Appendix 1

Brief For Scrutiny Panel

1. BACKGROUND AND RESPONSIBILITIES OF LOCAL AUTHORITY

Local Authorities have a primary responsibility to provide an Adult Mental Health Practitioner Service (AMHP) service, and ensure that there are sufficient AMHPs available in their area to provide access to a 24 hour service.

Local Authorities have a number of key duties in relation to AMHPs who undertake assessments on their behalf, these include:

·  Ensuring that all AMHPs have access to professional supervision and support in their role as AMHPs

·  Provide a minimum of 18 hours of refresher training, relevant to the AMHP role each year.

·  Responsibility for the health and safety of AMHPs whilst they are undertaking assessments on their behalf

·  Responsibility for professional competence in their role as AMHP, and for removing or suspending their warrant as necessary

·  Legal indemnity whilst undertaking the AMHP role

·  Access to legal advice whilst carrying out AMHP duties.

2. APPROVED MENTAL HEALTH PRACTITIONER ROLE

The AMHP has a central responsibility for co-ordinating the Mental Health Act (MHA) assessment process, considering the need for admission and pursuing alternatives to the use of compulsion wherever possible, and whilst working in partnership with other professionals, reaching an independent judgement about whether the use of compulsion is necessary and appropriate. They are the applicant in the process and as such have personal liability for the judgements made.

The AMHP has a number of statutory powers and duties, the main duties are:

·  Co-ordinate MHA assessments and arrange conveyance to hospital or implement any alternative care plans

·  Respond to S136 detentions in a police station or the 136 suite at the hospital

·  Make Community Treatment Order (CTO) applications and agree to revoke or extend a CTO

·  Supervise section 37/41 patients in the community and produce 3 monthly reports for the Ministry of Justice

·  Apply to Court for section 135 warrants if necessary to obtain entry to premises

·  Apply for Guardianship/Guardianship renewals

·  Consider a request for a MHA assessment from a nearest relative and, if the AMHP decides not to make a recommendation, to inform the nearest relative of the reasons why in writing

·  Apply to the court to displace the nearest relative if the criteria apply

·  Produce a statutory report on completion of an AMHP assessment

AMHPs therefore undertake a mix of planned and unplanned work, and the service has to have the capacity to respond to both. AMHPs also provide expert advice and support for other professionals preparing reports for Tribunals and Managers Hearings.

3. CURRENT POSITION IN RELATION TO THE AMHP SERVICE IN MIDDLESBROUGH

At the 1st August 2015 Middlesbrough Council had 9 AMHPs located in the following teams:

Team / No. of AMHPs / No. of AMHPs on the rota / Funding
Lakeside (Affective Disorder) / 1 / 1 / MBC
1x recharged to TEWV
Parkside (Psychosis) / 3 / 3 / MBC
Woodside (Older People’s Mental Health) / 0 / 0 / MBC
Forensic LD / 1 / 1 / MBC
Forensic MH / 2
(1 of these currently on maternity leave) / 1 / 2 x recharge to TEWV)
Criminal Justice Liaison / 1 / 1 / SLA
BIA Team / 2 / 1 / 2x MBC/SLA
TOTAL / 9 / 8

4. AMHP ACTIVITY

·  Between April 2013 and April 2014 128 statutory assessments were undertaken.

·  Between April 2014 and April 2015 188 statutory assessments were undertaken.

·  The increase in statutory work over the last year is due in part to the Cheshire West judgement that came in to force on 19th March 2014.

·  TEWV’s mental health legislation committee has also recorded that activity under the MHA remains relatively high across all areas and services across the Trust.

·  There has been an increase in AMHP work over the 2014/15 period whilst the number of workers able to undertake this work has reduced

Number of AMHPS employed by Middlesbrough between 2012 and 2015

January 2012 / 21
January 2013 / 18
January 2014 / 13
January 2015 / 13
August 2015 / 9

5. LOCAL INFLUENCES ON THE DEMAND FOR AMHP WORK

There are particular local factors which add to the volume and complexity of AMHP activity in Middlesbrough:

·  Middlesbrough scores worse in many key areas compared to the England average. Examples are in relation to the wider determinants of health, the percentage of adults with depression and the rate for hospital admissions for mental health.

