The Role of Nursing Homes for S117 in a Changing Health and Social Care System by Shrien Dewani

By: Shrien Dewani    

As we approach three decades as a family organisation in social care, we have been taking time to reflect, not nostalgically, but purposefully. Thirty years offers perspective.   It brings us back to a fundamental question - what are we here to accomplish for the people who choose to make one of our communities their home? 

Social care is not a static sector. It adapts, absorbs, expands, contracts, and reshapes itself in response to forces often beyond its control. Decisions about community hospitals, discharge pathways, commissioning priorities, and referral routes continually redefine the role of care providers. And yet, amid this constant flux, nursing homes remain one of the most crucial, yet least understood, pillars of the system.    

Group Living: A Decision Often Made in Times of Vulnerability  

I start from a realistic, human position, group living is rarely someone’s first choice.  

Most people move into a nursing home at a moment of acute need, a crisis, a decline, a hospital admission, or a sudden change in safety or cognition. It is less often part of a long-term plan, as it might have been a generation ago. This reality makes our responsibility even greater, to ensure that when people arrive, often at their lowest point, they enter an environment capable not just of keeping them safe, but of helping them stabilise, heal, and rediscover a sense of self.    

A System that Shifts, and an Industry Expected to Absorb the Shock    

Today, nursing homes often function as extensions of NHS (National Health Service) discharge pathways.  

We frequently receive individuals stepping down from acute hospitals, Pathway 2, Pathway 3, or long-stay mental health wards, whose next chapter depends heavily on the skill, stability and culture of the community they enter.  

For providers like us, who specialise in supporting people living with complex behavioural and psychological distress, this includes many individuals entitled to after-care under Section 117 (Section 117 after-care supports people who have been detained under the Mental Health Act, ensuring they receive ongoing support in the community). These are some of the most vulnerable members of our society. They deserve a system that does not simply discharge them, but transitions them into a home that can understand, respond, and walk alongside them with dignity.  

 Historically, 117 discharges were supported by robust MDT processes, clear information flow, and time for planning. As pressures on all agencies have intensified, these structures have become strained. Information is thinner. Assessments are quicker. Risk is higher. Professionals try their very best, but the system they are operating in is stretched.  

This is where nursing homes must step forward with clarity of purpose.  

The Work That Matters Most  

In our organisation, the work around complex mental health, trauma, risk and recovery is among the most meaningful we do. Not because it is easy, but because when the system is at its most fragile, people need communities that are at their strongest.  

Supporting individuals who have experienced long hospital stays or compulsory treatment requires:  

• Environments designed to reduce distress and increase autonomy  

• Teams trained deeply in human behaviour, trauma and psychological need  

• Governance structures that protect rights, voice, safety and progression  

• Multi-disciplinary partnership that is proactive, not transactional  

• A culture that sees the person, not the label  

This cares at its most human.  

A Shared Aspiration for 2026   

Looking forward, one of our organisational priorities is to work with our NHS and local authority partners to strengthen the way Section 117 after-care is commissioned, delivered, and sustained.  

Our vision is simple:  

To create safe, evidence-based, genuinely therapeutic community services for people stepping down from hospital, where aftercare is not just provided, but lived.  

We want to co-design services where:  

• Information flows freely and early  

• Risks are shared, not passed  

• Recovery is personalised  

• Teams are trained for complexity, not overwhelmed by it  

• People move not into “placements”, but into belonging  

We invite commissioners, clinicians, psychologists, social workers, and advocates to connect with us, challenge us, and partner with us. We believe that Section 117 services can be among the most hopeful spaces in social care, places where individuals rediscover trust, stability, and direction. But that can only be achieved through genuine collaboration. 

Why Nursing Homes Still Matter  

In a health and social care system that is constantly shifting, nursing homes remain one of the few places where individuals can receive consistent, relational, human-shaped support.   

We are not extensions of hospitals. 

We are not holding areas between decisions.  

We are not the fallback in a pressured system.  

We are communities.  

We are households.  

We are homes.  

And for thousands of people every year, particularly those leaving hospital after complex experiences, we are the bridge between survival and recovery.  

The future of S117 services depends on stronger relationships, clearer communication, and shared responsibility, not isolated decision-making.  

That responsibility is enormous.  

And it is one we are honoured to hold.