March 2011
Lambeth Living Well
Collaborative includes
membership from NHS
Lambeth, Lambeth Council,
South London and the Maudsley
NHS Foundation Trust, Lambeth
Community Health, voluntary
sector services and people who
use services and their carers.
Lambeth Living Well Collaborative
- A New Service Offer Executive Summary
This document sets out the vision and guiding principles which have
shaped the thinking of the Lambeth Living Well Collaborative. We have
come together to develop a radically different service offer for all people
with a diagnosis of serious and enduring mental illness resident in the
Lambeth Living Well area. This area has yet to be defined. Definition of
the area will require the building of a broad coalition with all publicly
funded services. This is because the effectiveness of our new service offer
will be greatly enhanced if citizens have access to all universal facilities
and services - and these are not within our gift.
Our new service offer has been born out of financial necessity but draws
on a long felt concern that despite the best intentions of each of the
services we represent, we do not meet all the hopes and needs of people
with serious mental illness. This means they are unable to lead the life
which as citizens of Lambeth they are entitled to lead.
We think the vision and guiding principles have wider applicability for all
citizens with a long term condition which affects either their physical
health or their mental health. This service offer accords well with the
values in the White Paper equality and excellence: Liberating the NHS
“We believe that the NHS is an integral part of the Big Society,
reflecting social solidarity of shared access to collective
healthcare, and a shared responsibility to use resources
effectively to deliver better health.”
“We want the principle of ‘shared decision-making to become
the norm: no decision about me without me’. International
evidence shows that involving patients in their care and
treatment improves their health outcomes, boosts their
satisfaction with services received, and increases not just their
knowledge and understanding of their health status but also
their adherence to a chosen treatment. It can also bring
significant reductions in cost, and improve the management of
long term conditions.”
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We are now using this document, and the accompanying leaflet which
describes the offer in more detail, to share our thinking with you and hope
you will join us in tackling the social injustice which people with a
diagnosis of serious mental illness suffer. If we work together we can
improve the opportunities and services which will enable people with a
long term condition to lead the life they are entitled as citizens of Lambeth
to lead.
Who are we?
We are a group of commissioners, providers of health and social care
services and service users and carers. We provide these services for, to
and with people when they have a diagnosis of severe mental illness. We
comprise organisations from statutory [GP/primary, community and
secondary NHS and local authority] and voluntary sectors. We recognise
that we are a small but representative sample brought together by the
Commissioners to develop a radically new service offer.
The Collaborative is strengthened by the participation of Vital Link (user
and carer engagement body) together with some of their members who
are experts by experience. Their valuable contribution is not a substitute
for full engagement and involvement of people who use our services and
their carers in developing the designs and plans for service change.
We welcome the involvement of commissioners [health and social care]
and recognise that they have set the conditions for us to do something
different. The conditions include a commitment to a much more flexible
approach to commissioning for outcomes rather than inputs. In proposing
the establishment of the Collaborative they have been brave in inviting us
to develop a different way of working and service offer. In that context
we have taken it as our responsibility as providers to be brave and
develop that radically different offer.
The involvement of Lambeth Council is crucial because the people who will
co-produce our new service offer with us are citizens of Lambeth. Citizens
have rights and responsibilities; see themselves as part of society and
work to create the life they want to lead. Citizens are not permanently in
the care of any organisation,rather they access services and facilities as
they need to and are expected to contribute to society as well as benefit
from what it has to offer.
We have been invited to be a demonstration site as part of the Lambeth
Council’s Commission into The Co-operative Council – a new settlement
between citizens and public services; A new approach to public service
delivery.
What was our task?
Our Commissioners invited us to develop a radically different service offer
which costs less than they currently spend and which is based on the
principles of rebalancing public services and civil society and co-production
– where public services are transacted through an equal and reciprocal
relationship between professionals and people using services, their
families and neighbours.
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Our new service offer includes a focus on prevention and population-wide
promotion of mental wellbeing which will ultimately improve the life
outcomes and reduce the expenditure in the Lambeth Living Well Area.
Delivering our vision will require the full engagement of all the publicly
funded services within the Lambeth Living Well area. As a first step we
are developing a new service offer for citizens with the long term condition
called serious and enduring mental illness. However it will be essential
that we rapidly build the broad coalition of all the other universal
opportunities and services which are the vital underpinning to our offer.
Whilst this offer has been built up around the needs and current service
provision for people with serious mental illness, we see it as being equally
applicable for people with any long term condition. By providing equity of
approach we feel it is possible to start to tackle the stigma and
discrimination which people with this particular long term condition suffer.
We feel that developing a radically new service offer for people with the
long term condition serious mental illness provides a challenging test bed
for this new collaborative approach. This is because they suffer social
injustice and we are committed to tackling it as part of the new offer. For
example they are frequently in poor physical health, live in poor housing,
connect with the criminal justice system in inappropriate ways, are
without paid employment or other meaningful daily activity and
stigmatised and discriminated against in social settings. We recognise
that it is these wider determinants of mental health and wellbeing,
including social inequality and exclusion that will be impacting negatively
on citizen’s chances of flourishing and living the life they want to live.
We initially came together in two facilitated scenario events in March and
May 2010. We decided to then give ourselves not much more than a
month to produce this new service offer and met weekly as a measure of
our commitment to work closely together. We agreed to each take
responsibility for discussing our new collaborative service offer within our
organisations – particularly with those who would be affected by the
proposal.
Our New Service Offer
We have produced a separate leaflet which sets out the detail of our
Lambeth Living Well Collaborative Offer.
The diagram below sets out the overall concept of our Offer. Its purpose
is to support and enable people with a diagnosis of severe and enduring
mental illness to contribute to society and to benefit from the universal
services which all citizens can enjoy.
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Living Well Collaborative Offer
al
ers
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i
Un
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ice
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Civil society
opportunities
Commissioning
Criminal Justice
system
GP’s
Time Banking
Community
Services
COLLABORATIVE OFFER
SLaM
Individual
Third Sector
Southside &
First Step Trust
COLLABORATIVE OFFER
Employment
Opportunities
Service Users
Housing
Council Social
Care
Commissioning
Leisure
opportunities
Lambeth Living Well Collaborative - New Service Offer.
Education
system
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ervic
S
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a
ers
Univ
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March 2011
Outline of the service offer (March 2011)
The service offer has been implemented incrementally from late January
2011 and comprises the following elements
• ‘Easy in, easy out’ arrangements for all services focused on
supporting recovery and independence
• Easier access to secondary care assessment and treatment (SLaM);
support for primary care including link workers ; easier access back
in should users require this ; improved discharge arrangements
• A resource information service – both virtual and physical (at the
refurbished Effra Centre from October 2011) to support patients,
carers and providers; Lambeth MIND Information service from Jan
2011
• Personal guide/community recovery workers within the Voluntary
sector
• Capacity for primary care and GPs to support and manage mental
health patients including easier access to social and community
support options (from April 2011)
• Peer support services led by service users
• Promoting social inclusion through various means including time
banking (currently located at Paxton Green practice and the former
Clapham park estate initiative) and volunteering.
As of March 2011 the offer has been targeted at 12 of the 52 primary care
practices within Lambeth. The plan is that this will be rolled out across the
whole borough during 2011-12.
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Annex A – Vision, Guiding Principles and Outcomes
Our Vision
Our Vision is that the Lambeth Living Well Area will provide the context
within which every citizen whatever their abilities or disabilities, can
flourish, contribute to society and lead the life they want to lead. This
requires taking a Total Place approach because the wider determinants of
health have the most significant impact on health outcomes. As a health,
social care and wellbeing collaborative our focus is on supporting a
particular cohort of people to build personal resilience and communitybased interdependence. This will enable them to minimise the occasions
when they are languishing and suffer the detrimental impact of poor
health, within the context of their long term condition.
Components which will encourage the successful implementation of our
Vision include

