Fern Foster Inquest – Melissa Hinton, Oxford Health PFD Evidence

The final witness to give evidence at Fern’s inquest was Melissa Hinton. She gave evidence after lunch on Day 11. She gave an affirmation.

C: Can I thank you for attending the inquest today, and you and your colleagues, for proactively considering matters as they’re unfolding and providing additional evidence to assist me in learning what’s happened to Fern … what’s your role, what is it at the moment, and why you’ve been invited to present evidence to us today?

MH: Head of Social Care for Oxford Health within Buckinghamshire, I’ve got responsibility, for the statutory responsibility delegated to us from Buckinghamshire Council. In role since June 2023, been employed here much longer than that in various social work capacity … asked to talk about arrangements for assessing under Care Act, at time when involvement with Fern, and describe how things have changed and what arrangements are at moment.

The coroner said it was up to Ms Graham how she wished to proceed with the witness.

AG: You’ve already told us it was delegated responsibility from Buckinghamshire Council .… can you tell us how assessments under the Care Act work now, as opposed to in 2020 please

MH: So at the moment we’ve got a dedicated Social Work Service that sits within Oxford Health in Buckinghamshire. That service sits within the rest of mental health services, we’ve got Social Workers in specific adult mental health and older adults mental health teams… those teams, they have really close links, co-located, working together with health colleagues. Line managers are separate to Team Managers. We’ve got this dedicated structure that I lead, all social workers have an Assistant Team Manager they report directly to, who oversees their work, then a Team Manager, then very new post in place in the last couple of weeks which is Service Manager, then I’m Head of Social Care.

Quite different to the way the service was structured when Fern was here. Changed in 2020, had review of Section 75 arrangement, legal statute that delegates responsibility from the council to health.

AG: You just said review in 2020?

MH: Sorry, 2022. Previous to the review the Social Workers were integrated into Care Management posts, your Care Manager might be by professional background a social worker, a nurse or an occupational therapist, they, regardless of professional background would have responsibility to identify someone who needed a Social Care Assessment and carry out that social care assessment in line with the Care Act. We had a very generic model, there were problems with that. The council had questions about how we were delivering their statutory responsibilities, and also had questions whether social work funding for health were doing social work tasks, or also doing health tasks… gradual move to come to conclusion this model wasn’t the most efficient way, or safest way, both parties wanted a change, so formal review of the Section 75 arrangements in 2022. Completely new structure, different team make up, different responsibilities for social workers, came into effect October 2022.

AG: Thank you. In terms of a Care Act Assessment … I understand also known as a Better Lives Assessment. Can you tell us what the obligations are under that?

MH: Buckinghamshire Council has an overall strategy called the Better Lives Strategy, their way of delivering Care Act Responsibilities. If they were here they’d talk about being very strength based approach … [fuller answer, missed] trying to mobilise someone’s network to support them, help live independently and achieve their goals. Better Lives Strategy also encompasses the Care Act Responsibilities. Criteria for initiating a Care Act Assessment is as basic as identifying someone lives in the local authority and appears to be in need of support. If identify someone needs that assessment under the Care Act now, that’s done by a dedicated social work team, or a social worker with enough training and competence to do that. They will look at, areas I outlined, what is happening in someone’s life at the moment, what it is they want to achieve, what is important to them, if necessary goes on to look at whether Care Act eligibility apply, whether someone meets those criteria, how we might arrange services to support them.

AG: We’ve heard a bit about the change to Keyworker from Care Co-ordinator, is that something in your team?

MH: No, we’re not getting involved in Keyworker… work closely and jointly with our health colleague who are the primary worker, we’re delivering the statutory functions. It’s not as mechanical as it sounds, you don’t do assessment, put in care package and leave person to it. Often long-term and we’re working with people in a very person centred way.

AG: How do you interact with clinicians dealing with the mental health aspect of a person’s care?

MH: We’re co-located with those adult mental health teams, sit in same space, we attend the same weekly, daily meetings … attend meetings where look at all inpatients, see what barriers might be to discharge for someone, is there sufficient care to support people in the community, we’ve got social workers involved in a range of forums throughout community.

AG: You said about systems, the system you use can be accessed by Adult Social Care. Can tell court about that?

