NATIONAL QUALITY PRINCIPLES & BEST PRACTICE GUIDANCE FOR THE PROVISION OF SOCIAL WORK SERVICES IN MEDIUM SECURE UNITS

Transcription

1 NATIONAL GROUP OF SOCIAL WORK MANAGERS IN SECURE SERVICES NATIONAL QUALITY PRINCIPLES & BEST PRACTICE GUIDANCE FOR THE PROVISION OF SOCIAL WORK SERVICES IN MEDIUM SECURE UNITS MAY 2010

2 CONTENTS Section/Chapter Page Introduction 3 Service Quality Principles 6 1. Best Practice Guidance for the Social Work Service in the Medium Secure Unit - Overview 8 - Quality principle Guiding Principles 10 - Quality 12 Medium Secure Unit Social Work Services to Patients - Pre-admission 13 - Admission 13 - Treatment 14 - Planning for Transfer or Discharge 14 - Statutory Responsibilities 16 - Safeguarding Children 16 - Family Members, Relatives and Carers 17 - Victims 17 - Unit Management Functions 18 - The Managing Local Authority Best practice guidance for the Management of the Medium Secure Unit - Overview and Quality principle Best practice guidance for a Local Authority Managing the Social Work Service - Overview and Quality principle Best practice guidance for Local Authorities with In-Patients Overview and Quality principle Best practice guidance for a Local Authority in whose area the Medium Secure Unit is Located - Overview and Quality principle Best practice guidance for the National Offender Management Service - Overview and Quality principle 6 31 Appendix A - Key Documents Appendix B - Glossary of Terms Appendix C - National Group of Social Work Managers Membership 38 2

3 INTRODUCTION This guidance has been prepared by the National Group for Social Work Managers in NHS Secure Services. The group has met quarterly at the Department of Health, Wellington House, London, since Membership of the group comprises of social work managers from a wide cross section of NHS medium secure units in England and Wales, (see Appendix C), with representation also from social work leads in the high secure hospitals. In developing this guidance, informal consultation has been undertaken with a wide range of commissioners and providers, including some providers in the independent sector. These Quality Principles address the best practice guidance for all the organisations and individuals contributing to the provision of quality social work services in medium secure units. They are closely related to the "National Standards for The Provision of Social Care Services in The High Security Hospitals," published in August 2001, arising from the Lewis Report 2000, and complement the Best Practice Guidance: Specification for adult medium secure services, published in July 2007 by the Department of Health. The principles also acknowledge and complement, Social Work at its best: A statement of social work roles and tasks for the 21 st century, published in March 2008 by the General Social Care Council. They take account of the fact that there are significant variations in how medium secure services are managed and delivered in different areas of the country, particularly in respect of social care provision. Some services are best carried out by a social work service based within a medium secure unit and integrated into multi-disciplinary clinical teams. This would be most applicable in connection with the care and treatment of in-patients. Other aspects of the service, such as the interface between the unit-based service and local community mental health services, are more properly determined by local negotiation and agreement, in accordance with local commissioning arrangements. The quality principles are intended to inform the regional commissioning teams for medium secure services as to best practice. In turn, regional commissioners will look to trusts and local authorities to agree local protocols to ensure the effective implementation of these quality principles and best use of available resources. The quality principles are divided into the following six free-standing sections, each of which addresses the best practice guidance for each of the organisations. This gives rise to some repetition with the quality principles recurring in different sections. This is intentional to ensure that there is no misunderstanding or ambiguity regarding roles, functions and responsibilities. 3

4 1. The Social Work Service in the Medium Secure Unit. 2. The Hospital Management of the Medium Secure Unit. 3. The Local Authority Managing the Social Work Service. 4. Local Authorities with Responsibilities for In-Patients. 5. The Local Authority in whose area the Medium Secure Unit is located. 6. The National Offender Management Service. It is not necessarily the case that the social work service in the medium secure unit will be under the direct management of a local authority, in which case some of the non-statutory responsibilities of the local authority set out in section 3 may be devolved to the trust or unit management. A specialist trust or independent provider may employ and manage its own social work staff in the medium secure unit. It is essential therefore that the role of social work in medium secure services is clearly defined in order to assist with clarity in the commissioning process. Local authorities will need to have agreed arrangements and protocols in place to ensure that any duties devolved to unit managements and staff are clearly defined and properly carried out. These quality principles are equally applicable to social work services in medium secure units in the independent sector, except in so far as any guidance relates to the responsibilities of a managing local authority or NHS trust that cannot be carried out instead by a private organisation. Social workers have an awareness of the social context and contribute to the holistic assessment of the individual s needs, incorporating the principles of equality and human rights. In doing so, social workers encourage the involvement of others, namely other agencies, statutory and voluntary, as well as family and carers. The social work service ensures that responsible local services are appropriately identified in order that they can fulfil their statutory responsibilities at every stage of the care pathway process. Social workers have an important contribution to make to the assessment and management of risk, liaising with the criminal justice system and having a key role in public protection issues through Multi-Agency Public Protection Arrangements, as well as having specific responsibilities in respect of safeguarding children and safeguarding adults. Wherever possible, the views of victims should be ascertained and their concerns taken into account in accordance with legislative requirements, Ministry of Justice guidance and Tribunal Rules. Hospital and local authority managers, together with the social work service and National Offender Management Service, will need to consider carefully how best to deliver clearly defined functional social work services. Effective information sharing between agencies is essential for the safe management of offenders who pose a high risk to others in the community. 4

