by Linda Hutchinson |
Following the success of Lambeth’s first alliance in mental health, Lambeth Council and CCG took the bold step of creating an alliance for all mental health services and support in Lambeth. Working with many of the same team from the first alliance, LH Alliances again provided alliance facilitation services throughout the development phases.
Lambeth Council and CCG had a positive experience of alliancing with the Integrated Personalised Support Alliance (IPSA). The IPSA had been a big success and Lambeth were keen to spread the alliance way of working to other areas. The IPSA provided services and support to people with severe and enduring mental illness. The Living Well Alliance has been set up to provide services and support to all those with mental distress.
The Living Well Network Alliance has responsibility for all adult mental health support and services in Lambeth. This covers prevention, early intervention and support as well as all clinical and inpatient services. It incorporated the previous alliance, IPSA, for those with severe and enduring mental illness and the Living Well Network Hub and related services. These had been running for about two years and had already helped reduce the number of referrals to secondary care services while increasing the number of people who were given support.
The Living Well Network Alliance has the same members as IPSA. Alongside the Council and CCG as commissioners, there are four providers; a mental health trust, adult social care and two charities. The Alliance went live in July 2018.
Updates on progress are available on the Lambeth Together website
LH Alliances provided advice and facilitation throughout. We joined the commissioner’s project team and helped with drafting the scope and proposition documents as well as the Alliance Agreement. We attended meetings of the shadow Alliance Leadership Team in the months leading up to the launch.
“I have been delighted to work with LH Alliances on our journey in Lambeth. Linda has shared her expertise and knowledge on the principles underpinning and behaviours supporting alliances. She provided excellent support and facilitation for key partnership meetings. She provided very helpful ‘critical friend’ challenge to us as commissioners at key points in our journey towards agreeing our first Integrated Support Alliance and our larger more complex Living Well Network Alliance. She and Robert Breedon also provided high quality, timely written materials including the Alliance Agreements and supporting schedules for both our alliances reflecting the negotiations between partners.
Our choice to work with LH Alliances on a number of occasions reflects the quality of the work and the strong relationships and facilitation Linda and team have offered in the development of our alliances.”
Moira McGrath, Director of Integrated Commissioning (Adults), NHS Lambeth CCG & London Borough of Lambeth
By 2016, the first alliance in Lambeth was up and running and doing well. Lambeth’s mental health commissioner, Denis O’Rourke was keen to start working through how alliancing could be applied to all mental health services. Graham Tuohey of LH Alliances gave some initial support and in August 2016, Linda Hutchinson joined the project.
The main issues in the design of the alliance strategy were the financial elements and the impacts on local providers, especially the mental health trust. This meant a lot of preparation work and discussions with senior leaders to ensure people felt the proposed alliance was beneficial for them.
In addition, NHS England commenced their Independent Support and Assurance Process for complex contracts and we needed to ensure we kept NHS England updated and informed and took on board their feedback.
Lambeth Council and CCG issued an open Expression of Interest Notice to test market interest in the proposition. They asked for expressions of interest from groups of providers who were interested in bidding once the invitation to tender was issued. As only one credible expression of interest was received, they decided to proceed to direct negotiation with that group, publishing a Voluntary Ex Ante Transparency notice to that effect.
The group was made up of those who were already members of IPSA so all had good experience of alliancing. The negotiation moved to a shared task of developing a robust delivery and financial plan for the first 2 years of the contract. This took several months and many iterations as the size of the funding allocation and the ambition for change needed to be reconciled.
Shadow governance was set up in autumn 2017 and together, the alliance members took responsibility for developing the plans. An independent chair was identified although a permanent chair was not in place until just prior to the launch in July 2018.
The appointment of the Alliance Director was pivotal. He brought leadership to the developing alliance and, along with colleagues from each of the member organisations, was able to inject pace and detail to the various plans and policies.
A specific feature of the Living Well Network Alliance is the range of existing subcontractors. These include housing, employment services and other organisations. Understandably they were keen to know how decisions about commissioning their services would work in the future. The members of the alliance spent time considering how they would collectively make decisions, the criteria against how decisions would be made and the associated risks.
The new alliance went live in July 2018. This was 3 months later than had first been planned, the time used to ensure the Board of the mental health trust was fully informed and supportive of the alliance and their role.
The contract is for seven years with an option for a further three years. The annual funding allocation is around £55million.
LH Alliances was the delivery partner throughout