MH: Sure. Buckinghamshire Council has electronic recording system called LAS, interactive system, more than recording system, use to write Care Act Assessments we do, to create the Care Plans, they get sent through the LAS system to different teams in the Council involved in the commissioning of services. Includes oversight of senior staff, if write assessment I’d expect staff to send on LAS that assessment to their manager. They check and make sure its legally compliant, can hear the person’s voice, involved families. They might send back to person and make suggestions, when they’re happy with it will sign off. So some governance built into that system and audit as well.

AG: Finall,y do you have experience of working with partner agencies? Could you explain a bit more about how social care in your team work with other partner agencies?

MH: Sure. To give an example, some partner agencies we’re working with are housing, local substance misuse support, community voluntary agencies that exist locally might work informally with or commission services and buy time from them. Then other parts of Council might be involved in.

Council has a Quality Standards and Performance Team who we meet with regularly, they have oversight of the quality of the Care Act work we’re undertaking

AG: Second part was how you see the relationship with partner agencies now, compared to 2020, whether see a difference?

MH: What’s improved now is it’s really clear within the Trust who has responsibility for those Care Act responsibilities, way structured before the ownership of it was less clear…. Teams mostly had social work leads, but there was just less clarity I think about who was responsible for what, but now it is really clear. I get a lot of enquiries from other agencies, other parts of Council, say concerned about this person having Care Act Assessment, Melissa you’re responsible for this service can you come back to me. Chain of delivery much clearer to us in Oxford Health, and to other agencies around us, who to go to and how to raise concerns.

Then it was over to Sam Jacobs, for Fern’s family.

SJ: I’m sure this is a gross oversimplification but is the heart of the changes you describe, the idea Social Care Assessments should be conducted by social workers, who have expertise and experience in doing those assessments?

MH: Yes

SJ: When the review was undertaken in 2022, were the concerns focused on the quality of assessments or also concerns about Care Act Assessments not being undertaken when they ought to have been?

MH: I think it was more the clarity that was needed about professional roles and who was doing what. It was probably part of it. There wasn’t specific incidents or cases that triggered this, think had been cultural shift both the Council and the Trust could see was needed

SJ: Is possible to see how a lack of responsibility could result in Care Act Assessments not being undertaken… the short point of the Care Act Assessment issue, if I can put it like that, is one wasn’t conducted. What is it specifically about the new arrangements would lead to reassurance if the same were to happen again, the Care Act Assessment would be conducted?

MH: I’d like to think that because of the social workers and social work leads involvement in those multidisciplinary discussions within those teams, and their proactive responsibility to make sure that someone has an assessment when it appears they need one, as I say the criteria for having an assessment, the bar is very low, someone who appears to need support. I think we’re much more aware as a social work group of what our statutory responsibilities are… it feels much safer to me, much tighter.

SJ: Clearly your assessment service, if I describe it like that, will assess people who are autistic. Can you explain the level of expertise you have, or don’t have, within your team and the pathways that you have to seek specialist input if that is necessary?

MH: Ok, we don’t have a Specialist Service within the Council or the Trust Social Care Service. That has been a matter of debate I think for quite a long time, should you shouldn’t you, pros and cons to both approaches. Sense in the Council and the Trust as Dr Malhotra said, autism needs to be everyone’s business. Our awareness of autistic people is growing, we’re seeing range of neurodivergent issues amongst a large range of people being supported by mental health services … been looking at training all staff, Oliver McGowan training is really helpful, but it’s a start. Have arranged training from the Forensic Intellectual and Neurodevelopmental Disability Service.

SJ: Catchy title

MH: They have a real specialism around working with autistic people, really wanted to make sure social workers were as skilled as can be, feedback was really good… just start… will complete all mandatory training in the Trust and have access to all training in the Council as well got access to…

SJ: Is the mandatory training the Oliver McGowan Tier 1?

MH: That’s right

SJ: Would you be concerned that may not be sufficient given the particular roles those assessing care and support needs have?

MH: I would actually. When applying statutory criteria and the service is going to meet those identified needs, the quality on that rests on your ability to do that assessments with someone and form relationships… its complicated… we definitely have people in our service who largely through experience have broader range of skills than if new in… we talk about that when discussing cases, will say is someone can benefit talking through with… also make use of Buckinghamshire Autism’s Reasonable Adjustment Service, who have been incredibly helpful. It is work in progress, there’s definitely more we could do.

There were no questions from any other interested persons for Ms Hinton. The coroner said it had been very helpful to have the full context and thanked her for providing a statement at short notice.

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