5 The good practice guidance is a framework to ensure that the social care needs of people who are detained in conditions of medium security are addressed. Through the promotion of social inclusion and recovery, their return to the community is more effectively facilitated by joint working with a range of appropriate agencies. 5

6 SERVICE QUALITY PRINCIPLES This document sets out service quality principles for all those organisations and agencies with responsibilities for social work services: 1. Best Practice Guidance for the Hospital Social Work Service in the Medium Secure Unit. QUALITY PRINCIPLE 1 The primary task of the social work service in the medium secure unit is to provide an effective social work service for all patients. 2. Best Practice Guidance for the Management of the Medium Secure Unit. QUALITY PRINCIPLE 2 The unit management should promote and support the contribution of social work services to the care and treatment of patients and to the management of the medium secure unit. 3. Best Practice Guidance for a Local Authority Managing the Social Work Service. QUALITY PRINCIPLE 3 The managing local authority should provide a high quality social work service. 4. Best Practice Guidance for Local Authorities with In-Patients. QUALITY PRINCIPLE 4 All local authorities should accept ongoing responsibility for patients from their areas accommodated in medium secure units and provide an appropriate social work service for those patients for whom they are responsible. 6

7 5. Best Practice Guidance for a Local Authority in whose area the Medium Secure Unit is located. QUALITY PRINCIPLE 5 The host local authority for a medium secure unit should provide appropriate support to the unit, particularly in ensuring the protection of vulnerable adults and children as patients or as visitors to the medium secure units. 6. Best Practice Guidance for the National Offender Management Service. QUALITY PRINCIPLE 6 There should be agreed procedures between the unit-based social work services and the Probation Service for the care, treatment, transfer/discharge and aftercare of patients and for the safeguarding of victims. 7

8 1. BEST PRACTICE GUIDANCE FOR THE HOSPITAL SOCIAL WORK SERVICE IN THE MEDIUM SECURE UNIT Overview The role of local authorities, and of social care professionals in particular, is to work in partnership with health professionals and managers and other agencies to ensure that all the needs of patients are addressed, both to aid recovery and especially to ensure that they are discharged to an environment that will promote rather than undermine their general health and well-being. The core functions in relation to patient care are to ensure that: a) the personal, familial, social, cultural and environmental issues that may have a bearing on the patient s illness or disorder are assessed at the outset and their importance recognised; b) these issues, where appropriate, are addressed while the patient remains in the unit as part of the overall treatment and care plan; c) planning for the patient s discharge and after-care is done in co-operation with the local authority that has responsibility for the provision of after-care under section 117 of the Mental Health Act, so that the patient will have access to the range of services and support that can assist a successful return to the community, while at the same time ensuring public protection; d) the needs of other groups, especially children and victims, as well as carers and others who are part of the patient s social network in the community, are addressed and given the appropriate degree of priority throughout the whole of this process. The need to balance issues to do with public protection and the rights of the individual patients should be seen as the cornerstone of all good forensic social work practice. The development of Multi-Agency Public Protection Arrangements (MAPPA) provides agencies, which have concerns about patients in the medium secure units, with a community forum for exchanging information and assessing and managing risk. 8

9 In relation to organisational issues, the core requirement for the service is to work with trust and unit managers and other professional groups to provide within the unit an organisational structure and environment that will ensure that: a) social care issues are identified and addressed within an integrated clinical governance framework; b) the service meets national performance quality principles for medium secure units and social work services; c) the care, treatment and rehabilitation of mentally disordered offenders is directed towards their social inclusion in society and is sensitive to issues of diversity. 9