Rebalancing what the State does and what Civil Society does.

Encouraging the use of co-production as the operating system for
many parts of the provider system. This requires the development
of a culture and skill base of all staff so that people feel listened to,
validated as individuals and encouraged to identify their assets,
contributions, needs and hopes.

Enabling professionals/paid staff to ask for reciprocity from the
people who use their services to encourage the building of
community connection and resilience.

Establishing a network of community based time banks across the
area for all local citizens to give and receive help and support and
thus develop a strong resilient community infrastructure; time
banks which operate from the evidenced-based understanding of
five ways to well being.

Establishing mechanisms within specialist time banks where people
who are assessed as being entitled to individual budgets can
contribute both time and money to the time bank to guarantee that
they can have specific help and services when they need them.

Clinical treatment services to be developed on an “easy out/easy in”
basis which will enable clinicians, carers and people who use
services to ‘let go’ as they will have confidence they can reconnect
if/when they need to. This approach to be extended to all parts of
the system.

Commissioners to reward collaboration and cross-referring amongst
providers to facilitate each provider doing what they are good at
rather than thinking they need to meet all the needs of the people
who use their particular specialist service.

Collaborating with local people, so that their experiences and voices
become used as one of the most valuable forms of evidence to
ground planning, delivery and evaluation.

Providers to work together to develop a virtual market place where
all service offers, including community-run services, are clearly
articulated and people are able to choose what they think is right
for them. A key service offer will be that of Personal Guide which
people could choose to use if they wanted help in understanding or
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



accessing the market place. All services will be “easy in/easy out”.
Personal Guiding as an approach is something which all parts of the
system will offer.
Develop the concept of time out space for people when they have
long term health problems to work through issues together with
their family and friends
Ensuring all publicly and community owned buildings and assets in
the Lambeth Living Well area are used optimally
Commissioners for the Lambeth Living Well area to identify about
six broad outcomes for 5, 10, 20, 60 years and ask that providers
work together to explain how these will be achieved. Long term
outcomes are essential if work on Prevention is to be prioritised.
The outcomes might be in the areas of e.g. crime reduction;
improvements in general health and wellbeing; better school grades;
parenting and health from -9 months to + 2 years; reducing
obesity in the under 5 years.
Providers to respond to these broad outcomes by proposing the
milestones and evaluation studies that will prove the changing
trajectories as a result of this radically different, trusting and
valuing approach.
What are our Guiding Principles?

We will design our new service offer on the principles of coproduction where citizens and providers jointly design and deliver
services – it is necessary for both to play their part for there to be a
service.

We will use our collective power to ensure that access to universal
services and facilities is enabled for all citizens with a diagnosis of
the long term condition, serious mental illness.

We will collaborate in encouraging the development of strong
resilient communities in the geographic area designated as the
Lambeth Living Well area.

