Lambeth Mental Health Alliance

Lambeth CCG and Council have let an alliance contract for Integrated Personalised Support for those with severe and enduring mental health needs. They recast separate contracts into one, using a single pooled budget between commissioners. Having first worked with Lambeth in 2012, LH Alliances were delighted to be invited back to be their delivery partner for this exciting idevelopment.

Why alliance contracting was chosen

An alliancing approach fits with the ethos and values of the Lambeth Living Well (LLW) Collaborative. Set up in 2010, the LLW Collaborative brings together people using services, providers and commissioners to create ideas and plans for improving mental health services and support in Lambeth. New local initiatives have been implemented but to move to the next level of transformation, Lambeth CCG and Council felt that a formal change to contracting and financial arrangements was needed.

The alliance

The Integrated Personalised Support Alliance brings together four providers: a mental health trust, adult social care and two charitable organisations. They are now working together to provide a seamless service for those with severe and enduring mental illness. The common aim is to maximize people’s independence, participation and enable them to recover and stay well. The new service went live in April 2015.

What changed for people

The alliance has been very successful for achieving its objectives of improving people’s lives, reducing the need for residential placements and meeting the financial challenges.

For a summary of its first year (2015/16) see here

For a more recent update (published May 2018) see here

Our approach

LH Alliances provided advice and facilitation services to Lambeth Commissioners throughout the end to end process of setting up the new alliance. We helped shape the contracting and procurement strategy, defined the outcomes, facilitated early workshops and meetings of the new alliance and, together with our legal partners Wragge Lawrence Graham & Co, developed the contract.

“We could not have done this without Linda. From the beginning she advised us on the collaboration and alliance, always ready to help in person or by phone and in drafting and reviewing materials. It was great to have her attend project meetings to steer and coach us on changing the way we commission and contract. Her facilitation at key alliance workshops and meetings was vital in bringing us all together. Linda blends the ability to support and enable relationship building while also challenging us when appropriate.

Linda was trusted by everyone which meant she could be an independent negotiator for the final detail of the agreement. Managing everyone’s requests in a fair and transparent way for a multiparty contract is no mean feat.”

Denis O’Rourke, Assistant Director Integrated Commissioning, Lambeth CCG

Development of the Alliance

Readiness

In early 2014, the commissioners reviewed the best contracting and procurement approach for achieving their aims. Following an options appraisal, they selected an alliance contract.

It was important to base the whole development on a robust set of outcomes that represent value to those using services.

Lambeth Living Well Collaborative Three Big Outcomes:

To recover and stay well and experience greater quality of life with improved physical and mental heal
To make their own choices and achieve personal goals
Participate on an equal footing in daily life.

The Lambeth Living Well Collaborative had a series of ‘Three Big Outcomes’ that had guided their work from the outset. Sub areas and proposed measures were developed by the commissioners. The final outcome set also includes a measure of change of bed based to community activity as well as good practice in safety and safeguarding.

Other readiness work included defining the scope, funding envelope and proposed governance as well as developing the draft Alliance Agreement.

Alignment

In forming the alliance, Lambeth CCG and Council invited proposals from providers who had shown willingness to invest time and ideas to collaboration through the LLW Collaborative. Providers were asked to demonstrate how their organisations were aligned with the outcomes and how they would work collaboratively and in an integrated way.

The alliance members were confirmed in summer 2014 and, together with the commissioners, formed the Integrated Personalised Support (IPS) Alliance. A series of alignment workshops were held to focus on the relationships between members of the alliance and to gain a deep understanding of the contribution each can make. Ideas were shared about new ways of delivering services that move away from traditional silos.

Shadow governance was set up to finalise details of the outcome based contract and commercial arrangements and to undertake further design work of the new integrated service.

Design

The IPS Alliance Leadership Team worked through the final detail of the contract and the commercial arrangements. The performance and commercial framework is designed to maximise the ambition for a whole-system focus on improvement of people’s well-being and preventing people to go into crisis.

The IPS Alliance Management Team designed the new service model. It will deliver integrated care addressing accommodation, relationships and clinical care. The funding envelope set was very challenging so they had to be creative and innovative. The core Alliance Management Team were able to tap into the expertise of others around to help them.

After 8 months the Alliance Agreement and associated service contracts (needed to meet NHS Standard Contract requirements) were finalised and the Service Operations Manual with pathways, policies and other important operational matters was in place.

Implementation

The new service model went live on 1 April 2015. The contract is for 2 years with an option for a one year extension.

Members of the IPS Alliance

Lambeth CCG – lead commissioner
London Borough of Lambeth
South London and Maudsley NHS Foundation Trust
Southside Partnerships (part of Certitude)
Thames Reach
Adult Social Care (part of London Borough of Lambeth)

LH Alliances input

LH Alliances are the delivery partner throughout. Our role included:

Advisory

Facilitating option appraisal to help the commissioners choose the most appropriate contract and procurement route to achieve their objectives
Design of the provider selection process
Providing guidance on application of good practice NHS contracts standards
Assisting with drafting for approvals through CCG and Council governance

Facilitation

Facilitation of the process for the provider selection
Facilitation of alignment workshops to refocus existing commissioner-provider relations to move towards working as a cohesive group
Set-up of the shadow governance, re-enforcing collaborative decision-making and the core principles of ‘the alliance way of working’
Aid the engagement journey for development of the alliance, facilitating stakeholder events on alliances and alliance contracts

Delivery

Individual and team coaching for alliance way of working
Ensuring the contractual terms meet everyone’s agreement, including scope, key result areas and commercial arrangements
Managing the change control process for the contract negotiations, ensuring transparency of suggested changes and decision making through shadow governance – working with our team of subcontracted lawyers through LH Alliances, ensuring to minimise legal costs.