10 QUALITY PRINCIPLE 1 The primary task of the social work service in the medium secure unit is to provide an effective social work service for all patients. Guiding Principles These guiding principles apply to all areas of social work practice covered within section one: Best Practice Guidance for the Hospital Social Work Service in the Medium Secure Unit. The primary functions of the social work services are concerned with: Preadmission; Admission; Treatment; Planning for discharge; Transfer/Discharge; Safeguarding Children. Social work services for patients families, carers and victims also need to be addressed and agreement reached with local authorities, where the families, carers and victims live, about respective areas of responsibility for provision of services The social work service will discharge its responsibilities to patients in a manner consistent with the locally agreed multi-agency procedures for the safeguarding of vulnerable adults. Agreed liaison arrangements should be in place with Local Safeguarding Adults Boards Families and carers should be kept regularly informed about the patient s assessment and care plan as is appropriate and consistent with the patient s wishes Social workers should safeguard and promote the welfare of children and work closely with local authorities' children and families services regarding leave of absence arrangements or a child visiting a patient. They should also liaise and work with Local Safeguarding Children Boards (LSCBs) whenever necessary Social workers should work with the members of multi-disciplinary teams to ensure the implementation of the Care Programme Approach (CPA) for every patient Social workers should ensure that they communicate in an appropriate and timely manner with other disciplines and agencies in the interests of the welfare of patients and the protection of the public The social work service should alert the responsible local authority when an assessment is required under community care legislation or carers legislation, as part of regular reviews. 10

11 1.7. Named workers from other agencies with ongoing responsibilities should be kept informed of planning for the patient, invited to relevant meetings and asked to contribute their views Social workers should support patient access to a range of advocacy services provided by the unit or by other external or independent agencies when required The social work service should be responsive to the views expressed by patients, families and carers about the provision and delivery of services and ensure that any such views are communicated to the relevant agencies The social work service should ensure that its operational procedures and professional practice promote equality and recognise diversity, so that services are delivered fairly and with consistency, regardless of race, gender, nationality, ethnicity, colour, religion, disability, age or sexual orientation The social work service should be provided in a manner that is sensitive to individual needs, delivered in a non-discriminatory manner and challenges oppressive practice The social work service should assist clinical teams in liaising with Probation Service Victim Support Units, so that due consideration is given to the views and circumstances of victims, and ensure that these are appropriately represented in the care planning process and in reports to Mental Health Tribunals and other statutory bodies Social workers should work with other agencies before and after discharge for an agreed period of time in accordance with the agreed CPA plan, and facilitate appropriate links with providers of accommodation and other key services The social work service should ensure that other professionals in the unit understand the key roles and tasks of social workers in respect of patients, family members, carers, children and victims The social work service should encourage and promote the involvement of other social workers with specialist knowledge and skills relevant to the care of mentally disordered offenders e.g. those skilled in safeguarding children, substance misuse, learning and other disabilities, welfare rights and benefits and rehabilitation programmes. 11

12 Quality The functions and responsibilities of the social care lead and of any deputies should be clearly set out and agreed between the employing authority and the unit and communicated to staff within the unit and to partner agencies The social care lead should ensure that an audit and research strategy and a performance management framework is in place for monitoring the quality and effectiveness of the work of the social work service Management arrangements should ensure the practice of case recording meets accepted good professional quality and the policy and procedural requirements of the social work service The social care lead should work with the unit to ensure that patients have appropriate information on how to obtain advice and assistance regarding their entitlements to welfare benefits, including housing benefit, and have access to specialist welfare benefits workers as the need arises The social care lead should ensure that information and assistance regarding the relevant complaints procedures is readily available to patients, families and carers Systems should be in place for ensuring that social workers have effective ways of consulting with patients about their communication and information requirements, (e.g. provision for translation and interpreting services) Systems should be in place to ensure that patients have appropriate access to their social care records in accordance with the Data Protection Act The social care lead should ensure that all social workers are effectively supervised, that the appropriate performance appraisal system is regularly applied to them, and that a staff development and training policy, which includes safeguarding children and adults, is in place in accordance with the General Social Care Council post-registration training and learning requirements Social workers should be located on site alongside other professional groups of staff, with links to specific wards and/or clinical teams. They should also have their own professional identity, which the social care lead is responsible for developing through regular professional meetings and practice forums. 12

