When West Yorkshire Liaison and Diversion service was developed, it was initially a very medical model, with band 6 mental health nurses, supported by band 5 nurses and band 3 support workers. The commissioners knew the mental health practitioners were needed for the assessments for custody and court but didnt feel very comfortable with that model. They recognised early on that the make-up of the team is vital. By only looking at nursing staff, the breadth of skill available is restricted. Every member of the team could potentially work with anybody seen by the service, but where possible the service tries to match the client to the practitioner that will best suit them. Realising that more than just mental health nurses were required, the service looked at the partners it had worked with to date and realised it needed some of those people to work within the team. They organised a number of secondments from different services and agencies. These included the local womens centre, substance misuse provider, the youth offending team, the speech and language therapy team and the police service. They then tried to broaden the net when recruiting band 5 nurses in order to hire people with more diverse skills and experience. They wanted to make sure they could accommodate people with a wide range of vulnerabilities. The Wakefield service is not based within a health trust which as meant one of the issues was recruitment. They found it very difficult to recruit nursing staff into the team because they cannot employ them directly (it has to be on a secondment basis). However, this arrangement forced the service to think more widely. As the manager of the team, you have been tasked as one of your responsibilities, to devise strategies to make resources available to ensure the health and wellbeing of diverse service users.

Question 1b: Discuss some of the complex challenges and opportunities of multidisciplinary working - with particularly emphasis on the distinct cultural communities in our society and explain how these factors may influence the decisions managers and multidisciplinary teams when making decisions such as formulating budgets and the impact that the identified challenges could have on the delivery of effective healthcare services.

LO2. Evaluate the factors that influence the decisions managers and multidisciplinary teams make in formulating budgets.

For higher marks student need to discuss some issues of inter-agency working such as:

• Legal duties and forced partnerships
• Reimbursement and hospital discharge as an example of forced partnership
• Accountability and risk
• Working through partner agencies
• Staying focused on service users

You may also consider some disadvantages of disadvantages of multidisciplinary working.

For higher marks students need to show good budgeting skill by describing the budget process including but not limited to:

• Review of previous performance
• Setting goal
• Identify income
• Identify expenditure and approval for best outcome for service users
• Examine various sources of funding/income (at least 3)