·  Tees, Esk and Wear Valleys NHS Foundation Trust have located some regional services at the Roseberry Park site in Middlesbrough which has impacted on the demand for mental health services

·  Although a National issue, the Cheshire West Judgement which came into effect on the 19th March 2014 has resulted in an increase in the detention of incapacitated individuals across Middlesbrough.

·  Section 40 of the Care Act 2014 makes changes to the ordinarily residence rules which will impact on 117 after care duties and responsibilities for the Mental Health teams.

7. VARIATIONS IN AMHP SALARIES ACROSS THE NORTH EAST

·  There are historical issues locally in relation to the employment and retention of AMHPs, mainly to do with remuneration. All AMHPs in Middlesbrough are qualified as Level L Social Workers and receive a supplement of £2,000 per annum if they participate on the rota.

·  The salary and supplement paid to Middlesbrough AMHP’s is below that paid by other authorities in the North East Region.

AREA / SALARY
Newcastle / Senior Practitioner pt. 41 (£35,662) to pt. 44 (£38,405)
Durham / Advanced progression pt. 39 (£33,857) to pt. 43 £37,483)
Stockton / Advanced progression pt. 39 (£33,857) to pt. 42 (£36,572). Senior Practitioners pt. 42 (£36,572) to pt. 45 (£39,268)
Hartlepool / Advanced progression pt. 41 (£35,662) to pt. 45 (£39,267)
Gateshead / Advanced progression pt. 40 (£34,746) to pt. 43 (£37,483) plus 2 increments
North Tyneside / Advanced progression pt. 39 (£33,857) to pt. 43 (£37,483)
Northumberland / Advanced progression pt. 40 (£33,998) to pt. 44 (£37,578) plus extra allowance if work after 8pm (separate from EDT work).
South Tyneside / Pay an additional 2 increments to salary up to max pt. 42 (£36,521). Senior AMHPs are higher.
Redcar / Pt 44 (£38,405) to pt. 46 (£40,217) with specific job description
Darlington / On scale £34,000 to £39,000 (approx.)
Middlesbrough / Pt 37 (£31,846) to pt. 38 (£32,778) to pt. 39 (£33,857). Plus a £2,000 supplement paid per annum.
Sunderland / Proposed scale £24,472 - £35,662 plus 2 increments.

8. AREAS OF CONCERN

·  In January 2012 Middlesbrough had 21 AMHPs. This number has reduced to 8 in August 2015

·  The consequence of having only 8 AMHPs on the rota has meant that AMHPs are expected to be on the rota 3-4 days per week. This creates major pressure for the individual AMHP and their teams who already manage high risk caseloads. The demands of the role also place significant pressures on the work life balance of the AMHP, an example of this is that a high majority of MHA assessments take place or continue outside of working hours.

·  The main reason for the number of AMHP’s leaving Middlesbrough is the discrepancies in salary compared to the other authorities within the Tees area , but also across the North East Region.

·  Over the last 4 years Middlesbrough has lost 7 AMHP’s to Redcar and Cleveland.

All 7 had completed their AMHP training whilst employed by Middlesbrough.

·  There is a risk that unless retention issues are not resolved , Middlesbrough, through losing AMHPs , will be unable to fulfil its statutory duties.

PRESENT SITUATION

·  2 social workers have recently completed the AMHP training programme (June 2015), although they will not be able to fully practice independently until November/December 2015.

·  A further 4 social workers have been identified to attend the next intake of the AMHP training programme this year, but if successfully trained, will not practice independently until November/December 2016.

·  The current cost to the Authority of training an AMHP is £2,500 approx per worker

·  In response to the current AMHP situation in Middlesbrough, the Department has agreed , and is now providing a £2000 per annum honorarium payment to all AMHPs on the rota, whilst further discussions take place regarding a longer term solution to maintaining and retaining AMHPs as a service within Middlesbrough.

. Future Cost options

Current Middlesbrough Salary Cost including additional £2K honorarium (annual costs) / Future Salary costs to bring costs in line with North East average
(Annual costs) / Future Salary costs to bring in line with Redcar& Cleveland
( annual costs)
9 Qualified AMHPs + 2 recently qualified / £363,833 /
£384,050 /
£402,170

The cost to Middlesbrough to bring AMHP salaries in line with the North East average would be £20,217 per annum

The cost to Middlesbrough to bring AMHP salaries in line with Redcar & Cleveland costs would be £38,337 per annum

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