The South London and Maudsley NHS Foundation Trust (SLaM) has a rich and fascinating history. Despite numerous challenges, it has a bright future. I spent an invaluable morning with trust chief executive David Bradley and chair, Sir Norman Lamb, and with clinical and support staff, and was truly impressed.
SLaM is the largest mental health provider in the country, providing world-leading national services and driving internationally renowned research. SLaM has seen demand for its services grow rapidly over recent years, while resources and capacity haven’t kept pace. Local demand for mental health care is well above the national average, thanks to high levels of health inequality and an incredibly diverse population. Pressure on inpatient capacity means people can spend hours or days waiting for a mental health admission in the neighbouring emergency department.
Spending time on SLaM’s ES1-ward, an all-female paediatric intensive care unit in the Maudsley Hospital, really brought home staff pressures. I truly admired the resilience, patience and compassion of nursing and support staff I met, doing their best to provide care for highly vulnerable patients amid major workforce shortages.
The communities SLaM serves
SLaM serves a large and diverse population with significant minority ethnic communities, which experiences deep pockets of deprivation. Engagement with these communities has been a particular area of focus for the trust in recent years; the trust is a national pilot site for the new Patient and Carer Equity Framework (PCREF). Challenges with quality of care, human rights issues, high rates of restrictive care and worse outcomes for ethnic minority communities, particularly within the Black community, have had an impact on community relations. This issue, while not unique to SLaM, is prominent and vitally important for them.
The team at SLaM is committed to rebuilding trust with ethnic minority communities through innovative outreach work, such as the ground-breaking South London Listens programme, which is beginning to pay dividends.
At the same time, the fundamental mismatch between demand and supply and resulting strain on resources requires the team to think about how to deliver high-quality care more efficiently and effectively.
The strategy
The trust’s five-year strategic vision focuses on developing new prevention care pathways through a proactive approach to population health, suicide prevention, physical health checks and employment. The trust is actively engaging communities, narrowing health inequalities and improving mental health outcomes.
The trust’s clarity of vision here is striking. They work closely with partners across their ICS, including voluntary sector and faith groups, building relationships with communities, putting in place practical interventions. Through the South London Listens programme the trust has helped create over 50 Be Well Hubs and provided training to pastors in local Pentecostal churches to identify and address poor mental health in their congregations.
At the same time, SLaM’s learning from other mental health care systems internationally, such as the Trieste mental health system, a community-based model of social psychology where restraint is discouraged, while dialogue and social relationships are encouraged. Linked to the Trieste model, the Open Dialogue approach to treating psychosis encourages interpersonal relationships and promotes dialogue above restraint.
Building and growing
A real highlight of my visit was the new CAMHs unit in Camberwell, housed in the Pears Maudsley Centre for Children and Young People. This building replaces the existing 1920s unit.
It’s delivered by the King’s Maudsley Partnership, a collaboration between the Trust, King’s Institute of Psychiatry, Psychology and Neuroscience and the Maudsley Charity. It enables a substantial increase in capacity to meet demand for children’s mental health care, on an inpatient and outpatient basis, alongside the Maudsley and Bethlem Hospital School. It includes an important research facility offering co-location with clinical services, substantially reducing the time taken for research to become practice. With an eye on the future of the NHS, it was great to see high quality building of this nature.
Where next?
We can’t afford to overlook the massive pressures facing the mental health system, which have consequences for the rest of the NHS. SLaM’s leaders David and Norman are committed and focused on delivering change and improvement needed for their trust, and they’re fortunate to have the great staff I met.
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