We will design our service offer with a view to those who coproduce them with us being primarily viewed as citizens of Lambeth.
Citizens have rights and responsibilities; see themselves as part of
society and work to create the life they want to lead. Citizens are
not permanently ‘in the care’ of any organisation – rather they
access services and facilities as they need to and are expected to
contribute to society as well as benefit from what it has to offer.
Outcomes
Short term:
1000 people who currently receive care co-ordination from SLAM will
receive services which are more appropriate to their needs and more cost
effective. We will seek to develop the context in which people will be
confident in the availability of other supports and opportunities available
from their own resources, their friends and Civil Society and, if necessary,
from primary and community sector based services. The new service offer
will be “easy in/easy out” for all parts of the system. This will enable
people to have better life outcomes and experiences including being able
to contribute to society and to build the life they want to lead.
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It is our working assumption that not everyone currently receiving care
coordination services from SLaM will require “care coordination” in the
new model. They may wish to access a Personal Guide to help them
navigate the market place of offers or they may not wish to avail
themselves of any of the offers.
Longer term Outcomes – the ‘Big Three’
To enable people with mental health and complex life problems to
• Recover: & stay well (experience improved physical and mental health)
• Choose: make their own choices (experience increased self
determination and autonomy)
• Participate in daily life on an equal footing with others and specifically
– To 'connect' eg with family, friends, neighbours
– To 'give' in the community (eg community activities,
volunteering, peer support)
– To be included in society with reduced stigma & discrimination
(especially in relation to mainstream services eg education,
employment, adequate income and stable housing)
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Annex B – the Terms of Reference which guided our work as a
Collaborative
Lambeth Living Well Collaborative –
Terms of Reference June/July 2010
Our Collaborative Meetings
We are clear that we are a short term “good enough” group drawn
together by Commissioners to develop a radical offer. Once the offer is
developed it will be taken back to each organisation and more widely with
in the Borough – perhaps as part of the Cooperative Council development
work – to be developed and refined prior to moving to implementation
stage. As such we do not see the need for elaborate Terms of Reference.
We have also not diverted our attention by electing a chair – instead
asking David Monk to continue as an independent to chair and ensure
delivery of our short term piece of work.
Principles of Communication
We think it is important that all members understand what is being
discussed and to that end straight forward language will be used.
Separate briefing sessions will occur between commissioners and Vital
Link members to ensure that there is an opportunity prior to the meeting
to fully understand the agenda and promote understanding.
Schedule of Meetings
Meetings will take place throughout June on:
Thursday
Thursday
Thursday
Thursday
10th June
17th June
24th June
1st July
All meetings will take place at Abbeyvilles Restaurant from 8.00-9.30.
At the last meeting the group will determine if further meetings are
necessary and agree a clear format and timetable. It is not envisaged that
this will be a long term working group.
[nb Further meetings then held on Thursday 15th and 22nd July and 5th
August. Agreement to work through the summer to continue to clarify the
Offer and to develop possible business models to underpin the
Collaborative.]
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Members of the Lambeth Living Well Collaborative
Name
Organisation
Adrian Mclachlan
GP
Practice Based Commissioning Collaborative
Aisling Duffy
Southside Partnership
Amanda Williams
Lambeth Community Health
Bill Tidman
Thames Reach
Ash Soni
NHS Lambeth PEC Chair / Pharmacist
David Monk (Facilitator)
Symmetric SD Ltd
Denis O’Rourke
NHS Lambeth, LBL Commissioning
Mark Bertram
SLaM/Vocational SErvices
Emilio Reyes
Vital Link - carer
Jim Hall Stevenson
Vital Link – service user
Karen Hooper
Vital Link - carer
Joiss Soumoharo
NHS Lambeth - primary care development)
Jonathan Bindman
Dr.
SLaM – Clinical Director
Ros Ramsay
SLaM – Con Pyschiatrist
Nicholas Campbell-Watts
Southside Partnership - Fanon
Lucas Teague
Vital Link coordinator
Patrick Gillespie
SLaM – Service Director
Ray Walsh
GP
Practice Based Commissioning Collaborative
Richard Williams
GP
NHS Lambeth
Ronnie Wilson
First Step Trust
Sarah Corlett
NHS Lambeth, Public Health
Susan Field
PCT/Lambeth Council, Commissioning)
Tom Craig
Prof.
SLaM/Institute of Psychiatry
Simon Froud
Lambeth Council – Adult Social care
