• Can you implement changes to create a truly personalised experience for people with severe and enduring mental illness and at the same time have a 20% reduction in costs?
• Can you make a fourfold increase in the number of people getting early support for common problems of mental health with a modest injection of extra money?
• Can you reduce demand by removing eligibility criteria?

The London Borough of Lambeth has shown how. The Council and Clinical Commissioning Group (CCG) are prepared to do things differently. With providers also prepared to work together, they have demonstrated the power of collaboration.

The story goes back to 2010 with the creation of the Lambeth Living Well Collaborative. A group of people using services, carers, frontline professionals including GPs and commissioners started meeting fortnightly for breakfast. The meetings are in a local café which provides training and employment for people who have experienced adversity. The breakfasts continue to this day. Over the years, the group has created new ways of working, peer support, crisis lines, new employment and financial advice services. They also host events to hear from people about what would make services better.

Two larger scale projects have also been implemented.

Living Well Network

The Lambeth Living Well Network was formed in 2013 to provide earlier support to people with common mental health needs. It functions as a ‘front door’ to mental health services. The support it provides is holistic, asset-based , building on people’s strengths, skills, interests and connections within communities.

The Living Well Network has already achieved fantastic results:

• Referrals to secondary care services have reduced from 100 people per month to 20
• Around 400 people a month, many who would otherwise not have been eligible for services or had to wait a long time to access them, have accessed earlier appropriate support
• Waiting times for support from secondary care have been reduced from one month to one week
• Secondary care staff’s workloads have reduced so they are able to concentrate their time on those who need their specialist skills

A big part of the network’s success was removing the barrier of eligibility criteria. This was a bold move and one that made many across the system particularly nervous. The default in times of high demand is to tighten eligibility thresholds, not loosen them.
Yet by removing eligibility criteria and introducing ‘self introduction’, the Living Well Network has able to operate in a preventative capacity. This has led to an associated reduction in demand for more intensive and more costly care options.

Sometimes when you ask people what they’re interested in, they’re taken aback because they’ve never been asked that before

Vanessa – Clinical Expert Practitioner, Living Well Network

Integrated Personalised Support Alliance

Lambeth Council and CCG were keen to test out a more formal approach to build on the good progress being made with informal collaborations.

In April 2015 five organisations entered into an alliance contract, the Integrated Personalised Support Alliance (IPSA), to help people with serious mental illness to live in more independent accommodation within the community.

Their notable achievements include:

• So far 75 people have moved into new accommodation and away from long term rehabilitation centres
• New entries into residential care have been reduced by 67%
• The numbers of discharges from residential care have increased by 30%
• Towards the end of the second year, the running costs for this cohort of people have met the target 23% reduction.

The stories about people who have had their lives turned around as they or a family member have been able to live independently, often for the first time in many years, are truly inspiring. The IPSA ‘one year on’ report is here.

Tell them this is brilliant. I never thought this would happen. It’s a real achievement for me.

Bernadette – now in her own flat after spending most of her life in institutions, including prison and five different hospitals

The future

Lambeth has confirmed that alliance contracting is the right approach for them for collaborative commissioning. It drives true sharing of risk and responsibility for all the outcomes by all the players with shared accountability for the whole budget. This means that people don’t only focus on their area of work, they discuss, debate and then make decisions that are ‘best for service’ across all.

The collaborative environment means staff skills, expertise, perspectives are pooled and the result is greater than the sum of the parts. Staff work as a single team without changing employer; the alliance is a virtual organisation.

Lambeth are now planning to create a Living Well Network Alliance with responsibility for all mental health activity. In Our Plans for the Future, they describe how the new Alliance will incorporate the activities already in place and seek to drive further innovations to enable more personalised care and early intervention. Watch this space.

Photo by Leigh Cooper