Lambeth Living Well
The Living Well UK programme has its origins in Lambeth, south east London, where, in 2010, a ‘Collaborative’ of people who use services, carers, NHS commissioners, Lambeth Council, voluntary and community sector, secondary care and primary care came together to try to ‘turn the system on its head’, by moving energy and resource from secondary care to primary and community settings.
They wanted to make it much easier for people to get help where and when they need it; make it much easier for people to get help where and when they need it; focus on people’s assets and strengths; and blend medical/clinical support with social offers that address the wider determinants of ill health.
Lambeth Living Well is a whole-system approach to commissioning, developing and providing services which has has co-production at its heart. The support provided helps those with mental health problems to recover and stay well, make their own choices and participate on an equal footing in society.
Living Well system features:
Outcomes
Are accountable for people centred outcomes that promote choice, recovery and citizenship
Access
Provide timely access
to support where it
is needed
Citizens
See people as citizens within communities, rather than ‘patients’ or ‘professionals’
Collaboration
Work collaboratively and flatten hierarchies
Voice
Put the voice of lived experience at the centre of services and the system
Strengths
Work holistically,
building up and on
people’s strengths
Networks
Activate supportive
social networks
Learning
Having permission to test and learn together
The Collaborative reframed the purpose of the system away from treating a subset of the population with diagnosed mental illness, towards creating a world where “every citizen, whatever their abilities or disabilities, can flourish, contribute to society and lead the life they want to lead”. This radical new vision spoke for all Lambeth residents, and even now it is a vision that anyone, wherever we live or work, can feel motivated by, whether or not we have a diagnosis.
The Collaborative itself expresses a relational response to the challenge of meeting mental health needs. Rather than clinical experts devising and delivering mental health treatments and services behind closed doors and in silo, the Collaborative worked as a platform in which relationships between people from different parts of the system could be used as the foundation for learning, co-designing and developing new models, initially the Living Well Network Hub.
And the method chosen for developing new models was prototyping, which enables quick cycles of doing and learning in order to evolve and improve practice and that builds on insights about what people actually need and want. Unlike piloting, prototyping reflects an understanding that in order to truly evolve effective models of support, the voice of people with lived experience has to be at the centre, and, just as importantly, practitioners wanting to better respond to need have to stay in connection, in relation to those voices.
This approach moved practice away from a way of working founded on assessing people against predefined categories of need and prescribing predefined treatments, to a relationship of co-production; where individuals are seen as unique and complex, and where support is tailored and evolved in collaboration with the person, practitioners and their community.
Through the use of story gathering and telling, co-design and prototyping, Lambeth was, in turn, able to start to evolve towards a more relational system. One of Lambeth’s “big 3 outcomes” over the last 10+ years has been to support its citizens to “participate in daily life on an equal footing with others”, by connecting with friends and family, volunteering in the community, and by being included in society, free from stigma and discrimination.
All of this is opposite to a mechanistic response to mental health that ‘others’ you and your mental health needs, and does not see the whole person and the full complexity of their lives.
The difference it makes
Number of people who
need support and are
getting it
Waiting times
at the front door
Number of people supported on a pathway to work
Referrals to secondary care mental health teams
Number of people using a personal budget to improve their wellbeing
Average cost of support
pro capita
"The Living Well Network Hub did in two weeks what others had been trying to do for two-and-a-half years."
- Bill, service user
From the evaluation
-
A 25% reduction in referrals to secondary care mental health teams and a 27% reduction in secondary care caseloads since its introduction
A Hub evaluation dated September 2017 found:
-
Reduced waiting times for support at the front door - from within one month to within one week
-
A reduction in the average (mean) cost of support per person. The average (mean) cost per person introduced to the Hub was £76. Making
comparisons with nationally published costs, this suggests that for many people the Hub is likely to offer a relatively lower cost (and high volume) alternative for support
-
An increase in the number of people receiving support: 500 people were supported by the Hub each month, whereas
previously only those eligible
for input from secondary care would have received help
-
An increase in the number of people who were able to access mental health support in primary care. In its third year of operation the Hub supported 6388 people (against its original target of 1500)
-
An increase in the number of people who self-introduced from 4% in year one to 11% in year three
-
16% of service users in complex care placements were supported on a pathway to work (2+ hours)
-
19% of people in placements were supported to use a personal budget to improve their wellbeing