The recent national L&D conference brought together commissioners, representatives from all NHS England commissioned L&D services and key government and voluntary sector stakeholders to celebrate the progress made to date and to launch the L&D Workforce Career and Competency Framework, developed in partnership with Health Education England and Skills for Health. Lord Bradley spoke about the history of L&D and hopes for the future of services. From NHS England, Kate Davies, Director for Health & Justice, Armed Forces and SARCs, and Andy Hunt, the National Programme lead for L&D, also both gave an overview of current and future L&D work and the wider priorities it fits within. The afternoon consisted of themed workshops which focused on female pathways, voluntary attendance, crown courts, peer support and learning disabilities.
The new L&D Workforce Career and Competency framework is designed to support the development and growth of the workforce in this area and to allow health care, social care and support staff to assess their own skills and competences. It provides a career structure for staff working within L&D services and outlines the skills and competencies required, as well as how such roles can provide a rewarding and enriching career. The role of, and career opportunities for, peer support workers also feature within the framework. The framework also includes 9 role profiles spanning from level 2 to level 8, which are included as appendices with the document.
This framework was commissioned by Health Education England and undertaken by Skills for Health with input from NHS England. An expert panel of commissioners, service managers, practitioners, support workers, and individuals with lived experience worked together to advise on the content to ensure the framework is fit for purpose. The intention is for services to use this framework in both the design and development of their services and workforce configuration.
Lord Bradley speaking at the national Liaison and Diversion conference, July 2018.
When females enter the criminal justice system, they enter a system designed predominantly for men. However, in many cases, the nature of female offending differs from male offending and once in custody women have different and specific needs. Research suggests that over half of females entering the criminal justice system have been sexually, emotionally or physically abused and mental health problems are far more prevalent among women. Many women end up in prison for less serious offences as a result of repeat offending and a failure to respond to non-custodial alternatives.
In 2007, the Corston Report outlined the need for a distinct, radically different, holistic, women-centred approach to improve approaches, services and interventions for women in the criminal justice system. In 2016, Dr. Phillip Lee, Parliamentary Under-Secretary of State for Justice, stated that women who commit offences are often some of the most vulnerable in our society. He emphasised the need for early intervention and a criminal justice system which can take proper account of the specific needs of women. The national L&D programme therefore is encouraging services to prioritise meeting the needs of women using L&D.
In February 2018, the L&D central team welcomed Nicola Tutty as the new national lead for women’s L&D pathways. Nicola is an experienced female specialist practitioner who, for the last 10 years, has worked holistically with women and girls involved in a range of criminal justice settings.
NHS England recently held two workshops for all L&D services from across the country, highlighting the specific needs of women using L&D. The aim was to convey to L&D practitioners the extent to which a different approach is needed when working with female service users and to identify the next steps in developing an L&D pathway for women. Wakefield, Gloucestershire, London and Birmingham L&D services all presented at the workshops and provided case studies and good practice examples of work.
The workshops explored ways in which L&D services could develop their female pathways, including potentially appointing a dedicated female lead to help sensitively and holistically address the needs of female offenders as they enter the criminal justice system. It was recommended that services offer to see all females coming into custody and provide the option of seeing a female practitioner for their ongoing support. The workshops emphasised the need for L&D services to map all available local support services and to develop close relationships with them.
Nicola Tutty, along with Emma Griffin from the central team, will be visiting L&D services to offer help and advice on how services can develop their female pathways, the aim being to increase overall female engagements rates within L&D.
What skills does it take to make up an effective Liaison and Diversion team?
Health Education England and Skills for Health are developing a career pathway and competency framework which recognises the multi-disciplinary nature of the L&D workforce. This will help commissioners when designing and employing for an L&D team as well as inform services and staff regarding career development, etc.
An expert working group has been formed to co-design the framework. The group have participated in three successful and well attended workshops and will now be asked to comment on the final draft products. The expert working group were comprised of the L&D national programme, commissioners, service managers, practitioners, STRWs, peer supporters and those with lived experience.
The framework has identified seven specific roles, volunteer, peer supporter, support time recovery worker, practitioner, specialist practitioners (i.e. for children and young people, learning disabilities, women and Crown Courts), service manager and strategic manager.
The finalised framework will be presented to the May L&D programme board and made available to services by the summer.
The introduction of the national Liaison and Diversion (L&D) standard service specification incorporated the role of ‘Support-Time Recovery’ workers (STR) into L&D practice, allowing providers to design innovative ways to develop this role that suits their service. The following examples show some of the different ways services have incorporating the role of STR’s.
The Dorset L&D service has made the recruitment and deployment of STR workers a priority. Team leader, Sharon Evans explains, “We are currently resourced with five [STR] engagement workers, both custody and community based, who, at the request of our practitioners, are able to react promptly to meet the needs of vulnerable clients”.
