Faced with dismal outcomes in mental healthcare, the Lambeth CCG undertook a massive overhaul of its systems to create a new framework of outcomes focusing on the service users. Denis O’Rourke shares the learnings to help others drive a similar transformational change
In Lambeth, we realised a few years ago that despite the big efforts and money we were putting into mental healthcare – particularly acute care – we weren’t getting great health outcomes. Our rates for severe mental illness stayed among the highest in London.
Plus, we had poor housing and limited employment opportunities, which were impacting our ability to get people successfully back on track.
We saw we needed to drive fundamental change. So, we reframed the conversation around mental health to talk about the people who use our services rather than “cases” and “patients with a diagnosis”.
We created a new framework of outcomes that looked beyond the clinical results to how the people we help are regaining hope and connections and getting on with their lives. And we built a strong alliance among those involved in supporting local people with mental health issues.
We reframed the conversation around mental health to talk about the people who use our services rather than ’cases’ and ‘patients with a diagnosis’.
The work to date is driving better outcomes – supporting up to 400 people a month before they reach crisis point – having led to a 43 per cent reduction in referrals to secondary care and reducing waiting times.
We’re still some way from where we want to be, but feel we’ve learned a few important truths along the way which may help others looking to drive transformational change – in mental health and beyond.
Building collaborative relationships trumps everything. It doesn’t come easy. It requires a huge investment of time and trust, and letting go of old ways. Even more difficult, it requires all parties to rise above the short term interests of their organisation, strong leadership and brave conversations.
Investment in building strong relationships is the single most important thing that’s led to our new bold plan in Lambeth – to bring all spending for adult mental health under one contractual alliance agreement worth £600m over 10 years. As commissioners, we’ve had to learn to step back, enabling others to step up and helping us focus our energies to foster effective collaboration.
Building collaborative relationships requires a huge investment of time and trust, and letting go of old ways.
Alignment of agencies, professionals, users and carers on vision, outcomes and ways of working is essential. It demands constant renewal and a creative approach to bring people together to showcase, tell stories and inspire. Testing new approaches hasn’t come without its challenges to us, clinicians, managers, commissioners and even users of services.
We are continuously trialling new things with service users, and inviting clinical staff to work side by side with non-clinical professionals, often with a different culture, language and outlook. Yet, it is that willingness to get out of our silos and professional comfort zones that’s made the biggest difference.
NHS and the local government are not the entire system – VCS, housing and employment agencies and communities are just as important. It seems obvious at this stage and yet too often teams work alongside each other but with little understanding of each other’s skills and assets. Through the Lambeth Living Well Network Hub, we’ve proved that bringing teams and people together from all parts of the system to deliver on agreed outcomes increases connections, releases previously untapped talent and leads to better solutions.
We still have some way to go. Integrating our work with services, which are also a lifeline for our users – like addiction services – is still a pending task, as is connecting better with our new Local Care Networks.
It will take the application of a relentless approach to innovation, co-design, prototyping – all freed up from heavy statutory sector governance – to make a meaningful transformation a reality.
People and their support networks should form the bedrock of what we do. From how we design and organise services to how we deliver the support, we should consider people and their support networks.
In 2015, we started the Integrated Personal Support Alliance (IPSA) – a commercial alliance agreement between multiagency providers and commissioners – to radically transform the outcomes for 200 people with complex needs.
So far, around 75 of those 200 people are now living independently. IPSA also achieved savings of 20 per cent against the original £12m budget. And it has shown that using an asset based approach, starting from people’s strengths rather than shortcomings, really can pay off. Services, clinicians, professionals should be on tap, not on top!
We are a long way from ”transformation”. As a sector, we are some way off the type of game changing breakthrough we need. For a long time in Lambeth, we kept our promising new ways of working relatively under the radar. We piloted interventions, took one step at a time. This allowed us to move in a more agile and connected way, free from the weight of overgovernance.
However, it will take the application of a relentless approach to innovation, co-design, prototyping (including seizing the many opportunities that technology offers) – all freed up from heavy statutory sector governance – to make a meaningful transformation a reality.
Denis O’Rourke is assistant director, integrated commissioning in mental health, Lambeth CCG