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27.Sep.2010

Specialist mental health courts lead to stronger cooperation between health and criminal justice agencies when it comes to working with offenders with mental health needs, research for the Ministry of Justice has suggested.

Two court pilots were run in Brighton and Stratford in East London between January 2009 and January 2010. The schemes have continued since the pilots ended.

Specialist mental health courts operate either as a dedicated session dealing with the sentencing of offenders who have mental health problems or learning disabilities or within a normal case list in a magistrates’ court.

The work is tailored to meet this type of offender. The courts:

• Identify relevant defendants through screening and assessments conducted by a dedicated practitioner
• Provide the court with information on a defendant’s needs to enable effective case management
• Offer credible alternatives to custody to ensure offenders are supported, whether that is with a community order with a supervision requirement or mental health treatment
• Provide enhanced psychiatric services at court
• Implement regular reviews of orders, and
• Direct individuals not suitable for the mental health court community order to mental health and other services that can appropriately address their needs.

The study conducted for the MoJ suggested that the pilots “focused minds”. It said: “Many agencies became involved in order to create solutions to long-standing problems, such as information sharing to support sentencing which had formally created barriers to identification and provision.”

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24.Sep.2010

Councillors at Suffolk County Council last night agreed radical plans for the authority to become an “enabling council”, with the focus on being a slimmed down strategic body that commissions the private sector, the voluntary sector and community groups to deliver services on its behalf.

If implemented, Suffolk’s New Strategic Direction will lead to the transfer of the vast majority of services it currently provides. The scheme is designed to cut the local authority's £1.1bn budget by 30%, and could see thousands of jobs put at risk.

A report prepared for the meeting claimed the characteristics of the new council would include being:

• Smaller: “employing less staff”
• Focused: “achieving the Suffolk Story and giving up non-priorities”
• Collaborative: “invisible organisational boundaries with health, other councils, police and voluntary sector”
• Leaner: “less tiers of middle management, a smaller strategic centre [and] less ‘process maintainers’ across all directorates”
• Able to support area based working: “particularly in deprived communities”
• Bolder and less risk adverse
• More customer focused: “less time spent in partnership meetings, more time spent face to face with customers”

The next stage of the process will be to develop the exact shape and functions of the “Strategic Council”, the approach to engaging communities and developing community capacity, and a strategy and programme for divestment.

The report before the council said no alternative to the New Strategic Direction was recommended as the principles within the model were still at a conceptual stage. “However, there will be choices to make in future about which services to divest early, how and in what type of enterprise,” it added.

The “Strategic Council” is expected to have a number of roles: enabling communities to do more for themselves “through local budgets and decision-making”; providing strong political governance and leadership; taking strategic decisions on the future of Suffolk, including determining priorities and funding; influencing national government; supporting people “to help themselves”; and supporting “the growth of markets in what have up until now been public sector services”. The papers also suggested that Suffolk was keen to pioneer place-based budgets.

The county council plans to encourage a supplier to develop a solution providing back office functions to divested services and other organisations such as GP consortia, the newly elected police commissioner, academy schools, social enterprises and so on.

In relation to statutory duties, the background report said: “The council will retain a range of statutory duties across a range of policy areas – including in education, adult care, children’s services and so forth. Where the council retained statutory duties, it would need to ensure it retained the expertise and the levers to be able to ensure it met those duties through management or contractual arrangements, enabling us to fulfil our statutory duties. For example, an effective commissioning function would need to be maintained in the Strategic Council.”

A number of services have been identified as potential early adopters for divestment. They include transactional property, registrars, Suffolk traded services, libraries, highway services, independent living centres, and early years and childcare.

Cllr Jeremy Pembroke, Leader of Suffolk County Council, said: “This decision was made with consideration to the financial deficit in the public sector and the coalition government’s priority to reduce the deficit and the size of the state. The coalition requires lesser government and a bigger society, and Suffolk County Council has responded to this change.”

He added: “Now that Full Council has debated the issue and agreed with the future model for the county council, we can begin to talk with the people of Suffolk so they can be involved in the shaping of services for the future.”

Unions reacted angrily to Suffolk’s decision. Dave Prentis, Unison General Secretary, said:
“This is not the way to run council services. There will be no democratic accountability. It is a disgrace that the council has not asked the public, or council workers, what they think.

“Leaving vital services like child protection, home care and support for young people to the vagaries of the market is very dangerous. Services will be sold off to the lowest bidder, starting a race to the bottom. People using local services, and those working to provide them, will pay the price.”