13 Medium Secure Unit Social Work Services to Patients Pre-admission There should be a social care assessment of the patient s needs before a decision is taken whether to admit the patient, to establish whether the unit is the most appropriate place or whether an alternative placement or service can be found This assessment can be a review of case papers and reports from other agencies, which should include social care agencies, and may include face to face interviews There should be social work participation in the unit s admission decisionmaking process with regard to all admissions. Admission The social work service should ensure that each patient is allocated to a social worker on admission, whose responsibility it will be to provide a comprehensive social history that should include a clear assessment of risk, including safeguarding children, the views of family and carers and agencies in the home area. The views of victims should be included where these are available The production of a social history should result in the formulation of a social care action plan, which should form part of the CPA care plan. The allocated worker is responsible for ensuring that this action plan is implemented If family members, carers or victims have needs identified as part of this process, a referral should be made to the appropriate agency, but only with their consent unless child or adult protection procedures dictate otherwise The allocated social worker should promptly inform the local authority with ongoing responsibility for the patient that the patient has been admitted to the unit. The authority should be requested to give formal acknowledgement of ordinary residence and section 117 responsibilities and to allocate a named officer within the authority to that patient. The patient should be told which local authority is responsible and the name of the officer when known The allocated social worker should liaise with the Probation Service to determine the nature of any involvement by that service. 13

14 1.33. Social workers should work with patients and all relevant parties to ensure that patients are properly informed of how to exercise their legal rights under the Mental Health Act, particularly with respect to Mental Health Tribunals, and that due account is taken of mental capacity issues. Treatment The primary focus of the social worker should be on social care issues The social worker should prepare an updated social care plan to be contributed to each CPA Review and attend reviews. This should involve contacts with the patient in advance of the meetings. The social care worker may act as the care co-ordinator, if this is appropriate and consistent with local policies Social workers should ensure that the social care reports they provide to Mental Health Tribunals and Hospital Managers are of good quality and address the need for community support and any funding or resource issues. This should be done in consultation with the local authority with the statutory responsibility for providing the appropriate social circumstances report and for meeting the patient s aftercare needs The social worker should have contact with the patient in advance of MHT and Hospital Managers hearings, which they should attend. When it is not possible for the allocated social worker to attend a hearing, every effort should be made to ensure that another suitably qualified member of the social work service is available to represent their views Supplementary reports should be requested from the local authority with responsibility for the patient whenever appropriate; for example, to provide information on the availability of resources and facilities post-discharge The social worker should continue to maintain appropriate links with other agencies, carers and family members, identifying needs and making referrals in accordance with 1.31 above as required. Planning for Transfer or Discharge Thinking ahead to eventual discharge arrangements, (including securing agreement for future funding), under section 117 of the Mental Health Act 1983 (2007) should start as soon as a patient is admitted to the hospital. Social workers should ensure that this happens in partnership with responsible health and local authorities. 14

15 1.41. It is the duty of the local authority with section 117 responsibility for the patient to ensure the completion of an Assessment of Need as required by Section 47 of the NHS and Community Care Act 1990, unless there is a local agreement in place with the social work service in the medium secure unit specifying alternative arrangements Social workers should assess the social care needs of patients on a continuing basis, taking into account the views and needs of family members, or others with whom they have significant relationships, including children. Patients should be actively involved in care planning and discharge arrangements in accordance with the requirements of the Care Programme Approach (CPA) The social worker should ensure that the patient receives advice and assistance, if necessary from specialist workers, to claim the welfare benefits to which they, their dependants and carers are entitled In the case of a restricted patient the social worker shall advise the relevant agencies (i.e. local authority or Trust with ongoing responsibility for the patient), at an early stage of the need to agree the appointment of a suitably qualified officer to act as social supervisor. This role may be undertaken by a member of the social work service within the unit The future social supervisor should be identified as far in advance of discharge as possible in order to promote an effective working relationship between the social supervisor and the patient The patient, his/her carers and all key agencies should be made aware of the elements of the care plan, including arrangements for ongoing support and care prior to discharge. Agreement to the plan needs to be obtained, before the discharge takes place, from all service providers Similar arrangements should exist if a patient is being transferred to prison or another unit Social workers should provide responsible local authorities and other appropriate agencies with full background social care information, including information on child protection matters, and social care reports on patients who are being transferred or discharged Social workers will work with clinical teams and local MAPPA coordinators to determine whether a referral to the local Multi-Agency Public Protection Panel (MAPPP) is required when a patient is granted leave under section 17 of the Mental Health Act 1983 (2007), or is to be discharged from hospital. Referrals should be made in accordance with the locally agreed MAPPA. 15

