The South London Mental Health and Community Partnership (SLP) is a mental health, learning disability and autism provider collaborative and programmes partnership which brings together south London's three mental health trusts: Oxleas NHS Foundation Trust, South London and Maudsley NHS Foundation Trust, and South West London and St George's Mental Health NHS Trust. The partnership, which formed in 2017, aims to make the best use of the resources available while providing better care for patients through working at scale across a 3.7 million population footprint.
The three trusts collaborate across a range of mental health, learning disability and autism programmes, ranging from child and adolescent services (CAMHS) to adult eating disorders, to acute care projects. Each of these programmes has a lead provider, and/or clinical director appointed from one of the trusts. However, key decision making takes place through a committee in common with representation from the boards of each provider including the three CEOs. This includes oversight of budgets, and commissioning decisions relating to specialised services, which the partnership oversees, as well as locally devolved budgets from the two integrated care boards and local authorities.
In the eight years since the partnership was formed, significant progress has already been made. Through their shared programmes the trusts have developed new models of care and clinical pathways by establishing new shared assessment standards and consistent access across south London. They have been able to move care closer to people’s homes, reduce the number of out of area placements, and shift inpatient care into community settings.
Bringing care closer to home
A particular area of success for the partnership has been to bring care closer to home for their patients and aiming for community-based care in the least restrictive environment possible – resulting in changes to how specialist services are provided, and care is delivered. The adult secure collaborative's work has reduced patients cared for out of area by 60%, while 50% fewer CAMHS patients are in out of area placements or in the independent sector.
The shift to care outside hospitals means there are now 24% fewer inpatient beds used by forensic patients, 31% fewer inpatient beds being used by adult eating disorder patients, and more people across all services supported by SLP programmes now being cared for in the community.
One particular programme, which SLP has developed, in partnership with the two ICBs (South East London and South West London) and 11 local authorities, has focused on improving the care for patients described by the CQC as 'funded and forgotten' (CQC, 2018) by stepping down care to local wards and community services.
The highly innovative, multi-partner Complex Care Programme (CCP) aims to place patients across south London in the most appropriate and least restrictive setting, as close to home as possible, and for each patient to have an outcomes-based care plan to meet their needs. The programme, which began in 2018, supports a cohort of people who have severe mental illness, the majority having a diagnosis of psychosis with significant comorbidities requiring placement or the need to access a funded placement (including private inpatient rehabilitation, residential, nursing or supported living placements). This cohort is eligible for Section 117 aftercare, some of which is fully NHS funded, while some is jointly funded by the NHS and social care.
The programme initially saw NHS-funded budgets for more than 450 people, mainly in inpatient settings, devolved to the CCP. Following the success of this phase, further ICB budgets - covering the NHS element of shared NHS-social care funding – were devolved. The current total of delegated budgets to the SLP CCP is £43 million.
By bringing these budgets together, the partnership has been able to develop and implement a new approach, creating a single point of access, a new centralised clinical assessment team, joint assessment panels and succeeding in moving a significant proportion of rehabilitation accommodation and services into the community, and investing in community-based initiatives including:
Two new 14-bedroom community rehabilitation facilities have been introduced, supporting patients stepping down from wards to community living more quickly and reducing overall length of stay. They are delivered in partnership with a specialist third party housing provider, and a further unit is planned, giving full south London coverage of this innovative new community housing. This out-of-hospital provision helps patients who require rehabilitation to avoid admission into restrictive inpatient care, which has previously often been provided out of area.
Three new teams dedicated to supporting complex emotional needs (CEN) patients, helping them to stay well within the community and avoid hospital admissions.
A new team delivering targeted intervention for patients with dual diagnosis of substance misuse. The team, which includes people with lived experience, supports recovery on SLP trusts’ inpatient rehabilitation wards.
In addition, investment has been made to train and employ peer support workers to help patients and families on the rehabilitation wards, including preparing for discharge and community-based living. Personal health budgets have been introduced for more than 60 patients, to give people more control over their care. And new NHS standard contracts have been put in place for all 'spot' placement providers, which enables robust quality and performance monitoring against agreed standards, maintaining care quality and consistency for all patients.
The percentage of people being treated through the CCP in their home borough has increased from 38% to 55%. The percentage of people cared for in south London (not out of area) has risen from 42% to 84%.
One example of the transformation to patient outcomes is a patient who had spent five years in a secure inpatient unit, before the CCP moved him onto a new proactive recovery-based pathway with supported community living support. He is now living in the community, with increased independence and quality of life.
The programme has seen improved patient reported outcome measure scores (PROMS) – with 80% of people saying their care has supported their recovery. Of the patients stepped down to less restrictive settings, 25% had been in restrictive inpatient care for more than three years, 33% are now in supported community living and 24% are at home or another local setting.
Overall, the trusts involved have seen utilisation of local inpatient rehab wards increased from 90% in 2021 to 100% in 2024 – making best use of available NHS resources and supporting capacity management. There are 75% fewer patients cared for in independent sector beds or out of area.
One of the guiding principles of all the partnership’s programmes, including the Complex Care Programme has been to bring care of the most vulnerable, complex patients back to south London. This includes new placements and 'repatriating' patients from often expensive out of area, private sector settings. This has been achieved alongside creating more local capacity to support patients with the most complex needs in the least restrictive settings, increasingly in community-based accommodation, with services delivered closer to home.