Adult Mental Health Transformation in Lambeth via Alliancing February 2018
A Whole System Alliance Alliance structure ✓ Procurement process ✓ All providers encouraged to participate ✓ EU light touch regime since April 2016 requires ✓ market notification 7/8 core alliance members (including primary care, social care, VCS, secondary care & commissioner) ✓ Prior Information Notice (PIN) as Expression of ✓ Interest (EOI) – March 2017 (5 EOI received, only one Other providers will be network providers serious and credible from incumbent grouping) ✓ Enabling partners to support transformation ✓ First NHSE/I checkpoint meeting (1 of 3) held on ✓ Community, people who use services & family & carer 4 th July ’17, approval to proceed granted. voice ✓ VEAT notice served 14 July, closed 25 July 2017 ✓ Total adult mental health investment of ✓ Shadow Alliance board formed August 2017 c£68m ✓ ✓ Development/negotiation commenced 6 September 7 years plus option to extend to 10 years 2017 ✓ 14% savings required across years 1 – 7 ✓ April 2018 proposed contract commencement ✓ Pain and gain share c2.5 to 5%
An Alliance is… ▪ A vehicle to share risks, responsibilities and opportunities ▪ A way of working based on alignment around the outcomes and commitment to the principles and behaviours ▪ Not a legal entity; participants retain own identity and internal controls 3
Traditional contract Alliance Commissioner Commissioner P P Commissioner P P P P P P P P P P Alliance • • Separate contracts with each party One Agreement, one performance framework • • Separate drivers for each party Aligned objectives and shared risks • • Performance individually judged Success judged on overall performance • • Commissioner is the co-ordinator Shared co-ordination, collective accountability • • Provision made for dispute Expectation of trust • • Contracts based on tight specification Agreement describes outcomes • • Change not easily accommodated Change and innovation in delivery are expected 4
Lambeth Living Well Network Alliance Living Well Network Alliance Enabling Partner Provider Provider Provider Lambeth Living Well Collaborative Commissioner Provider Provider Enabling Partner Provider Provider Provider Provider Provider Network Providers 5
Whole System Outcomes Number Outcome Person Statement Big Three 1 Improve people's rating of their own mental health I feel that my mental health is better Increase the number of people able to access support in their own 2 homes I receive support in my own home as much as possible The support that I receive helps me to build up my confidence and independence so 3 Reduce the number of people becoming dependent on services that I don't become dependent on services 4 Reduce the number of people reaching crisis point I receive early support that helps me to avoid reaching crisis point Recovery and 5 Ensure that people in crisis receive appropriate support I am treated with dignity and respect when I experience mental health crisis Staying Well Reduce the premature mortality rate for people with mental health 6 issues I live equally as long as rest of the population Reduce the physical health issues experienced by people with 7 mental health issues I am supported to improve my physical health Reduce the stigma around mental health and increase awareness I feel comfortable to speak about my mental health and I know where to go if I 8 of available support need support Reduce the overrepresentation of black ethnic groups in acute Different ethnic groups in our communities are represented proportionately in 9 mental health services services across the system 10 Increase the range of care and support offers in Lambeth I can choose support that I feel is suitable for me from a range of different offers 11 Ensure that support is delivered in an asset-based way I receive support which builds upon my strengths, abilities and aspirations Own Choices Ensure that support and services are co-produced with people I feel that I have an active and equal role in the design and delivery of services as 12 using services well as equal, reciprocal relationships with those supporting me Increase the number of people living in places of their own 13 choosing I am able to live in a place of my own choosing Increase the number of people in or started on the pathway to 14 work I have a meaningful day-to-day role in society that suits me Participation 15 Increase the number of people with strong social networks I feel connected to and supported by other people in my community and networks Increase the number of carers feeling supported and involved in I feel sufficiently supported in my role as a carer and respected as key partner in 16 decision making decision making 17 Increase staff ability to innovate and influence change I feel empowered to influence change wherever I work in the system 18 Increase staff ability to do their jobs effectively I have the necessary tools, resources and training to carry out my role effectively 6
Our current resources in Lambeth Supported Living/Domiciliary Care Social Care Supporting People VCS IAPT + Primary Care Secondary Care IPSA Total Investment ~£68m
Service Transformation Work Community Placements (IPSA+) Remodelling of all community placements Integrated ‘front door’ across Lambeth based on Integration and learning from IPSA and alignment of all first expanding its scope access points to mental health services in 3 Elements Lambeth of Community Offer Acute Care Work to reduce delayed transfers of care and length Rapid crisis response of stay in secondary care, Targeted/intensive support Development of which are driving increased Remodelling of service offer coordinated service offer OBDs for people in the community, for crisis which is including review of range of available at all hours and community teams and offers a speedy function of care coordination response
Our brief in this initial design exercise was to define the key principles underpinning elements of the community offer. In particular, we focused on 3 priority areas: Priority 2: Improving targeted/specialist Priority 3 : Improving rapid response Priority 1 - Building an integrated and stronger ‘front door’ to mental care coordination for people who need more support, especially out of hours and intense/medium term support alternatives to bed admission health services (building on the Living Well Network Hub) What are we talking about? What are we talking about? What are we talking about? ● Services which are accessed after an ● Services which are accessed in a assessment has taken place and determined crisis/emergency situation. ● First points of access to services in support needs. ● Providing support in an emergency as routine circumstances. ● Longer term, more intensive support for more well as short term stabilisation. ● Services that provide assessment complex clinical or social issues. as well as short term, 'general' ● Care coordination. What’s not working? support offers. What’s not working? What’s not working? ● Too many episodes of crisis are treated as emergencies, meaning that too many ● Data suggests that currently, over 80% of the people find themselves in ● There are multiple entry points to people admitted to inpatient care are known to hospital-based care mental health services in Lambeth. mental health services, which indicates that ● Crisis response is not 24/7 This is confusing for service users the care and support provided to a number of Waiting times to be seen by secondary and inefficient for providers. people in the community is not having the services after a crisis desired impact. Black Wellbeing commission has ● There is duplication in service provision. flagged need for better crisis response ● Referral routes into CMHT services are as a priority complicated and confusing. 9
Describing the key functions 10
Describing the key functions 11
Describing the key functions 12
Describing the key functions 13
The Future System 14
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