Zoë Reed
SLaM – Executive Director
NB updated May 31 2011
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Annex C – Definitions of underpinning themes
Theme 1: Total Place
Total Place provides ‘a real opportunity to rip up the text book and
redesign the way public services are planned and delivered’
Total place weaves together counting, culture and customer needs
1. Counting; mapping what we spend, in total, across the whole
range of public sector budgets in a single geographical area –
looking for overlap and inefficiency
2. Culture; describing the way in which we currently do things –
looking for common sense ways of doing them differently
3. Customer needs; using the insight of consumers to bring fresh
ideas to how we design the way we ‘do things’
Theme 2: Co-production
Co-production means delivering public services in an equal and
reciprocal relationship between professionals and people using
services, their families and neighbours.
Work being undertaken by the NESTA/nef Innovation Lab over the past
few months has identified practical working examples of co-production
within public services and has identified 6 themes which make them
successful
1.
Building on people’s existing capabilities – Altering the
delivery model of public services from a deficient approach to
one that provides opportunities to recognise and grow people’s
capabilities and actively supports them to put these to use with
individuals and communities.
2.
Mutuality and reciprocity
Offering participants a range of incentives which enable people
to work in reciprocal relationships with professionals and with
each other, where they have mutual responsibilities and
expectations.
3.
Peer support networks
Engaging peer and personal networks alongside professionals as
the best way of transferring knowledge and supporting change.
4.
Blurring distinctions
Blurring the distinction between professionals and recipients,
and between producers and consumers of services, by
reconfiguring the way services are developed and delivered.
5.
Facilitating rather than delivering
Enabling public service agencies to become catalysts and
facilitators of change rather than central providers of services
themselves.
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6.
Recognising people as assets
Transforming the perception of people from passive recipients of
services and burdens on the system into one where they are
equal partners in designing and delivering services.
If the new idea has a core then the idea of ‘exchange’ is at its heart. Most
importantly colleagues [at our March 2010 event] described a system
within which we build on the notion of individual Time Banking 1 and
extending this to whole organisations and communities. In essence the
following captures this idea
“Encouraging the use of time banking [based on the core values including
taking an asset-based approach and reciprocity] as the operating system
across the provider system”.
Theme 3: Rebalancing the role of the State and Civil Society
We are at a watershed in terms of the relationship between state and civil
society. A variety of interlinking issues – the rise of welfarism as an
unintended consequence of the post war Beveridge settlement; the
introduction of markets into the relationship between state and civil
society; the lack of money for the state to support initiatives; the
widespread cynicism about the state and its probity and effectiveness; the
inexorable rise of voice and choice and the demand for ever more
personalised services; the evolution of citizens into consumers – mean we
are now at a crisis in the relationship.
This points to a smaller, more strategic state, enabling, not prescribing,
action and setting permissive, not restrictive, legislation. The response of
Civil Society may well be patchy. In places where there is a rich tradition
of philanthropy and civil action there will be relatively straightforward
transition. However in other places, most critically, in areas of high
deprivation, there is a deficit in the capacity of Civil Society to
respond. This will require more nuanced approaches to rebalancing the
relationship, and the state may well be required to play an enabling
role. In Lambeth this may well take the form of an exploration of more
varied mutual and co-operative ways of the state and Civil Society
working together.
However the transition takes place it is certain that an irreversible change
is underway. In twenty years time we will have a smaller state and we
will have more activity driven by Civil Society - more local, more personal,
more connected and more varied.
Theme 4: Language
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Language may not always seem central or relevant and focussing on it can
sometimes divert people from the central challenge of driving through
change.
However having said this there is clearly a fundamental need to establish
a new narrative that is the real deal when establishing the new service
framework and integrated offering. In particular participants embraced the
following