16 1.50. Social workers, together with the clinical team, will assist the hospital managers in discharging their responsibilities to remind patients subject to The Sex Offenders Act 1997 of their obligation to register with the police on discharge from hospital or when granted substantial community leave Social workers may continue to work with patients once they have been transferred or discharged with the agreement of their line manager and as part of the patient s care plan and in accordance with local protocols. Statutory Responsibilities Appropriately qualified social workers in medium secure units may act as social supervisors to patients subject to conditions under the Mental Health Act 1983 (2007) and to restricted patients, who have been conditionally discharged from the unit into the community, in accordance with local protocols. With regard to restricted patients, reports will be submitted by the social supervisor to the Mental Health Unit in accordance with the requirements set out by the Ministry of Justice A unit-based social worker authorised to act under the Mental Health Act 1983 (2007) may carry out assessments, make applications and provide reports as required in respect of persons being considered for admission to the medium secure unit under the provisions of Part II of the Mental Health Act, subject to guidance set out in the Code of Practice and Memorandum. Safeguarding Children The social work service should establish links with the Local Safeguarding Children Board and have agreed policies and procedures for child protection work, which accord with the principles and requirements of the Children Act 1989 and the guidance in Working Together to Safeguard Children. Social workers should demonstrate that they understand the implications for safeguarding and promoting children s welfare In safeguarding and promoting the welfare of children, social workers should work closely with local authority children and families services regarding leave of absence arrangements or a child visiting a patient In respect of child visiting procedures, the social work service in the medium secure unit is responsible for ensuring that local authorities children and families services are made aware of the nature of the assessment required of them in each particular case in accordance with Circular LAC(99)32. 16

17 1.57. The social work service should monitor the views of patients, family members and those with parental responsibility for a child visitor, about the child visiting arrangements. The children s views should also be included Social workers should ensure as part of their key role that they communicate fully, speedily and appropriately with other disciplines and professionals in the secure unit in respect of any issues concerning the safeguarding of children and their welfare The social work service should use its best endeavours to ensure that all requests for children to visit patients are considered in a timely way in accordance with the unit policy and local arrangements. In determining these arrangements the interests and welfare of the child shall be considered to be paramount. Social Work Services to Patients Family Members, Relatives and Carers Social workers may make a general assessment of the separate social care needs of the patient s family members, relatives and carers on admission, and on a continuing basis as necessary, in support of the treatment and care plans for the patient If family members, carers or victims have needs identified as part of this process, a referral should be made to the appropriate agency for their needs to be assessed and met locally, but only with their consent unless child or adult safeguarding procedures dictate otherwise Assessment of need under The Carers (Recognition and Services Act) 1995, the Carers and Disabled Children Act 2000 or the Carers (Equal Opportunities) Act 2004, should be undertaken by the local authority, which would have responsibility for meeting the needs of identified carers Family members, relatives, carers and significant others should be involved in assessment, care planning and discharge arrangements and kept regularly informed about the patient's progress, consistent with the patient s wishes and the need to ensure personal and public safety. Victims The social work service should take the lead in developing and agreeing protocols between the medium secure service and local Victim Liaison Units of the National Offender Management Service, in order to ensure that the circumstances and views of victims, who wish to be kept informed of possible changes in the patient s circumstances and /or legal status, are 17

18 reported to the multi-professional clinical team for consideration at key stages of the care planning process, in accordance with guidance issued by the Ministry of Justice, and the provisions of the Domestic Violence and Crime Act 2004 and the Mental Health Act 1983 (2007). Responsibilities of the Social Work Service to Unit Management Functions The social care lead should be a member of the operational management team in the medium secure unit, and be fully involved in the strategic planning and development of services The social care lead should maintain appropriate links with local and regional commissioning agencies and promote good working relationships with regional forensic case managers The social work service should be appropriately represented with other professionals in the development of policies, procedures and practice in the medium secure unit in accordance with the clinical governance framework Social workers should be involved in training programmes for other professionals within the unit. The Contribution of the Unit-based Social Work Service to the Managing Local Authority The social work service has a particular responsibility on behalf of the local authority to ensure the effective implementation within the medium secure service of the multi agency procedures for the protection of vulnerable adults and to arrange for the investigation of specific safeguarding concerns The social work service should ensure that it is appropriately represented with other staff members in the development of policies, procedures and practice within the managing local authority Social workers from the medium secure unit should be involved in training programmes for other staff members of the managing local authority Social workers may contribute to other activities of the managing local authority as agreed within the service level agreement. 18

