Inspired by the values of Lambeth’s Co-operative council, the biggest innovation has been a transformation of the commissioning approach. The council and CCG has joined forces with providers, including excellent organisations like South London and Maudsley NHS Trust and community support provider Certitude, in an ‘Alliance Contract’. Pioneered in the construction industry, this approach radically re-writes the purchaser-provider relationship. Instead of being focused on existing assets or activity (such as secure residential settings or clinics), contract incentives (both the ‘gain’ as well as the ‘pain’) are focused on the rehabilitation and recovery of service users themselves. Thanks to the alliance structure, all partners in the Integrated Personal Support Alliance (IPSA) now have an equal financial stake in getting – and then keeping – people well.
Guided by the Lambeth Living Well Collaborative, a collective led by users of mental health services and including carers, GPs and providers working with council and the CCG since 2010, commissioning has been turned on its head. Where in the past service users were often treated at the point that their condition became a serious problem and frequently placed in expensive residential care, now the Living Well Network gives service users a voice before their problems become too serious.
The Living Well Network, at the instigation of service users, is investing significantly more in prevention via our Network Hub and community prevention programme. There is Mosaic’s Living Well ‘Clubhouse’ in Brixton, where people can go if they feel they might have a mental health issue or may be referred by GPs or other professionals giving opportunities for peer-to-peer conversations, advice and an understanding of what is available to help. New crisis services – with peer support a key feature – have also been launched.
The Living Well Network also provides earlier support and a ‘front door’ to mental health services for people with everyday needs. To encourage people to seek earlier help, the decision was made to remove eligibility criteria and introduce ‘self-introduction’. This shift towards a more preventative approach has produced impressive results. The number of referrals to secondary care per month has fallen by 43 per cent and there has been a marked increase in the number of people accessing support. And we have been able to begin addressing the debilitating over-representation of BME populations in our mental health system via our new Black Thrive partnership.
The approach is now being formalised into a £63.8m whole system alliance, comprising all the Council and CCG mental health services into an alliance contract, with the new agreement expected to be in place by April 2018. The aim is firmly focused on preventing people developing mental health problems and to treat them early when they do.
Service users have wanted this change but it has not been easy to achieve. Providers have been able to change their business models in radical ways to meet shifts in service need and priorities across the borough. Change has been hard won. Hopefully Lambeth is a lesson for the next Labour government about how we can put people in control and focus on outcomes when we deliver mental health care.To find out more about the Fabian Society’s health network contact: firstname.lastname@example.org