The success of collaboratives in bringing care close to home has been enabled by several factors: a cycle of success breeding success, devolved responsibility for budgets and care pathways, the power of partnerships, and patient voice at the heart of design and delivery. These are detailed below.
Success breeding success
Mental health provider collaboratives have demonstrated the impact and benefit of working at scale. Successes in bringing care closer to home and improving outcomes for patients have built confidence from key stakeholders, including trust boards, systems and regions, and encouraged further innovation and improvement. For example, the South London Mental Health and Community Partnership (SLP) demonstrated significant success over its first five years: a 60% reduction in forensic patients out of area, 50% reduction in CAMHS patients out of area and in private sector beds, and a 74% reduction in complex care patients out of area or private sector beds. As a result, the collaborative's ICBs and six local authorities were confident to transfer commissioning budgets for complex care placements to SLP, bringing investment into community rehabilitation units to enable patients to receive a community-based offer.
This pattern of success has been the case for many MHLDA provider collaboratives. By taking on devolved management of budgets and resources, mental health providers are effectively supporting some of the most vulnerable patients in their systems. They have successfully demonstrated positive outcomes and the capability to transform services.
Devolved responsibility for budgets and care pathways
The commissioning and contractual arrangements in use by mental health provider collaboratives support investment in community-based services. The lead provider model allows provider collaboratives to take on some planning, improvement and monitoring functions which previously sat with NHS England. This enables trusts’ clinical and operational teams to play a bigger role in planning and improving services.
For example, by managing budgets locally and making savings, SLP has been able to invest in local services designed to improve patient experience and shift capacity towards community-based and preventative services. These include expanding a community forensic outreach service, launching a new community forensic support service, and investing in a partnership programme to support complex care patients.
Mental health provider collaboratives are demonstrating the impact of devolving budgets to drive transformation and enabling specialist care to be provided in the community.
The power of partnerships
Mental health provider collaboratives are leading the way in formalising partnerships with non-NHS partners. Many involve a range of partners from ICBs, the voluntary sector, and independent sector providers, as well as working closely with local government.
The Reach Out provider collaborative in the West Midlands includes St Andrew's Healthcare, a charity providing specialist mental healthcare, as a founding member. By involving all providers across the region, the collaborative delivers local integrated pathways, minimises unnecessary variation, addresses inequalities, and improves patient outcomes and experience.
The SLP complex care programme has involved local authority partners to support patients with complex needs. Bringing together health and social care budgets has enabled investment in a community accommodation facility in partnership with a specialist third sector housing partner. Working in partnership with local organisations including social enterprises and charities is key to supporting the shift to more community-based care, enabling local provision to be tailored to local needs.
Patient voice at the heart of design and delivery
Another key component supporting mental health provider collaboratives to build capacity in the community is the involvement of people with lived experience. Bringing in experts by experience and clinicians was one of the original principles underpinning the mental health collaborative model. Both collaboratives featured in this report have ensured that service users were involved from the outset of new programmes and approaches. This involvement ensures that community provision is appropriate for patients and their recovery.
The Reach Out provider collaborative has employed ex-service users as peer support workers to support current patients through their recovery and transition to community care. The peer support workers are involved in designing, planning and delivering support and education for recovery. They support newly discharged service users through community drop-in groups, and help current service users with advice about supported accommodation and building links with the local community.
Similar approaches have been used by other collaboratives, demonstrating how involving service users and members of the community can help ensure care is tailored to prevention and recovery.