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The AMHP Workforce Plan,

Standards and CompetenciesPositive development of the Future AMHP workforce

Mark Trewin

Mental Health Social Work Lead DHSC

Mental Health Social Work advisor NHSE

MHA Review working group

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The AMHP Workforce Plan

• AMHP Workforce Plan

• National guidance on the

development, support and workforce

requirements of AMHPs

• Includes draft AMHP Standards

• Includes draft AMHP competencies

• Guidance for LAs, NHS Trusts and

Social Work England on the employment,

support, recruit and retention of AMHPs

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Expanding the AMHP workforce

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HEE New Roles in Mental Health group

• Social Work one of 8 key professions in MH. Recommendations:

• Guidance supporting SWs employed in the NHS

• New leadership and development recommendations

• Cross agency support for the AMHP workforce

• Cross agency support for the Forensic SW workforce

• Roles:

❖ Named SW role

❖ Specialist community SW role

❖ Development of forensic social supervisor role

❖ Development of approved clinician role

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Developments supporting the AMHP role

• New Guidance for NHS Trusts employing Social Workers

• Social Work for Better Mental Health is working with over 60

areas to support MHSW exploring new models of integration

• DHSC MH workforce planning now includes social work

• Green Paper for Prevention and Social Care

• NHS Long Term Plan:

• Community MH Framework

• New models of Crisis and Urgent Care

• Forensic, secure care and prisons

PSW Network Conference

AMHP Workforce Plan –National AMHP

Service Standards

5th July 2019

Robert Lewis - AMHP Service Manager, Devon County Council and member of AMHP Leads Steering Group

Karen Linde - Lead for Social Work for Better Mental Health (SWfBMH)

AMHP service context• 152 LAs in England, 22 LAs in Wales with responsibility to provide

AMHPs

• Estimated 3,900 AMHPs, no national register, no full-time equivalency figure (65% have combined roles)

• 142,000 MHA assessments per year and climbing (2016/17)

• 64,000 detentions and climbing (2015/16)

• Useful workforce and demand surveys in recent years, there are no minimum data sets. Demand and activity is hidden nationally

• Diversification of AMHP service arrangements/ways of organising social work service

What is an AMHP service?• The CQC review (2018) noted that there was no single definition of an

AMHP service and the lack of over-arching AMHP service standards

• There had been some recent guidance to DASSs and Trusts around what supports they should be offering AMHPs, but generalised to the AMHP rather than the development of AMHP ‘service’.

• AMHP literature focussed on role and stress. Minimal (but growing) research into AMHPs and AMHP services and organisational factors in effectiveness

• Diversity of AMHP service delivery models in a wide range of organisational structures developed in response to a variety of pressures/influences – rather than proactively to achieve effectiveness

Models of AMHP Service DeliveryThree main forms

1) Traditional(or “disparate AMHP rota” - the Masked AMHP)

AMHPs providing a duty cover service, while primarily holding other roles. AMHPs based in different diagnostic/service-user teams, potentially picking up the ‘off-duty’ AMHP work.

AMHP Leads. Local AMHP forums

Decreasing as a form

Strengths

AMHP cohort will likely come from a broad base of current experience, often sat directly with MDT colleagues. Provides workers with an additional specialism/role on top of case carrying

Weaknesses

Professional isolation. Inflexible at times of peak demand role conflict/resource demands. Leads are not managers

Models of AMHP Service Delivery

2) Hybrid Might be a ‘hub and spoke’ arrangement – a small dedicated group of AMHPs providing triage, referral management and back-up to a locality rota or rotas. AMHP manager, plus AMHP Leads

Significant shift towards this model and positive reports

Strengths

Provides clear oversight of day-to-day operations. Improves capacity and prioritisation. Promotes peer discussion/problem solving and knowledge building. Builds sense of being a distinctive service as well as a role

Weaknesses

Capacity generally focussed on the day-to-day and covering shortfalls (sufficiency), rather than more preventative work. Does not address the issues that lead to burn out for the majority of duty AMHPs providing the rota cover

Models of AMHP Service Delivery

3) Dedicated

Centralised, dedicated AMHP service and/or collection of ‘virtual’ team(s) across an authority. Single referral point. AMHP Managers, rather than AMHP Leads. Can include responsibility for other roles/related tasks – social supervision, etc. Focus is non-case

carrying AMHP-led practice

Increasing but small numbers

StrengthsGreater control of the AMHP workforce capacity, their training, and operational governance. Ability to promote consistent peer-led practice and professional support with AMHPs. Reduces isolation, as AMHPs work in identified teams with an AMHP manager

WeaknessesRisks being inward looking and reactive AMHP role less embedded in CMHT AMHP establishment numbers reduced – knowledge and skills concentrated in a smaller number of colleagues. Risks being overly focussed on the AMHP role at the expense of other professional skills

