The programme continues to move towards having NHS England commissioned L&D services accessible to 100% of the population by March 2020, with more new services forming and other initiatives, such as Crown Court L&D support and peer support work, becoming embedded within some existing services. The programme recently launched the L&D Workforce Career and Competency Framework to help services design and develop their workforce. The research into L&D by RAND continues as the data collected is analysed and the programme also recently had its annual conference in July 2018, with representatives from all services present.
NHS England’s initial focus has been to embed Liaison and Diversion (L&D) service delivery to the police and Magistrates’/Youth Courts. Plans are now in place for further investment to deliver enhanced L&D services across Crown Court centres. NHS England have been working with the Ministry of Justice and HM Courts and Tribunals Service to identify potential levels of demand for L&D services at individual Crown Court centres, so they can use staff and resources most effectively. The Senior Presiding Judge has also indicated his support for this work.
The programme has adopted a three level approach to the delivery of L&D at the Crown Court. This means that, depending on the identified demand for services, the following will apply:-
- Level 1 – The permanent presence of a senior L&D practitioner at the court
- Level 2 – An L&D practitioner will be available to attend, when required
- Level 3 – It is unlikely an L&D practitioner will be required to attend but services will be contactable if needed
Four L&D schemes have been chosen to implement the delivery of enhanced L&D services at Crown Court centres. These include Birmingham, Bristol, Liverpool and Nottingham. This work builds upon two innovative schemes that have already been running at the Central Criminal Court and Newcastle Crown Court. Similar schemes have also been developed at Snaresbrook, Wood Green, Harrow and Isleworth Crown Courts and have been well received by the Judiciary.
John Stocks, Crown Court L&D Practitioner at Nottingham Crown Court, said the following about his new role. “Having worked closely with the L&D team in Nottingham over the past 2 years I am delighted to have been chosen to take the lead on extending the service into Nottingham Crown Court. I have received a warm welcome from court and probation staff. Having observed Court sessions in preparation for being open for referrals in April there seems to be a definite place for L&D involvement.”
A workshop was recently held to launch the new initiative. This brought together providers and stakeholders from the chosen schemes along with experienced Crown Courts practitioners from London, Liverpool who shared advice and experience concerning the best ways to work in a Crown Court setting.
The enhanced L&D service is designed to help ensure early intervention and advice on mental health issues and for other vulnerabilities. It will assist with case management functions, help to reduce delays and also provide information that can be used to inform sentencing decisions. Any information collected from previous assessments which took place at police custody suites or within Magistrates’/Youth Courts will be shared with Crown Court teams.
Some of the key elements of this service, taken from the draft service specification, include:-
- The screening, assessment and referral of defendants;
- Providing advice, to reduce adjournments for full medical reports, through the provision of quality reports prepared by L&D staff on the day of a court hearing;
- Specialist mental health advice for cases where in-depth or full psychiatric reports are required;
- Support and advice regarding the appointment of intermediaries;
- Assisting with probation reports, including the coordination of risk management and community assessments.
This more efficient way of working may also achieve cost savings for all agencies involved, through the faster turnaround of cases. For example, the presence of a senior psychiatric nurse at Crown Court can significantly reduce delays as there will be access to expert advice and recommendations ‘in house’ without the need to obtain external psychiatric expertise.
Glyn Thomas, Head of Implementation for the Liaison and Diversion Programme at NHS England, notes that “L&D staff will be able to provide timely expert advice and support to Judges, court staff and criminal justice agencies, so that they can deal with individuals presenting complex health and social care needs. This vital support will help criminal justice professionals working in the Crown Court who may not have an understanding of complex mental health conditions, needs or treatments, to manage cases more effectively and to provide options for tailored psychiatric support as part of sentencing decisions.”
NHS England plan to roll-out the three-level delivery model of L&D services to all Crown Court centres by 2021.
It gives us great pleasure to announce that the Treasury has now approved the programme’s Full Business Case (FBC) for Liaison & Diversion (L&D) services. The overall endorsement of the FBC will allow for further rollout of L&D services, with an additional £12 million injection over two years to help roll out services to a wider population.
L&D services currently cover 53% of the population of England. The decision of Her Majesty’s Treasury to back the FBC by releasing an additional £12 million to permit further expansion of L&D in 2016/17 and 2017/18 is a very positive step for the Department of Health, NHS England, and our partners, the Ministry of Justice and the Home Office, as well as for those most in need of help and support. We will focus over the next two years on increasing coverage so that more people across England can access the same high-quality services.
Juliet Lyon, Director of the Prison Reform Trust, said: “Extending liaison and diversion services will help to ensure a fairer and better response to the large number of men, women and children with mental health needs and learning disabilities caught up in the justice system. Care Not Custody was inspired by the tragic death in prison of the son of a Norfolk WI member. Thanks to the determination of the WI, backed by a coalition of over two million health and justice professionals, Ministers have decided to do the right thing and divert vulnerable people away from prison wherever possible into the care and treatment they need.”
