
Since disaggregation we are better managed and supervised and have better working conditions but the work itself, as MHSW points out above, has become more routine and boring, consisting of endless assessments for care packages and reviews (involving hugely bureaucratic and time consuming work on a cumbersome database). Most of our work is now with older adults requiring these services and the opportunities for working with adults of working age are limited. Also communication with health colleagues is much more difficult and less frequent as they focus on CPA targets and we on Care Act responsibilities.
My preference would be for a ‘semi-integrated’ model where staff are co-located but separately managed and supervised, allowing closer joint working and better communication. Managers could decide locally how this model worked best in practice, fulfilling their respective organisational targets and responsibilities whilst making best use of resources.
Social workers within a mental health setting have specialist training in psychiatric disorders and treatment working with people with severe and enduring mental health problems and their carers and families. They have comprehensive knowledge of the Mental Health Act, Mental Capacity act and Human rights Act. They work within multidisciplinary teams alongside psychiatrists, psychologists, occupational therapists and CPNs making a unique contribution which emphasises the psychosocial perspective. They are upholders of social justice who work tirelessly for the needs of those who experience some of the worst types of discrimination and stigma.
The government recommendations are that there should be greater integration of health and social care, not disintegration which will ultimately lead to staff stress, burnout, dissatisfaction with some choosing to leave the county or even the profession.
THe withdrawal of mental health social workers will predominantly be a cost cutting exercise. It takes no account of the impact it will have on service users caught in the middle as CMHTS shrink further and are unable to meet the needs of this very vulnerable group of society. If this proposal is approved and mental health social workers withdrawn, they will be expected to complete Care Act assessments and manage care packages. What a terrible waste of expertise, knowledge and experience, not to mention money spent on training.