19 2. BEST PRACTICE GUIDANCE FOR THE MANAGEMENT OF THE MEDIUM SECURE UNIT Overview The responsible managers of the medium secure unit should determine, in conjunction with a local authority managing the social work service, the appropriate mechanisms for involving the social work service and the local authority in both the strategic development of services and the operation of the service. The managers will need to determine the best mechanisms for ensuring that there is an effective dialogue with the local authority on all strategic matters. QUALITY PRINCIPLE 2 Unit managers should promote and support the contribution of social work services to the care and treatment of patients and to the management of the medium secure unit Unit management should negotiate with a managing local authority a service level agreement that reflects the key social care tasks that need to be undertaken There should be a formal agreement covering the following areas between the management of the unit and a managing local authority: the accountability and management structures for the service both at senior and operational levels within both agencies; the key social work services to be provided and the staffing levels required to achieve these; funding arrangements; support to be provided by the trust to the social work service including accommodation, administration, IT and corporate services; services to be provided by the unit-based social work service to support the local authority in meeting statutory duties; arrangements for monitoring the service and the agreement Unit management should ensure that the social work service is located alongside other professional groups of staff within the medium secure unit. The accommodation should be fit for purpose and the social work service should be appropriately resourced to enable it to carry out its responsibilities Unit management should ensure that social workers are able to work in a safe environment and are able to access appropriate equipment and training to ensure their personal safety and the safety of others. 19

20 2.5. Trust management should establish links with the LSCB and agree policies and procedures for safeguarding children visiting patients in the unit In carrying out their responsibilities to safeguard and promote the welfare of children visiting the units, unit management will look to social workers within the units to play a leading role in implementing child visiting policies. This is a most appropriate task for social workers to undertake, though responsibility for ensuring the welfare and safety of children visiting falls on all staff within each medium secure unit Unit management should ensure that all unit staff involved in overseeing child visits are effectively supervised, their performance regularly appraised and that a staff development plan and training policy, which includes safeguarding children, is in place Unit management should ensure that all staff are aware of the local multiagency procedures for the safeguarding of vulnerable adults Unit management should support social workers in ensuring that patients and their families are aware of the unit s complaints procedure Unit management should liaise with the local authority managing the social work service within the unit to ensure that: there are clear reporting and accountability lines both within the unit management structure and to the Director of Social Services / Chief Officer and councillors; adequate management support is available to social workers there are clear policies especially in respect of casework management and supervision; there are clear arrangements between the medium secure unit and other services regarding the division and transfer of responsibilities to meet the continuing health and social care needs of patients; the nature of the links and relationships between social workers and other unit-based professional staff is made clear; there is a formal workforce strategy covering recruitment, training, supervision and career development Trust management should support: social workers in ensuring that other professional staff in the unit understand their key roles and tasks; appropriate participation of social workers in multi-disciplinary teams; joint training for social workers with other professionals; 20

21 appropriate representation of social workers with other professionals in the development of policies, procedures and practices within the unit Unit management should encourage and support social workers in the medium secure unit to train under the Mental Health Act as part of their ongoing professional development Unit management should be involved with the social work service in negotiating protocols with the high security hospitals, other medium secure units, other psychiatric hospitals, the prison service, voluntary organisations and social care agencies (including local authorities and the National Offender Management Service), for the care, treatment, transfer/discharge and aftercare of patients Unit management should ensure that advocacy and interpreting services are available to patients to enable them to communicate effectively with social workers, including those from other agencies Unit management should ensure that the social work team receive training on welfare rights and are able to access advice and assistance when necessary for both the team and individual patients from specialist welfare rights workers. 21

22 3. BEST PRACTICE GUIDANCE FOR A LOCAL AUTHORITY MANAGING THE SOCIAL WORK SERVICE Overview The role of social care agencies, and of local authorities in particular, is to work with health professionals and managers to ensure that all the needs of patients are addressed both to aid their recovery and, especially, to ensure they are discharged to an appropriate environment that will promote their general health and well-being. The employing authority will also ensure the maintenance of professional registration requirements in relation to staff. The employing body shall fulfil its Health and Safety duties to employees having due regard to the nature of the particular responsibilities undertaken in working with offender patients. Where the employing body for the social work service is an NHS Trust these responsibilities should be discharged by the Trust and will be the subject of agreed protocols between the Trust and the local authority. QUALITY PRINCIPLE 3 The managing local authority should provide a high quality social work service The social work service should be accountable to a local authority as part of its wider responsibilities for the care and support of people with mental health problems Agreed arrangements should be in place to allow the local authority to contribute to the strategic and operational management of the medium secure service The managing local authority and the management of the unit should prepare and agree a service level agreement that reflects the key social care tasks that need to be undertaken. 22

