Right Care Right Person

Keith Campbell

Now Live, and the Questions That Remain

The Concern for Welfare stage of Right Care Right Person (RCRP) went live across Northern Ireland on 1st November. This follows the revised Mental Health Order Code of Practice in September. Together they represent the most significant change in years to how people in crisis are responded to. Further phases, including the conveyance of patients and the handover of people to healthcare, are still to come with indications that these may be introduced sooner rather than later.

It is important to be clear from the outset about what RCRP is, and what it is not. This is not solely a mental health change. It affects welfare and safety concerns right across Health and Social Care – older people’s services, children’s services, learning disability and mental health alike. Almost any one of our members, in almost any setting, may feel its effects.

NIPSA has consistently supported the principle behind RCRP. People experiencing a health, social care or welfare need should receive support from the service best placed to meet that need. The police should not routinely be used to compensate for gaps elsewhere in the public sector.

But there is an equally important principle — the right service has to actually be there to provide the care.

The PSNI says it responds to more than 30,000 concern-for-welfare calls each year. Under RCRP, the police will no longer routinely attend many calls where there is no crime and no real and immediate risk to life or serious harm. Many of those welfare concerns, and the difficult judgement calls surrounding them, will now have to be managed through Health and Social Care and other appropriate service pathways.

It is worth being clear about what this means in practice. In these early days, the police may still attend particular incidents depending on the circumstances and risk presented. That should not be mistaken for the position being unchanged. The fact that police attended one particular incident is no guarantee that they will attend a similar concern on another occasion.

Whilst this change may release significant police capacity, it does not create additional Health and Social Care capacity. And that remains NIPSA’s central concern.

The risks are no longer disputed

In the days before implementation, a paper distributed by the Department of Health set out the very risks and structural gaps that NIPSA and frontline staff had been raising throughout the development of RCRP. They included:

  • The sustainability of the Approved Social Worker workforce
  • Capacity and delays within Article 129/130 processes under the Mental Health (NI) Order 1986
  • The absence of a single adult welfare access point equivalent to daytime Children’s Gateway, or to the 111 service used in England and Wales
  • The out-of-hours response for vulnerable adults who are not known to services
  • Uncertainty around care homes, missing vulnerable adults and domiciliary care pathways
  • Consistency in the application of THRIVE and professional decision-making
  • Wider pressures involving mental health capacity, crisis services and workforce sustainability

It is significant that these concerns are now recognised at regional level. But recognising a risk is not the same as resolving it. Monitoring a known structural gap is not mitigation of that gap.

The adult welfare gap is particularly concerning

While Children’s Services has an established daytime access point through Gateway, there is currently no equivalent single point of contact for adult welfare concerns, and even the children’s Gateway service is under considerable pressure before any of this properly begins.

Adult Safeguarding has a vital role, but it was never designed to become the receiving service for every concern involving a vulnerable adult. That leaves a number of very practical questions in the following type of scenario:

A care worker arrives for a scheduled visit to an older person who is normally settled and familiar to them.

Today the person is confused and increasingly agitated. Their behaviour is unpredictable and intimidating for the worker. They are pacing, shouting, refusing support and saying that they feel like punching something. They have not assaulted anyone, no crime has been committed and there may be no immediate medical emergency, but the worker is becoming concerned both for the person’s welfare and for their own safety.

What happens next?

  • Does the worker remain in the property or withdraw?
  • Who assesses whether the person’s behaviour presents an immediate risk of serious harm?
  • Who does the worker contact for an urgent welfare or mental health response?
  • What happens if the police conclude that their threshold for attendance has not been met?
  • What happens if an ambulance is not clinically indicated?
  • What happens if the person is not already known to mental health or social work services?
  • And what happens when the same situation occurs at night or over a weekend?

If the situation becomes an emergency involving an immediate risk to life, serious harm or crime, the position is clear: emergency services should be contacted. The difficulty lies in the substantial grey area before that threshold is reached.

Who supports the worker, who assesses the risk, and who actually responds — and, critically, how quickly will the response be?

The issue is not simply who says no. The issue is who says yes — who takes responsibility and actually provides the response the person needs?

These questions are hard enough during the working day. Outside normal working hours, the available options narrow considerably. For social work concerns, the Regional Emergency Social Work Service (RESWS) is one of the few regional out-of-hours routes available, alongside relevant Trust on-call and emergency arrangements, and RESWS is already operating under significant pressure before additional RCRP demand is fully understood.

RCRP is being introduced into an HSC system already experiencing substantial staffing and capacity pressures. The regional risk paper itself acknowledges recruitment and retention difficulties within Approved Social Work, pressure on RESWS out of hours, and the limited ability to rapidly increase specialist workforce capacity. The wider Health and Social Care system faces similar pressures. And that matters, because:

  • A pathway is not a workforce.
  • An escalation protocol is not capacity.
  • A risk register is not a service.

