Live Well Kent

Most of this case study was compiled in April 2020. There is an updated section at the end.

Overview

Live Well Kent (LWK) is a county-wide free service to help residents over 17 improve their mental and physical health and wellbeing. Under-17s are supported through Children’s Service Commissioners; Kent County Council is working to increase the coordination between these services. It takes a person-centred approach to helping residents build their best possible lives. This involves identifying and tackling barriers to personal success – whether this is in housing, employment or other aspects or their lives. Services are provided by an extensive network of community organisations, coordinated by two strategic partners, within a single framework. If appropriate, the strategic partners can provide one-to-one support from an individual support worker.

How and why the programme was constructed

This is very different from the system in Kent four to five years ago. Then, the County Council issued around 60 grants to the voluntary and community sector each year. These were issued on a basis which only considered the needs of each organisation in isolation. This hampered an assessment of the service through Key Performance Indicators (KPIs) but also seemed likely to represent poor value for money.

Kent wanted a much more joined up service that provided wrap-around support to its residents. The council embarked on a one-year consultation period to determine what this would look like. At first, this caused considerable consternation among those receiving grants, suspicious that services and their funding might be cut. The council therefore devoted time and effort to working with existing providers and the wider market, and undertaking further consultation, to develop a service-user driven model. This was helpful as providers were able to contribute detailed knowledge which helped the council understand what was possible. The model adopted was a two-stage one: strategic partners would be commissioned by the council, who would then commission services from other organisations. To ensure that a wide network of organisations would be involved, the council put a limit on the percentage of the service that the strategic partners could themselves provide. (This was a percentage of the value of the contract.)

The council identified possible strategic partners and invited them to make offers. The county was divided into four areas for this purpose, based on CCG areas. Two strategic partners were commissioned: the Shaw Trust covers two of the four areas and Porchlight covers the other two. It was actually the strategic partners, in partnership with service users, who proposed the name Live Well Kent and put together the service’s website.

No wrong door for an upward path

The service has been run as a partnership with the CCGs, using a joint pot of funding. (Note added June 2021: there is now just a single CCG for the area, Kent and Medway CCG). The main aim is to help people to remain well or stable, or move on an upward path, not a downward one. The programme therefore looks to prevent the use of expensive/specialist care services, to improve health and care outcomes, prevent relapse, crises and suicide and aid recovery, and to improve outcomes such as housing and employment. They have a “no wrong door” approach: anyone can access it through any of the organisations in the network, although it is recognised that most participants will get involved as the result of a referral by a health or care professional. Indeed, there are links with One You Kent, the local implementation of PHE’s One You programme: if some approaches One You Kent for smoking cessation or alcohol abuse, a Making Every Contact Count (MECC) assessment may signpost them to LWK. (LWK also has MECC assessments so signposting can go in either direction.)

Participants and their experiences

Data at the start of the programme categorised potential participants into those with Common Mental Illnesses (such as depression and anxiety) and those with Severe Mental Illnesses (such as schizophrenia or psychosis). The data suggested that most of the provision would be for the former group. However, there have been more participants with Severe Mental Illnesses than expected. (Indeed, consideration is being given to whether this is the most appropriate categorisation for the programme.)

The stories of some participants are shared on the LWK website[1]. Most of them speak of feeling isolated at home, not leaving the house. They often feel scared the first time they are asked to do so, but LWK ensures that once they take this step, they are in a friendly, supportive environment. Sometimes this is an activity group for their interest or hobby run by one of the network partners – such as cookery, painting, woodwork, gardening, music or board games – sometimes it is meeting a support worker in a local café. They grow in confidence, becoming more socially connected and eventually ambitious. Everyone finds their own unique pathway through this process over time – it is not mapped out at the start. Their descriptions of their experiences include:

• “I began feeling like part of the community again.”
• “Before working with the Community Inclusion Service, I did not trust people. Now I trust people easier and quicker.”
•  “Now, I have regained control of my life, regularly taking solo trips to the gym, swimming pool and more.”
•  “If you’d have said to me a year ago that I would be doing all of this, I wouldn’t have believed it. The person I am today is completely different from the person I was last year.”

They speak highly of the support workers and the activity groups, for example:

• “For the first time I felt like someone really cared. If my support worker said she’d do something, she would do it.”

• “…the Swale Your Way groups are always happy and it is contagious.”
• “SpeakUp CIC LGBT group has helped so much… the first thing they asked me was ‘how would you like to be known?’. That was so respectful and straight away I felt comfortable and like the people here understood me.”

Many have subsequently trained towards qualifications, started running groups themselves and/or started other volunteering such as mentoring – particularly in mental health, caring and other areas of healthcare.

Where relevant, participants are helped to apply for advocacy, such as for autism or deafness. There are also culture-specific services, for people from particular BAME and/or faith groups. Specific services to help with employment and housing are also provided in each area, by the strategic partners and others. The employment services can include, for example, job clubs and personal development courses, while the housing services can tackle such issues as rent/mortgage arrears, benefits and debt, homelessness, repairs, domestic violence, and drugs and alcohol.

In addition, LWK has an Innovation Fund dedicated to particular themes – last year it was carers; this year it is 17-25 year-olds.

How the programme has progressed and keys to its success

While the sign-up rate remains high for the programme, there is also a high rate of participants leaving the programme, as they have found themselves on an upward path and built up their resilience to the point that they do not need to continue in it. The offer to participants has also evolved over time as the providers have grown and adapted to this new environment. The strategic partners have built strong relationships with the delivery network, NHS Trusts and others, and Kent has learnt a lot from them.

To monitor the progress of the programme, Kent has performance trackers which are accompanied by quarterly narrative reports. These inform quarterly performance meetings with the strategic partners, a system that Kent has found works well. The performance trackers are based on a full set of KPIs, which were put together early on, but have evolved over time. A contract review has recently been completed.

A crucial factor in LWK’s success was allowing enough time for the initial stakeholder engagement. Providing clear, simple feedback at this stage, of the form “You said…, we did…”, helped alleviate the concern that is inevitable with any big change.

Update June 2021

From 1 April 2020, LWK has continued to support people aged 17+ across Kent with their mental health and wellbeing, while making some adaptions to follow the latest official advice and guidance on COVID 19. Staff mainly delivered support over the phone and online. Services utilised online chat forums so that they can deliver one-to-one and group support. More recently, the service has re-established face-to-face support following official advice and guidance. It is expected the service will continue to provide a blend of virtual and face to face support moving forward.

Indeed, the geographic coverage of the service has increased. Both Strategic Partners were approached by Kent and Medway CCG to look at expanding LWK into Medway based on the success of the Strategic Partner model and the value and positive contribution the service has had in Kent. Shaw Trust and Porchlight worked together on a joint Strategic Partner Proposal for Medway, which was approved by Kent and Medway CCG. Consultation with stakeholders and clients took place in the first three months of 2021, which informed a tendering process for a locally led funded network. The service went live in May 2021.