STR workers strive to develop effective therapeutic relationships with clients, as illustrated in the following case study.
A young man was seen in police custody having been arrested for a series of suspected indecent exposures. The STR worker met them to arrange a GP appointment to address insomnia. The young man shared feelings of isolation since the death of his mother and ongoing issues with his sexuality.
On release from custody they agreed to meet at a local library and the STR worker was able to find appropriate web-based support groups for the client. He had limited experience of using the internet so was assisted to sign-up for an Internet ‘Access Course.’ Further follow up appointments involved accompanying him to ‘Over The Rainbow,’ a LGBT Support Network, ‘Dorset Mind’, a LGBT support group, a ‘Gay Outdoors’ group and ‘Steps2wellbeing’ which involved talking therapies.
The STR worker liaised with the client’s employer and ensured he was provided with a sickness certificate. As the client had struggled to cope financially when on sickness benefit arrangements were made for him to receive a food parcel and new bedding. The STR worker liaised with his landlord following concerns regarding his personal hygiene that were impacting upon his tenancy. They also accompanied him to a launderette and gave advice regarding his self-care needs.
The STR worker supported him through when attending both magistrates’ court and Crown Court. They shared relevant information with his legal defence. The client received a 3-year Community Order, with a requirement to attend a sex offender treatment programme. The young man has since returned to employment and is engaged with floating support for a further two years, providing support for his ongoing vulnerabilities.
Norfolk & Suffolk
In this service, the role of the STR workers in the community is varied and complex, involving all aspects of a person’s social care and related needs. For example, helping with housing issues, debt, benefits, accessing a GP, providing support at court, as well as addressing substance misuse and offending behaviour issues. STR workers are trained to focus upon the strengths of the people they are supporting, recognising that we all have talents and skills we can draw upon to help us manage the things that we find more difficult. The service strives to recruit STR workers with the right attitude, strengths and skills to work in this way.
They use the ‘Justice Star’ tool to enable staff and service users to focus, encourage motivation and create sustainable change. Another key element is effective networking; having knowledge of the other local agencies or services and establishing relationships with them.
‘Julian Support’ (JS) provide the social care element of the Norfolk and Suffolk L&D service, which is part of Norfolk and Suffolk Foundation Trust. The L&D team undertake the initial screening process and then refer directly to JS colleagues when social care needs are identified.
Penny Newton, service manager at JS states, “Our commitment and drive to deliver excellent outcomes for the people we support remains core to both agencies working together. Service users continue to be at the heart of what we do.”
Richmond Fellowship work in partnership with, Northumberland, Tyne and Wear NHS Foundation Trust to deliver community support to people engaged with the Northumbria L&D Service.
There are two elements to this work, as outlined by Karen Ainsley, the Richmond Fellowship locality manager. “[We have] Community Link Workers [who] provide a time-limited service. They work with the person to identify their needs, address immediate needs and support them to access relevant services to address longer term needs…
Our Peer Support Coordinator recruits, trains and supports peer support volunteers who provide ongoing peer support. Volunteers have lived experience of the criminal justice system and/or mental health issues and services”.
One of Richmond Fellowships peer support volunteers illustrates her experience of working within the service;
“When I saw the advert for peer support I saw how valuable the service would have been to me. Discharged from a section onto the streets I ended up in-and-out of cells. The police kept me safe, addressed my immediate housing and medical needs and accessed a social worker. This was not the role of the police, though they are probably the reason I survived that period….
I was initially plagued with self-doubt [about being a volunteer], but the team encouraged me through training and built my self-confidence. Acknowledging personal recovery…removes barriers otherwise present in a professional role, fostering openness, mutual respect and commitment….”
CLW Emma and PSV Michelle recently accepted a ‘Commendation Award’ on behalf of the Richmond Fellowship for a contribution to reducing crime in the Borough.
The Northumbria L&D service has partnered with the Richmond Fellowship to create their STR-type roles. Pictured is Emma (Community Link Worker and former volunteer) and
Michelle (Peer Support Volunteer) accepting a Commendation Award, on behalf of the Richmond Fellowship for its contribution to reducing crime in the Borough.
Peer support in place in some Liaison and Diversion services
Individuals with experience of the criminal justice system who experience vulnerabilities, such mental health problems, learning disabilities, and/or substance misuse, can provide both emotional and in some cases practical support to people using Liaison and Diversion (L&D) services. These individuals, known as Peer Support Workers (PSW’s), bring their own unique experience of being arrested, charged and in some cases sentenced to prison to the role. They can also help to engage more with those service users reluctant or refusing to engage with L&D practitioners.