Barriers to sustainable and effective AMHP service provision• Previous lack of national service

focus/standards/framework

• Well documented issues related to work place stress, pay, and key resourcing issues (beds, doctors, police availability, courts, and ambulances, reduction in community resources)

• Lack of systems thinking. AMHPs and AMHP services sometimes lost in partnerships and local authorities

• Acute care culture - splitting off from community orientated care

• Recruitment and retention

• Aging AMHP population (1 in 3 over 55)

Leadership in AMHP Practice• Strong professional identity and clarity of role for AMHPs

• Well led, peer-led, highly-skilled, educated and experienced workforce (57% have 10+ years’ AMHP experience)

• National AMHP Leads Network – success of self-organised support, primarily web-based/supportive/problem solving, with a non-funded AMHP Leads Network Steering Group

• In recent years, the profile of AMHPs nationally has improved and the influence increasing with greater organisation ownership

• Significant achievements in embedding CPD/refresher training

Development of the AMHP Service Standards• In response to the identified lack of National

Service Standards, in conjunction with the Leads Network, SWfBMH and contributions from across a number of organisations

• The aim of the Standards is to begin to develop a shared language across AMHP service providers, AMHPs and those who receive services, promoting service development, building a knowledge base of good practice and provide a framework against which to begin to measure the effectiveness of AMHP services in supporting the work of AMHPs

• Links to local and national quality improvement leadership especially Social Work England, PSW

Draft AMHP Service Standards• Not prescriptive about service model

• To be used as a reflective tool to promote local dialogue across stakeholders with support resources.

• Six headings:

• Local Authority governance and connection to national and regional AMHP networks

• Governance within 24-hour AMHP Services• AMHP Service scope• AMHPs’ personal, professional, physical and psychological

safety• Service and professional development• Improving the experience of people who come into contact

with AMHP services

1. Local Authority governance and connection to national and regional AMHP networks

• Direct line of sight between DASS and frontline AMHP service and CEOs of Mental Health Trusts, where Partnerships exist

• Ensuring clear approval, re-approval and authorisation processes.

• Ensuring connection and development of local, regional and national AMHP Lead networks

• Responsibility placed upon the DASS to ensure that a Lead AMHP/AMHP Manager is connected to the AMHP Leads Network.

2. Governance within 24 hour AMHP Services

• Clear operational responsibilities set out across the 24 hour time period – access to peer, managerial, legal supports and so on

• Referral management and data collection processes clear and robust. Reporting into multi-agency forums and systems to ensure the support of strategic planning

• Clear contingencies around accessing capacity at times of high demand

• Clear escalation and reporting mechanisms in place.

3. AMHP Service scope

• AMHP services to be viewed as integral to mental health services, active in system development – particularly, prevention, safeguarding and crisis care.

• AMHP should promote localism and be able to have connection to all teams (not just adult mental health), with clear access points.

• The AMHP workforce should reflect the diversity of their communities and targets should be set to reflect this ambition.

4. AMHPs’ personal, professional, physical and psychological safety

• AMHP services should be configured to ensure that AMHPs’ safety and well-being is at the forefront of operational considerations

• Lone working in non-contained environments should be removed

• Clear arrangements for supporting AMHPs who work passed their contracted hours

• AMHP independence should be supported through access to individual and peer support and supervision

5. Service and Professional development

• AMHP services should be considered ‘open learning environments’. AMHP s should be supported to promote human rights and rights-based agendas, safeguarding, the social model of mental health and access to social care

• As system leaders, AMHPs should be empowered to contribute to the learning of others.

• Routes to AMHP training should be clear for all eligible professions

• Emphasis should be given to service user experience and the understanding of social trauma.

6. Improving the experience of people who come into contact with AMHP services.

• AMHP services should promote the dignity and human and civil rights of those they come into contact with. Social models and perspectives should be reflected in how AMHPs record and the systems they utilise.

• AMHPs should help address racial and cultural disparity through the development of competence, awareness, staff capability and behavioural change.

• AMHPs should embed the principles of co-production and should explore ways to capture the experience of those they come into contact with; with those people having routes into influencing and developing AMHP services locally.

• AMHP services should ensure the availability of clear information; which should be co-produced and culturally appropriate.

Testing the standards• The standards will be tested in a range of organisational settings

identified through the SWfBMH sites and the AMHP network

• A self-assessment workbook and guide with online resources

• Aim to encourage ownership of the exercise by quality networks, such as PSW and AMHP network, CCGs and Trust and Council QA

• Encourage local service user involvement in assisting review

• Encouragement of use as regional benchmarking tool

• Establish a practice network to support feedback and data support

• Promote service-user direct feedback as a resource for service improvement

Questions?

robertlewis2@nhs.net

01392 208948