In July 2023, Black Country Healthcare NHS Foundation Trust identified a need for specialist support to develop a harmonised Section 117 aftercare policy, across the Black Country health and care system, to ensure legal and statutory duties were being met, with mental health services in alignment.
Two experienced, registered mental health nurses from Arden & GEM’s Clinical Support team led a process of stakeholder engagement and policy development to put in place a system-wide aftercare policy which underpins clinical practice and ensures service users are offered access to support which meet their needs.
The challenge
ICBs and local authorities have a legal and statutory duty to plan and provide mental health aftercare for people who have been detained in hospital under a treatment section of the Mental Health Act (1983). This is known as a Section 117 (S117) responsibility and the necessity for service agreements and funding arrangements is also covered by the National Framework for NHS Continuing Healthcare and NHS Funded Nursing Care.
Black Country Healthcare NHS Foundation Trust provides specialist mental health services for the population of the Black Country, including delegated responsibility for S117. The Trust covers a wide geographic area, working with four different local authorities:
- Dudley – Dudley Borough Council
- Sandwell - Sandwell Metropolitan Borough Council
- Walsall - Walsall Council
- Wolverhampton – City of Wolverhampton Council.
In July 2023, the Trust identified a need to review and harmonise S117 aftercare across the four places, ensuring service alignment and efficiency through an overarching system-wide policy.
Our approach
Providing the support requested would require a team with specific knowledge of mental health services, how they work alongside local authorities and the legal detail of S117. Arden & GEM’s Clinical Support team assigned two experienced registered mental health nurses to lead a project which would develop a co-produced and co-owned policy.
Stakeholder engagement
Stakeholders from the Trust, ICB and four local authorities were brought together as part of a policy working group which met over a 16 week period. Identifying and engaging with a wide range of stakeholders was key to fostering system-wide working relationships and agreeing key principles.
Including Experts by Experience in this process was critical and the team arranged dedicated sessions with two volunteers to enable their active involvement in a more informal and comfortable environment.
"Arden & GEM’s clinical knowledge provided evidence based solutions to support the delivery of the project. They were proactive and pragmatic in their approach to challenges and ensured that everyone's voice was heard. They were clear on the expectations and limitations of the project, which enabled new ways of working to be considered."
Project Stakeholder
Developing the policy
A new policy was developed by building upon existing practice and collaborating closely with the working group. Policy areas, or segments, were shared with the working group and their edits and changes incorporated to ensure a truly co-produced output. Input was also sought from each organisation’s legal team before a final version was circulated and submitted for ratification.
Clinical and operational alignment
The team consulted with clinical and operational colleagues to ensure principles agreed would work in practice. This included attending additional meetings with operational healthcare leaders to ensure the policy was workable and prioritised.
Alongside the policy working group, a process working group was also established to develop documentation – such as forms, letters and templates – that would support frontline clinical processes. The outputs were showcased with clinical teams in a face to face environment through away days and business meetings.
Outcomes
The Black Country now has a collaboratively developed S117 aftercare policy – ready for ratification – which is agreed and owned across the entire Integrated Care System. The policy will underpin clinical practice to ensure service alignment, process efficiency and, most importantly, appropriate aftercare provision to meet service user need.
Feedback from the Trust and project stakeholders has been very positive with an appreciation for the high engagement levels, working relationships, operational insight and objectivity brought by the Arden & GEM team.
"Having external support and a fresh perspective has been invaluable in working with Arden & GEM. They really supported and facilitated a solution focussed approach to resolving some very complex historical issues. Those involved also clearly had a strong and relevant clinical background to the project, drawing upon their own experiences and relating this to practice issues and delivery within our work."
Project Stakeholder
The policy is expected to be ratified in summer 2024. An ongoing review process will provide evidence and understanding of the new policy’s impact on care and outcomes.
Find out more about our mental health support services here.