The national L&D Programme Board asked its ‘Lived Experience Team’, which provides service-user insight and scrutiny of the Programme, to develop a model of peer support for L&D services. The resulting model consists of both paid and volunteer PSW’s and is currently being trialled in both Wiltshire and Birmingham, where each site is testing slightly different versions of the model.
Avon and Wiltshire Mental Health NHS Partnership Trust, who deliver the L&D services in Wiltshire, have employed a lead PSW with direct responsibility for managing a team of trained peer support volunteers (PSV’s). They are an integral member of the L&D team. They see the more complex, higher risk, cases and allocates lower risk cases to the volunteers, who then report back. All the PSV’s are given appropriate training and support. The PSVs are expected to volunteer for no more than 18-months and will be supported at the end of their volunteer period to find opportunities to volunteer in other areas or work in paid employment.
In Birmingham, the charity ‘Shelter’ provide two paid PSW’s to work within the L&D team, which they refer to as ‘Peer Mentors’. Shelter is a specialist provider of PSW’s and is responsible for their human resources, line management and support. They also help the L&D service to find people to be PSV’s. The two PSW’s are studying for their ‘NVQ Level 3’ in Health and Social Care, as well as accessing NHS courses through Birmingham and Solihull Mental Health Trust, the provider of the L&D Service.
Both L&D schemes have been supported by the National L&D Programme Team and Revolving Doors Agency to make their peer support service happen and all agencies worked together to undertake an initial review of the progress made. The Health and Justice Commissioners, the L&D Service managers and the PSW’s and PSV’s are all very enthusiastic about peer support in action and the additional benefits it offers.
Kevin Heffernan, Health and Justice Commissioner for the West Midlands, notes that, “The peer support work has more than exceeded our expectations, and has integrated very smoothly into the team.”
Steve Jenkins, L&D Service Manager for Birmingham and Solihull Mental Health Trust, reports, “I saw at first-hand how much of an impact peers make on service users; someone who steadfastly didn’t want to engage, did so easily with our peer mentors; and both the peer mentors [we employ] have added another dimension to our team”
The emerging benefits of introducing peer support into an L&D service appear to be:
- A clear willingness from service users to engage with the peer supporters and an increased capacity for the L&D team to offer an appropriate level of support to service users.
- Increased capacity in the service to engage with the very hard to reach service users and frequent re-offenders, who have historically failed to engage with an L&D service.
- An increased capacity, through use of volunteers, to offer help at Court by supporting service users through the anxiety experienced at this stage.
- The L&D team are made more aware of a wide variety of mutual aid, voluntary sector and community support services, which are well known to the peer supporters but often difficult for statutory providers to access.
Volunteers report significant successes, “When I told her [the service-user] I knew what it felt like because I had been there myself she listened and visibly relaxed; I told her I would be there at Court with her and she told me it made such a difference!”(PSV, Wiltshire).
Peer supporters report they are enthusiastic about the project and benefitting from the experience, both personally and professionally. They report feeling enthused by their ability to connect with service users, to broker relationships for them with L&D practitioners and help to and support them into services. One PSW working in Birmingham said, “I am loving it here, seeing how we make a difference, and looking forward to our future.”
Both schemes are collecting additional data and the initiative will be reviewed in March 2018. This will include looking at other models of peer support which are currently being delivered and also the costs involved.
It is hoped that if these two models of peer support prove successful that the updated specification outlining the peer support work will be available to all L&D schemes to work from and that the provision of peer support will become an integral part of L&D services across England.
For further information, please contact Peter Grime, National L&D Programme lead for Peer Support firstname.lastname@example.org.
New journal article on the role of learning disability nurses in L&D
6 January 2016
Vanessa Shaw, Learning Disability (LD) Lead for the Lancashire Criminal Justice Liaison and Diversion Team, has been supporting people with learning disabilities and/or other associated issues for over 23 years, pursuing her career in supporting people in forensic settings.
She has just written an article about her role in the Lancashire scheme for a special edition of subscription-only ‘Journal of Intellectual Disabilities and Offending Behaviour’ (JIDOB). ‘Liaison and diversion services: embedding the role of learning disability nurses’ is due for publication in early 2016.
Vanessa believes, “It is through sharing experiences that future LD nurses in L&D services can ensure they provide a high-quality, effective service for people with LD who come into contact with the criminal justice system, reducing health and social inequalities and meeting the expectations of current service delivery.” Vanessa hopes that the article will help LD nurses to overcome some of the challenges that can be encountered in practice, as well as sharing the achievements of the first months of delivery.
She concludes, “I plan to write in the future should the opportunity arise. I will seek to meet the needs of my colleagues, and I will continue to reinforce the importance of LD nurses in practice using my skills, knowledge and passion.”