We are currently working with our commissioners to plan the rollout. By 1st April 2018 we aim to have reached at least 75% of the population – a significant expansion in coverage. Look out for a profile of our new wave 3 schemes in a future edition of L&D News
Vanessa Fowler, Head of Health and Justice Commissioning NHS England (South), notes that “NHS England’s Health and Justice commissioners have relished the opportunity to work closely with police and courts colleagues when identifying, assessing and diverting vulnerable people away from custody when appropriate. Practitioners in police custody suites can offer support to the detainees quickly and advise police colleagues about the nature and function of peoples’ needs…
Support at the court stage and the justice outcomes can now be informed by trained professionals already supporting the individual, improving access to community services which will help them recover and manage their vulnerability without coming to the attention of criminal justice services again”.
For many individuals in the criminal justice system, coming into contact with a Liaison and Diversion service will be the first time they will have been assessed for their vulnerability. Without this service, their condition may not be identified until they enter prison, and the opportunity to divert people away from the criminal justice system or to provide much needed support would have been missed. L&D services are being widely recognised as essential for the wellbeing of vulnerable people in contact with the criminal justice system.
The feedback from those who have lived experience of mental health conditions, learning disabilities, and other vulnerabilities whilst in the justice system also supports the view that L&D works well, as reported through NHS England’s Lived Experience Team.
A member of the L&D Lived Experience Team said that “The announcement of the further funding of L&D services is very much welcomed by the Lived Experience Team, as we will now see a model designed with service users and fully informed by lived experience rolled out nationally, reaching those who need support.”
Chief Constable Simon Cole of Leicestershire Police has had first-hand experience of L&D services in his force. He said: “Having witnessed the success of Liaison and Diversion in my own force area, I cannot envisage how criminal justice agencies and health would adequately and consistently address the needs of some of the most vulnerable individuals in society without it. My officers and staff are more knowledgeable and confident as a direct impact of having L&D teams in custody…., offering advice, guidance and training in relation to communication, accessing appropriate services and supporting them in making key decisions…..
….Liaison and Diversion teaches agencies to work better together and, in the process of doing so, leads to better, more timely information sharing, enables better informed risk assessments and more appropriate decisions by the police and the Crown Prosecution Service on charging and disposal. All of these benefits lead to financial efficiencies due to the amount of public service time saved across all agencies, as individuals receive the healthcare and support they need to help them break the cycle of their offending behaviour, or avoid becoming victims or reaching crisis point.”
As well as expanding coverage to new areas, this approval secures funding for wave 1 and 2 Liaison and Diversion services to continue their hard work ensuring that people with vulnerabilities have their issues addressed and receive support before they go to prison or become lost in the system.
Prior to the positive FBC decision and the £12 million injection, L&D services covered some 53% of the population. In the first 2 years of operation, from April 2014 to March 2016:
- almost 63,000 adults and over 8,500 children and young people have engaged with L&D services;
- 22% of adult cases and 24% of children and young person’s cases involved female service users.
A range of needs and vulnerabilities were identified in these individuals, including:
- mental health needs (in 70% of adult cases and 55% of children and young person’s cases);
- alcohol misuse (31% of adults and 11% of children and young people);
- substance misuse (28% of adults and 21% of children and young people), and
- accommodation and financial needs, learning disability, and social and communication difficulties.
L&D intervention led to almost 20,000 referrals into treatment and support services for adults, children and young people.
With the new plans for an extended rollout, enabled by the financial boost, NHS England is firmly focused on working with its commissioners and supporting its providers to reach an even greater number of clients. We will be covering the rollout of services in more detail in future editions.
The ‘RAND Europe’ evaluation of wave 1 Liaison and Diversion services has been published alongside the Full Business Case. It found that the national model has been implemented as planned across the 10 first wave sites, with strong partnerships created with the police, courts and local agencies.
Many positive findings came through in the qualitative research, providing a good evidence base and giving insight into the way that services work. Findings include:
- An increase in the total number of people identified with vulnerabilities, such as those with mental health needs, substance misuse and learning disabilities
- The support worker function is a major strength of the national model. Support workers provide hands-on practical help to service users, and support engagement and referrals, filling a potential gap between contact with L&D staff and the first appointment with a service in the community.
- An increase in relevant and timely information available to police, courts and partner agencies. This has enhanced magistrates’ and police officers’ confidence in their decision-making and is perceived to have sped up processes.
The Department of Health has commissioned RAND Europe to conduct a second phase of research, to determine the outcomes of L&D services in relation to the impact on re-offending, diversion from the justice system, the impact on healthcare utilisation, and a full economic analysis of the services.
The second phase evaluation, including both wave 1 and 2 services, will take account of the developing strategy for health services in the justice system. It will also conduct comparative research to measure the ‘before and after’ effect of the introduction of L&D services. Look out for more information about ‘RAND 2’ in future editions of L&D News.