23 3.4. Local authorities responsible for managing the social work service within medium secure units should ensure, in co-operation with unit managements, that: adequate management support is available to social workers; there are clear reporting and accountability lines both within the unit management structure and to the Director of Social Services / Chief Officer and councillors; there are clear policies especially in respect of casework management and supervision; there are clear arrangements between the medium secure unit and other services regarding the division and transfer of responsibilities to meet the continuing health and social care needs of patients; the nature of the links and relationships between social workers and other unit-based professional staff is made clear; there is a formal workforce strategy covering recruitment, training, supervision and career development; the managing local authority's performance appraisal system is applied to the social work service A formal agreement covering the following areas should be entered into by the managing local authority, commissioners and unit management: the accountability and management structures for the service both at senior and operational levels within both agencies; the key social work services to be provided and the staffing levels required to achieve these; funding arrangements; support to be provided by unit management to the social work service including accommodation, administration and IT; services to be provided by the unit-based social work service to support the local authority in meeting statutory duties; arrangements for monitoring the service and the agreement The local authority, in consultation with the unit managers, should devise a policy statement which makes explicit the role, functions, responsibilities and the overall objectives of the social work service, and ensure that this is reflected in social workers job descriptions The local authority and the social work service should provide management structures, operational guidance and systems which enable the agreed objectives of the social work service to be met in an effective, efficient, economic and equitable manner. 23

24 3.8. The local authority should ensure that: the social work service has a statement of its priorities, its quality principles and the minimum level of service that all patients and their families can expect; the social work service has the required level of professionally qualified staff (including individuals authorised to act under the Mental Health Act) to meet the agreed objectives and quality criteria of the social work service in the medium secure unit; the functions and responsibilities of the head of the social work service and any deputies are clearly set out and understood by all Social workers should be supported in ensuring that other professional staff in the unit understand their key roles and tasks in respect of patients, families, children and others The local authority should agree protocols between the social work service and the high security hospitals, other medium secure units, psychiatric hospitals, voluntary organisations and social care agencies (including local councils and the National Offender Management Service), for the care, treatment, transfer/discharge and aftercare of patients The local authority should ensure that the social work service has established links with the appropriate LSCB and has agreed policies and procedures for keeping children safe The local authority should support social workers in safeguarding and promoting the welfare of children and the protection of the public by ensuring that its officers work closely with unit staff regarding leave of absence trips or a child visiting a patient The local authority should ensure that social workers are aware of the local multi-agency policy and procedures for the safeguarding of vulnerable adults and that staff act appropriately in accordance with these procedures The local authority providing the service to the medium secure unit should have a strategy for widening the skills base of the social workers; for example by offering secondment to specialist workers within the authority or from other specialist agencies such as the National Offender Management Service The local authority should ensure that the social work service adopts the authority's equal opportunity policy and has a strategy for implementing and monitoring it. 24

25 3.16. The local authority should ensure that its recruitment to the social work team has regard to the ethnic profile of the patient group The local authority should ensure that the social work team in the medium secure unit has access to staff support. This should include appropriate arrangements for supervision and specialist training The local authority should ensure that social workers in the medium secure unit are provided with opportunities and appropriate support to train and practice as approved mental health practitioners as part of their ongoing professional development The local authority should ensure that the social work team receive training on welfare rights and are able to access advice and assistance when necessary for both the team and individual patients from specialist welfare rights workers The local authority should support and encourage joint training for social workers with other professionals The local authority should ensure that all staff of the social work service are effectively supervised, their performance regularly appraised and that a staff development and training policy, which includes safeguarding children and adults, is in place The local authority should ensure that the social work service has effective systems for collating information and analysis which inform management decisions and are compatible with the trust and council IT systems The local authority's information strategy for service users should include consideration of how the social work service will communicate with patients and their families. The strategy should identify an appropriate range of information on subjects including patients rights, complaint procedures and social care services, and should consider how it is to be delivered to intended recipients Leaflets or other written material should be available in forms which appropriately set out the social work service s policies and procedures in formats and language that can be easily understood by patients and their families, and by other professional colleagues and interested parties The local authority should review the social work service s information strategy and practice at regular intervals. 25

26 3.26. The local authority in co-operation with unit management should ensure that arrangements are in place for independent interpreters and translators to be available to the social work team for patients and their families when needed The local authority, through its performance management of the social work team, should ensure that non-discriminatory practice, based on principles of equality and diversity, within a framework of equal opportunities legislation and guidance, is reflected throughout the social work service s practice and is evidenced in case records. 26