Releasing police capacity does not create equivalent Health and Social Care capacity. We cannot THRIVE-assess our way out of a capacity problem.

There is a further point that goes to the heart of this. A significant amount of the police time RCRP is intended to release is not spent on welfare checks at all. The PSNI has also highlighted the significant time officers spend in hospital settings on matters that are not a policing role when someone experiences a mental health crisis. In practice, much of that time is spent with people awaiting assessment or already assessed and detained under the Mental Health Order, waiting, sometimes for many hours, for a psychiatric bed to become available. That is not a policing problem RCRP can solve. It is a shortage of beds, one that long predates RCRP and has not eased since inpatient provision was reduced. RCRP does not create a single additional bed. So that time does not disappear into a solution. The person still waits, while Approved Social Workers, clinical teams and emergency services are left trying to manage the consequences of a lawful detention for which the system cannot provide the required inpatient resource. That is an organisational capacity failure. It must never become the personal responsibility of an individual, such as an ASW, to cover for ongoing and known gaps in psychiatric care provision.

Plainly put, you cannot discharge a person to a bed that does not exist.

What NIPSA believes is needed now

The immediate priority must be safe implementation. That means:

  • One clear and authoritative source of current guidance
  • Clear pathways for individual programmes of care
  • A workable adult welfare access route
  • Clear and properly resourced out-of-hours arrangements
  • Practical training for all affected workers, including domiciliary care and other frontline social care staff
  • Named and accessible management escalation routes
  • Consistent arrangements across all five Trusts
  • Monitoring not simply of activity, but of delays, unmet demand, workforce pressure and failed pathways
  • Rapid regional action where implementation identifies a structural problem

Regional problems require regional solutions. Individual Trusts should not be left to develop five different workarounds for gaps which ultimately require regional policy, commissioning, service redesign or additional resource.

And this is perhaps the hardest part to accept. SPPG and the Department of Health have had many months to consider these risks. They have also had the opportunity to learn from the implementation of RCRP elsewhere and from the difficulties that arise when police thresholds change before alternative pathways, capacity and responsibility are entirely clear.

Yet Northern Ireland has now reached implementation with significant structural and workforce risks formally acknowledged, and without additional resource having been identified to resolve many of those gaps. A major shift in policy and responsibility cannot be delivered simply by changing the threshold at which another public service responds.

You can transfer demand through a policy change. You cannot create the staff, services or capacity needed to meet that demand simply by changing the policy.

Advice to NIPSA members

RCRP changes interagency arrangements. It does not mean individual workers should personally absorb organisational gaps or be left carrying risks because another service is unavailable.

Members should:

  • Follow the current approved procedure for your service and any specific RCRP guidance provided by your Trust.
  • In an emergency involving a real and immediate risk to life, serious harm or crime, contact the emergency services as normal. RCRP does not remove the role of the PSNI in those circumstances.
  • Be clear about the risk. Record what is happening, who may be harmed, what has already been attempted and what additional response you believe is required.
  • Do not treat “RCRP” as an explanation in itself. If another agency does not respond, establish the decision, the reason given and the appropriate escalation route.
  • Escalate early where responsibility or the pathway is unclear. Use your line manager, senior manager or agreed out-of-hours and on-call arrangements.
  • Keep a clear contemporaneous record of requests made, advice received, decisions taken, names and roles where appropriate, times, outstanding actions and any continuing risk.
  • Where a service cannot deliver the response identified by the pathway because of staffing or capacity, record and escalate that fact. A workforce shortage is an organisational issue, not an individual worker’s failure.
  • Use the Trust’s incident and governance reporting arrangements where appropriate, particularly where there is delay, repeated interagency disagreement, an unsafe situation, or a pathway has failed.
  • Raise recurring problems with NIPSA. We need members to tell us what is actually happening on the ground so patterns can be identified, evidenced and challenged.

Most importantly, members should not feel they have to improvise unsupported solutions outside their role because the system cannot identify who should respond.

Escalate it. Record it. Protect the person, protect yourself, and make the organisation own the organisational problem.

What happens next matters

NIPSA wants Right Care Right Person to succeed. Success, however, cannot simply be measured by a reduction in police deployments. The real test is whether a vulnerable person who needs help continues to receive a safe, appropriate and timely response. There will inevitably be learning as such a significant change beds in, but there is a difference between unforeseen implementation issues and structural gaps which were known before commencement.

You learn from unforeseen problems. You mitigate foreseeable ones.

And this is only one stage of RCRP. Further changes will follow, making it all the more important getting the foundations right now because the demands on the system will grow, not shrink.

The risks have been identified. The responsibility on HSC organisations, SPPG and the Department is to act on them.

Right Care Right Person can be the right principle. But Right Care Right Person cannot mean Wrong Resources.