Open letter to Executive Director of Adult Social Care – Mental Health social work dispute.
Dear Dawn
As a registered social worker, you will be aware of the professional standards set out by our regulatory body, Social Work England, and the expectation that social workers should raise concerns about unsafe practice and should challenge practices, systems, and processes where necessary. We implore you to act on your responsibilities within the social work profession and also those set out within the framework of the law.
The Care Act 2014 is underpinned by the responsibility for local authorities to promote wellbeing and to prevent, delay, and reduce a person’s needs for care and support. We have been reporting that we, on the front line, do not feel that we are meeting this statutory responsibility and are concerned about the safety and wellbeing of the residents of Barnet, the impact on ourselves as regulated professionals, and the impact on Barnet Council. Whilst you will be aware, through our consistent reporting, of our areas of concerns, this open letter stresses a number of the key areas:
The Local Government & Social Care Ombudsman consider it reasonable for a person to wait 4-6 weeks for an assessment. In August 2022 we were raising concerns about staffing levels and that our waiting list for an assessment under the Care Act was up to six months. Since then, the situation has continued to become far more critical, with 14 staff members leaving within a year and the waitlist more than doubling. The staff who left were often the staff members with the most experience, many working their entire 20-30 years careers as social workers within Barnet mental health. This means that our teams have been left without an experienced workforce. In one team, figures demonstrate that when looking at the years of mental health experience of permanent staff, the team has lost 75% of the experience in the past year alone. The impact is that our waiting lists have now drastically increased, reaching up to 15 months, and alarmingly continue to grow. Based on rates of increase, without adequate intervention, we predict that the waiting list will reach two years in 2024.
It should be stressed that these are not people with low level needs for whom it is safe to wait for an assessment. People with high and complex needs are frequently waiting up to 15 months. Without adequate support, people with serious mental disorders are at significantly increased risk of deterioration to their mental state. Far too often our work becomes crisis management, which statutory guidance is clear cannot achieve wellbeing. The Care Act emphasises the need to not wait to respond until people reach crisis point and the need to focus on preventing and delaying needs for care and support, which we are not doing.
When people are left to deteriorate, unmanaged risks to their health and wellbeing put them at significant risk of harm, and even death, whilst awaiting an assessment. This is particularly concerning given that the people we work with have serious mental disorders, which already elevates risk. We further see this in complex presentations of self-neglect owing to a deterioration in mental state. It is particularly concerning that people on our waiting list are deteriorating to such a degree that the risks to their health and wellbeing falls under the scope of safeguarding.
On the subject of safeguardings, the London Multiagency Adult Safeguarding Policy & Procedures set out the target timescale for safeguarding enquiry actions as being undertaken within 20 days. However, in Barnet mental health social care we do not always have capacity to even allocate the case to a worker within this timeframe, let alone undertake enquiry actions. The result is that safeguarding enquiries have, at times, become held by duty workers, which we feel is unsafe, or worse yet, left on the waiting list awaiting capacity to be allocated.
Returning to deterioration, we are all too aware that deterioration means that people’s needs are much greater at point of assessment. We do not see leaving people to deteriorate for up to 15 months as being in line with the responsibility to promote wellbeing nor to prevent needs. It also increases the input needed from workers and much time becomes spent working diligently to engage people who are unwell and to work collaboratively to reduce serious risks to the person’s health and wellbeing. Needing to work so intensely with people means that the progress of work is much slower and this subsequently creates further delay in workers having capacity to pick up new cases. This adds yet further pressure to the waiting list.
The Care Act specifically states that reviews should be undertaken, at a minimum, of every 12 months. However, in Barnet mental health social care, people are not receiving regular reviews in line with this statutory requirement. It is rare that we undertake reviews within this timeframe and Mosaic evidences that many people have not had a review in several years, prior even to the existence of the mental health social care teams. Only those who contact social services to request a review are being added to the active waiting list, though they too join the up-to 15 months wait.
Many of the vulnerable people we work with do not have informal carers and their needs are simply going unmet whilst they await input. However, for those who do have informal carers, we have seen that the significant waiting lists are placing high levels of stress on the carers, which is resulting in carer breakdown or carers not being able to engage in areas central to their own wellbeing, owing to increased pressure on their caring role. This too, we feel is not in line with the responsibilities we have for carers under the Care Act.
The Care Act sets out pathways for young people approaching transition to adult services. However, despite children’s services bringing young people to our attention six months prior to their 18th birthday, we do not have the capacity to allocate these young people a social worker and they are not receiving assessments before they turn 18, which is not in line with the Care Act.
We have been told that there is no money within Barnet Council. However, current practice is costing Barnet Council significantly more money than necessary and reorganising of funds would likely be beneficial in helping to achieve responsibilities under the Care Act. For example, as people are being left to deteriorate for up to 15 months, their needs for care and support are increasing. The subsequent increased packages of care and placements in care homes costs Barnet Council more money than timely care and support that reduces, delays, and prevents a person’s needs. The fact that we are not able to undertake timely reviews means that people who were placed in supported accommodation or care homes as a temporary measure are not receiving input to step them down and promote their independence. This too means Barnet Council is paying for more care than needed, often for many years, at which point the person has become dependent on this care.
As people with severe mental ill-health are not receiving the support they need to remain well and live in the community, they are at increased risk of avoidable, or delayable, deterioration to mental health, which can result in the person’s compulsory admission to mental health hospital. This too has financial implications for Barnet Council in regard to the increased need for Mental Health Act assessments undertaken by Approved Mental Health Professionals. Furthermore, if a person is compulsorily admitted under relevant sections of the Mental Health Act, Barnet Council has financial responsibilities to meet the person’s needs under S.117. Again, as these are not being regularly reviewed, Barnet Council is overspending on care which should not be necessary.
We have been told that there are similar issues across adult social care. However, we have been informed by our colleagues in the non-mental health social care teams within Barnet Council that their waiting lists are nowhere near 15 months. In the absence of any statistics provided by Barnet Council we have no other option than to resort to anecdotal evidence. We have also spoken with our social work colleagues in other London Boroughs who also inform us that their waiting lists are nowhere near 15 months, with one worker, who left Barnet this year, informing us that the waiting list at the London council she now works for is only up to 6 weeks.
The remaining staff are desperately trying to plug the gaps and the result is a significant impact on staffs’ own wellbeing, with staff reporting poorer physical and mental health. When surveyed, 100% of staff who responded stated they had considered leaving the service. We remain deeply concerned for the vulnerable residents of Barnet who we serve, and continue to challenge the lack of a safe service and the unreasonable and increasing waiting lists which put Barnet residents at risk of harm, and even death. We feel that Barnet is not meeting its statutory responsibilities and we are asking for a means to provide a stable, experienced, and permanent workforce. To do this, we are asking for a reasonable recruitment and retention payment, already in place for Family Services, to promote staff to remain in Barnet rather than leave for better paid and lower stressed positions. We ask that you please engage in negotiations so that we may all come together to meet our statutory responsibilities and the needs of Barnet residents.
Yours sincerely,
Barnet Mental Health Social Workers