27 4. BEST PRACTICE GUIDANCE FOR LOCAL AUTHORITIES WITH IN- PATIENTS Overview Responsibility for meeting the social care needs of patients in medium security does not rest solely with the unit-based social work service. Every local authority, as the primary agency for social work services in the community, should accept its ongoing responsibility for patients ordinarily resident in its area, but accommodated for the time being in the high security hospitals and medium secure units. A court case (R v (1) Mental Health Review Tribunal, (2) Torfaen County Borough Council, (3) Gwent Health Authority, ex parte Russell Anthony Hall) has clarified the responsibilities of local authorities in planning and providing after-care services under section 117 of the Mental Health Act; a process that should begin at the time of admission to hospital. After-care should be provided by the local authority jointly and in partnership with local health services and, where appropriate, the National Offender Management Service. QUALITY PRINCIPLE 4 All local authorities should accept ongoing responsibility for patients from their area accommodated in medium secure units and provide an appropriate social work service for those patients for whom they are responsible All local authorities should be aware of and have systems in place for carrying out their own responsibilities for patients within medium secure units When a local authority is informed that a patient from its area has been admitted to a medium secure unit, the council will confirm its commitment to provide a social work service to that patient in accordance with the locally agreed protocol All local authorities should: provide the social work service with an assessment of the patient s needs under community care legislation, when required, as part of regular reviews; work with the social work service before and after discharge and ensure appropriate links with commissioners; work closely with the social work service to safeguard and promote the welfare of children regarding leave of absence or a child visiting a patient. 27

28 4.4. As the lead social care agency, the local authority should ensure that all members of the LSCB are kept fully informed of and involved in issues to do with keeping children safe from their area who are visiting the medium secure units Local authorities should ensure that the welfare and safety of children are given priority when they receive requests from medium secure units to contribute to discharge plans or are consulted about leave of absence arrangements When local authorities receive a request for a child who may have lived in their area in the past to visit a patient in a medium secure unit, they have a responsibility to respond quickly to requests for information. They should have systems in place for ascertaining whether such children might have been known to other agencies in their area and whether these agencies should be consulted All local authorities should be fulfilling their ongoing responsibilities as set out in Circular LAC(99)32 for the welfare of any child in contact with a patient in a psychiatric hospital. Similar responsibilities apply in respect of patients on leave from a hospital All local authorities need to balance issues to do with public protection and the rights of the individual patients. They should have policies in place regarding the disclosure of information to meet the requirements of MAPPA All local authorities should have procedures in place for the safeguarding of vulnerable adults, which shall include patients in medium secure units. 28

29 5. BEST PRACTICE GUIDANCE FOR A LOCAL AUTHORITY IN WHOSE AREA THE MEDIUM SECURE UNIT IS LOCATED Overview "Safeguarding and promoting the welfare of children requires effective coordination in every local area. For this reason, the Children Act 2004 requires each local authority to establish a Local Safeguarding Children Board (LSCB). The LSCB is the key statutory mechanism for agreeing how the relevant organisations in each area will co-operate to safeguard and promote the welfare of children in that locality, and for ensuring the effectiveness of what they do." (Working Together to Safeguard Children, 2006: para 3.1-2). The LSCB in each area where a medium secure unit is situated should work with and offer support to the unit, in order to ensure that the arrangements for children visiting patients, or otherwise coming into contact with them, are in accordance with government policy and guidance and with good practice. "Local authority social services departments should play a co-ordinating role in developing the local policies and procedures for the protection of vulnerable adults from abuse." (No Secrets, 2000: para 1.4). Local Authorities, through their Safeguarding Adults arrangements, should ensure that medium secure units are offered adequate support and access to their services, so that they can ensure appropriate arrangements are in place to protect vulnerable adults. QUALITY PRINCIPLE 5 The host local authority for a medium secure unit should provide appropriate support to the unit, particularly in ensuring the protection of children and vulnerable adults as patients or as visitors to the medium secure unit A local authority in whose area a medium secure unit is located should have an agreement with the unit to ensure that there are effective policies and procedures in place to safeguard children visiting the unit The host local authority should work with the social work service of the medium secure unit and the LSCB to ensure that the policies and procedures used in the unit are consistent with those of the local LSCB The host local authority, together with the LSCB, should ensure that there is joint training for its own staff and unit-based staff concerning the particular issues affecting the safety and welfare of children, whether visiting patients in the medium secure unit or otherwise coming into contact with them in the community. 29