The Lambeth Living Well Collaborative was established in 2010 and is a platform of partners aiming to radically improve the outcomes experienced by people with severe and enduring mental health problems. It involves citizens, mental health service users, peer supporters, commissioners, the voluntary sector, and health and social care staff.
It was set up in response to challenges facing the borough including: poor outcomes experienced by people with serious mental health problems; concern that the system of care was overly medical and too dependent upon hospital beds; and signs that support was not being provided early enough to avoid crises. There have also been significant funding reductions, especially in social care (40% reductions from 2014/15).
In response to this significant range of challenges, partners in Lambeth realised that they needed to transform from a crisis-dominated system and focus more on prevention and early intervention. It took nearly four years for the scheme to take full effect in the system.
The commissioners used methods such as asset mapping to build a more collaborative approach. They also used an alliance contracting model. Out of this they have developed a series of services including peer support services, a Community Options Team, and the Living Well Network - a new ‘front door' to the mental health system.
Lambeth gave no new additional budget to the Collaborative. It was all funded through existing commissioning budgets. Some services which were not working effectively were cancelled and their funding re-commissioned to newly co-produced services.
The Lambeth Living Well Network has received over 1,200 introductions (140 per month on average) which has resulted in a reduction of about 50% in monthly referrals to secondary care since November 2013. Over 60% of people who have been supported were previously not known to secondary care services. Over 500 people have been supported within the Community Options Team and Primary Care Support Service. Over 600 contacts have been made with the out of hours peer support service, Solidarity in a Crisis. Over 550 people have accessed Connect and Do, an initiative that focuses on building confidence and reducing social isolation.
Lambeth are reducing the number of acute beds being commissioned as they move away from a crisis orientated approach to one that focuses on early intervention and prevention. A £12 million budget that is currently spent on in-patient care, rehabilitation beds and residential care as part of the Integrated Personal Support Alliance is being completely recommissioned to focus on community based support and interventions through an alliance contract. Again, the projected outcomes of this are improvements for people with complex needs and financial savings of about 20% of the original budget.
Lessons learned:
- It can take time for the culture of co-production to develop and transform systems;
- Asset mapping and alliance contracting are effective methods for implementing co-production and could be used by both local and combined authorities at a range of scales;
- Co-production supports a focus on prevention which can lead to a reduction in expensive acute care;
- By moving to a person-centred form of health and social care, co-production is a good model to follow for devolved bodies who are integrating their health and social care.