Taking the ‘mental’ out of ‘mental health’ – the focus is
improving the well being of the community

Focus on neighbourhoods/community development - away from
medical model of ‘treatment’ to wellbeing, personal ownership
and recovery
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Annex D – Ways of operating as a Collaborative
Ways of behaving – our commitments
We have developed a number of commitments as to the way we will
behave as a collaborative to ensure that we continuously focus on the
needs and wishes of citizens when they use our services. These include:
 We will exercise reciprocity between ourselves. This means we will
expect to give and receive – to trade expertise; knowledge of research
and evidence of what works; space; resources and other assets.
 We will work from the assumption that each organisation involved in
the Collaborative has something to share and something to improve.
Managing the money flows – Collaborative Contracting
We are exploring possible mechanisms to ensure that our agreed ways of
behaving carry through into the way the money moves around the system
and looking at possible models including:
- Alliance contracting
- Collaborative Advantage
- Joint venture
Alliance Contracting
In New Zealand a group of providers and commissioners are developing a
contractual framework called alliance contracting which will be considered.
Collaborative Advantage
We are also exploring the work around collaborative advantage and set
out below a brief description of this approach.
Collaborative advantage2 is a term to describe where partners, rather than
focusing solely on e.g. legal and financial benefits and risks, recognise
that partnerships are living systems with humans in them and need to be
cultivated. The full benefits of partnerships are realised through building
trusting relationships.
‘…smart managers know that alliances involve much more. Like human
relationships, business partnerships are living systems that have endless
possibilities. And companies that know how to tap those possibilities and
manage alliances effectively have a key corporate asset’
The slide is from the work of the Marmot Review team (Fair Society,
Health Lives. February 20103,4 )
2
Moss Kanter R. Collaborative Advantage: The Art of Alliances. Harvard Business
Review. 1994, July-August.
http://mis.postech.ac.kr/board/upload_data/global/CollabAdvantage.pdf
3 Main site for Marmot Review http://www.ucl.ac.uk/gheg/marmotreview
4 Launch of Marmot Review; presentations, podcasts and videos (easier to look at!)
http://www.marmot-review.org.uk/
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The conclusion of the research in this field is:
 nurture, nurture, nurture partnerships
 recognise the complex balance between outcomes, processes,
milestones, recognition and pride
 success is a matter of perspective and never absolute
 stories of success may derive from realistic expectations
The risks to success of such approaches are fairly obvious when systems
are under severe financial constraint however maintaining a focus on
collaborative advantage (i.e. recognising the partnership process as
contributing value in itself as well as a means to and end) is a means to
overcome some of the negatives and preserve, protect and promote the
longer term added social value of what is being ‘produced’.
Taking the work forward
It is our intention, as a “good enough” collaborative of organisations and
individuals to develop a Lambeth Living Well Collaborative Agreement as a
worked through model.
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