Prentis vowed that Unison would work “with the local community to challenge these damaging plans.”

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22.Sep.2010

The scope of the aftercare services that authorities are required to provide has been clarified by a recent High Court ruling. Laura Forsyth, Simon Lindsay and Tracey Lucas assess the judgement and set out what councils should do.

In R (Mwanza) v Greenwich LBC and Bromley LBC [2010] EWHC 1462 (Admin), Mr Justice Hickinbottom clarified the meaning of section 117 of the Mental Health Act 1983 and the scope of the aftercare services which authorities must provide.

The case concerned a patient who was discharged from section 3 in January 2001. He initially engaged with services in the community but from late 2001 onwards had little contact with them and generally appeared to be doing well. The services did not hear from him again until mid 2009 when his mental health was reported to have deteriorated. It was clear to the court that the reasons for this deterioration were linked to his immigration status and were, in the main, the effect of destitution and his inability to work.

The patient argued that the scope of section 117 is wide and includes any services which could be provided to prevent a possible deterioration in his mental health and reduce his chances of relapse or readmission. The London Borough of Greenwich (against whom the section 117 argument was made) said that section 117 only required the provision of services to meet needs arising from or related to his mental disorder. Greenwich said that therefore ordinary accommodation and basic living costs (e.g. food) did not fall within its scope.

The judge, in the main, preferred Greenwich’s interpretation and stated that section 117 was to provide for the specific needs of those with mental disorders and not to provide general support to those who needed it. He gave an example of a person’s need for assistance to find employment or housing (which may fall within section 117) as opposed to a person’s need for that employment or housing. However, he disagreed with Greenwich’s submission that ordinary accommodation could never fall within section 117 (although he appeared to admit that it was difficult to envisage when this may occur).

The judge also made it clear that it was for the authorities, who have the necessary professional expertise, to decide what needs a person has and that they have a degree of discretion as to what services are required to meet those needs. The judge approved the following quote from the judgment of Lord Phillips MR in R (K) v Camden and Islington Health Authority [2001] EWCA Civ 240 at [29]: “The nature and extent of those [after-care] facilities must, to a degree, fall within the discretion of the [authorities] which must have regard to other demands in [their] budget.”

This judgment provides much needed clarification on the extent of section 117 services. When determining what services fall within section 117, authorities should consider the patient’s needs arising from their mental disorder first and provide services to meet these needs. If a patient has a need for accommodation or similar services for reasons other than their mental disorder, they should be directed to other sources. Further, a service which, if provided, is likely to reduce the patient’s chances of relapse or readmission does not have to be provided under section 117 unless required to meet an assessed mental health need.

What should you do as a result of this judgment:

• Consider issuing guidance to relevant staff on the scope of
section 117 and/or review existing guidance
• Ensure staff making decisions about the provision of section 117 services are cautious not to widen the scope of services beyond those needed for mental health
• Review existing section 117 care arrangements to ensure you are only providing services required to meet an assessed mental health need.

Laura Forsyth (solicitor), Simon Lindsay (partner) and Tracey Lucas (senior associate) are at Bevan Brittan (www.bevanbrittan.com). For more information, contact Simon on 0870 194 1710 or via This email address is being protected from spambots. You need JavaScript enabled to view it..

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21.Sep.2010

A number of councils are already increasing charging for home care and tightening the eligibility criteria for access to services ahead of the comprehensive spending review, a charity has warned.

Counsel and Care said its survey of 56 authorities showed that care budgets are under severe financial pressure. More than half of the respondents said they would be carrying out budget cuts in social care or reducing the services available.

Six of the councils meanwhile revealed they were considering increases to home care charges, while another four were consulting on raising charges.

Counsel and Care said two local authorities were consulting on removing or increasing the weekly maximum charging that they had previously set for home care per week.

Chief executive Stephen Burke said the charity was extremely concerned about the knock-on effects such increases in charges will have on the quality of life for older people and their carers.

He warned: “If these short-sighted plans are put into action, the impact will be felt first by the most vulnerable, who will have to go without vital care and support and then on acute health services as people are forced to reach crisis point before they get help.”

Burke insisted that local authorities had other choices. “We are aware of councils extending their eligibility criteria to support older people with low and moderate needs,” he claimed.

Counsel and Care’s chief executive added: “We acknowledge the pressures that local authorities are under, but call on councils to protect vital frontline services for older people and their carers. This worsening postcode lottery highlights the need for urgent reform to create a fair, simple and sustainable care system for older people and their families and carers.”

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16.Sep.2010

MPs on the health select committee have endorsed Dame Jo Williams’ candidacy for chair of the Care Quality Commission.

However, they warned that while the CQC had “made encouraging progress in many areas of its agenda, a substantial number of issues remain”.

In a report the committee called on the CQC to address several areas of concern:

• The need to implement robust processes to allow whistleblowers to provide information to the Commission without necessarily prejudicing their own position. In her evidence Dame Jo said the CQC recognised the challenge of helping people speak out
• Handing ‘soft data’ a proper role in assessing the quality of care, particularly in residential social care settings. “We strongly support the use of soft data but believe that for it to be truly valuable it must be collected and applied in a rigorous, structured manner rather than on an informal basis”
• The need to consider the implications of the shortage of doctors to provide second opinions under sections 57 and 58 of the Mental Health Act, which the committee believes leads to the inappropriate use of section 62 (urgent treatment)
• The need to work closely with ministers and established LINk groups to ensure the effective discharge of the “significant” responsibilities involved in establishing HealthWatch England within the CQC. This new body is designed to provide leadership to local HealthWatch bodies, advice to the NHS Commissioning Board, Monitor and the Secretary of State for Health. It will also propose CQC investigations of poor services
• The quality and accessibility of the information available from the CQC both to the public and to commissioners and providers of care. The committee welcomed the CQC’s consultation on making its findings understandable to the public and helping them make informed choices.

The health committee, which plans to review the CQC’s work on an annual basis, said a number of the Commission’s challenges related to continuing work to consolidate it as a single unified body following the merger of its three predecessor bodies (the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission).

The MPs said there was a need to establish a clear understanding of the distinctive roles of the chair and board on the one hand, and the chief executive and management on the other – and to establish an effective working relationship between the two.

They added that there was a need to develop a common “CQC” culture across the different historic fields of responsibility, and a need to develop clear internal cost and efficiency targets and procedures for reporting performance against these targets to the board.

Practical challenges arising from the merger – such as the consolidation of information technology systems and the development of an integrated management structure – were also still an issue.

The committee said it recognised that the CQC’s objectives needed to be achieved against the background of declining real resource.

Details

16.Sep.2010

The Local Government Ombudsman has criticised a local authority for failing to understand that human rights were an issue when it refused an application for a disabled facilities grant.

Mr and Mrs F had complained about the way Blaby District Council handled their request for adaptations to their bathroom. The changes were needed to make the bathroom accessible for Mrs F, who had a range of health problems.

Blaby agreed that the adaptations were necessary and appropriate, but did not pursue an application for a grant as a result of the complainants’ refusal to take out house insurance.

Their refusal was based on their religious beliefs as committed Christians. However, the council said its policy was only to allow applications to be awarded where such insurance was in place.

The LGO said this requirement was not “on firm ground”, given that Blaby’s own research showed that half of local authorities did not require there to be a policy.

The failure to apply for a grant meant that Mrs F was unable to have a bath for more than nine months.

The Ombudsman, Jane Martin, concluded that there was fault in how Blaby had conduced the screening of the application. The initial officers should have taken individual circumstances into account and not wholly relied on policy, she said.

A more senior officer had done so but had failed to consider relevant issues such as the risks to the council of a lack of insurance, Mrs F’s general vulnerability, the application of human rights, and the validity of her religious beliefs.

The LGO found that there had been maladministration causing injustice. Blaby has agreed to remedy this by:

• Carrying out the adaptations to the bathroom
• Paying Mrs F £1,000 in recognition of the stress and discomfort
• Paying Mr F £250 for the time and trouble in making this complaint,
• Reviewing its policy so that officers are clear that exceptions can be made.

Martin said: “Human rights are important and councils need to be aware of them when they exercise those of their duties that impact on the citizen.

“The right of freedom to pursue religious beliefs is one which seems so obvious in our society that it can be overlooked. But I believe in this case the council did not fully understand that the human rights were an issue here, nor did it have sufficient information upon which to reach a decision.”

The LGO added that the complainant’s needs should have weighed more heavily in the assessment and that its refusal to consider a grant for the badly needed works condemned the complainant to “inadequate and degrading bathing potentially for as long as she lived”.