Partners involved in this provider collaboration:
- Oxleas NHS Foundation Trust
- South London and Maudsley NHS Foundation Trust
- South West London and St George’s Mental Health NHS Trust
Background
The South London Mental Health and Community Partnership (SLP) is made up of three mental health trusts, they have around 12,000 staff between them working across a population of 3.6 million, spanning two ICSs and 12 London boroughs.
Setting up the partnership
The three trusts collaborate in a variety of informal and formal ways, including through a lead provider collaborative model. They established a committee in common in 2020 with chief executive-led portfolio boards for each of the SLP's programmes and dedicated clinical directors for each provider collaborative programme.
One of the SLP's priority areas for collaboration is the delivery of services that are part of the national NHS-led mental health provider collaborative programme. The SLP also has locally developed collaborative programmes focused on nursing workforce development, complex care, acute care pathways, and corporate services. These programmes have their own programme and/or clinical directors from one of the trusts, and a chief executive lead from a different trust, to ensure a sense of balance across the partnership.
Matthew Trainer is the chief executive of Oxleas NHS Foundation Trust and the senior responsible officer for the partnership's forensic services provider collaborative programme.
There has always been a small central function that is dedicated to the running of the partnership. Matthew highlights that it was essential that this small team had enough capacity and seniority to push the partnership's work forward and to build relationships where needed. It now includes a commissioning hub in order to help the SLP best manage the £100m specialised care budget and £35m of CCG complex care budgets it has been delegated to manage to date.
The impact of the partnership so far
For Matthew, one of the most positive impacts of the SLP’s work to date has been the improvements made in South London’s children and young people’s services. The trusts' use of children and young people's general adolescent beds has reduced by a third and the average distance of placements away from home has reduced on average from 73 miles to seven miles, thanks to the trusts working together.
They have also been able to reduce the number of forensic patients being sent out of area by a third and bring down the number of readmissions to forensic inpatient services by two thirds. More broadly, Matthew tells us the partnership has enabled the sharing of best practice between the three trusts and facilitated more joined up care for patients and service users across inpatient and community services in South London.
The SLP's work has also had a significant impact on workforce challenges facing the trusts. Its nursing development programme has resulted in a 5% increase in nurse retention rates. The partnership has also worked to develop shared career development pathways and a staff passport so that it is easier for staff to move between organisations and work more flexibly across South London.
All of this progress has meant the partnership has been able to reinvest £9m into the creation and delivery of new local care models to date – for example specialist community forensic services across South London and a new dialectical behaviour therapy service for children and young people at one of the trusts.
Matthew stresses the importance of providers being able to reinvest the savings made through collaborative working into genuinely new and improved services. This gives 'real-life' examples trusts can show to staff, patients and the local population more broadly in order to demonstrate the tangible difference this way of working is making.
Sharing lessons learned
Personal relationships between the chief executives of the three trusts, built on mutual trust and respect over several years, have inevitably been an important factor in the SLP's success to date. Strong leadership modelling from each of the three chief executives has also been vital, as they have made it clear to all staff that working collaboratively is important and needs to be prioritised.
The trusts' chief executives have also made a point of engaging with staff members' concerns about this new way of working – from the frontline right up to board level. For example, any rumours about mergers or politics stemming from new funding and commissioning responsibilities have been discussed openly and honestly. This approach has been equally important when it comes to engaging with key partners and stakeholders outside of the partnership. For example, the SLP had to work hard to allay concerns from some local authorities that the partnership's work might have undermined local NHS accountability and existing borough relationships.
Matthew also highlights the importance of the partnership's strong investment in staff, genuine clinical leadership from across the three trusts, and use of simple governance that "doesn't make life difficult for individual providers" and involves non-executive directors.
Being transparent about finances and resource allocation has been particularly important. Matthew explains that the SLP has a simple mechanism for reinvesting the surpluses it generates – the funding is split three ways, with an emphasis on "levelling up" any areas where this is needed between the three trusts first and foremost.
He also stresses that the three trusts working together and communicating more informally as "providers who collaborate" has been just as important as the work they do as a formal provider collaborative.
Challenges
The three trusts deliver services independently where it makes sense to, and Matthew emphasises how important it has been for the SLP to focus only on "work that could be done better together than one trust could do alone". He also stresses the value of the partnership's work being guided by three simple principles: care closer to home, better patient experience and outcomes, and better value for the NHS.
Matthew reflects, in particular, on the SLP's attempt to use a collaborative model to deliver a single adult inpatient service across South London. They realised very quickly that it was the wrong scale and type of service for this collaborative model because it is less specialist and has more links at place level than a children and young people's eating disorder or forensic service for example. The trusts are therefore working together to standardise their adult crisis and home treatment service specifications and use a shared clinical model across their own services instead.
A key lesson learned by the SLP was that organisations and individual teams need to understand and work through any cultural differences and incompatibilities. Matthew shares an example of when the SLP had to "wind back" and spend time working on bringing the culture of certain teams from different organisations closer together in order to make the progress the partnership has been able to make to date.
Matthew also stresses the importance of each partner in a collaborative working arrangement being willing to compromise in order to make broader, strategic long-term progress that benefits the local population as a whole. For example, Oxleas has invested significant amounts of funding into an assessment area in one of their local acute hospital's emergency departments to reduce long waits for patients with mental health needs, which has improved collaborative working between frontline staff and also enabled other endeavours to progress.
Next steps
Looking to the future, Matthew tells us that working out how the two ICSs and multiple provider collaboratives and places within each will interact with the SLP and its three constituent trusts is a key area of focus and needs to be well thought through.
Discussions are also now taking place between the partnership and its ICSs about taking on more day-to-day commissioning moving forwards. But Matthew was also keen to emphasise the importance of providers being given the time and support to consolidate the areas they have worked collaboratively on already, before expanding and taking on further opportunities.
National policy to support provider collaboration
Matthew has some concern about the number of different collaborative arrangements trusts could be involved in and the risk of complicated governance arrangements. Whilst the SLP’s governance has become more developed now that it holds formal contracts, Matthew stresses the importance of avoiding overly complex arrangements as much as possible, so as not to stifle innovation and the pace of delivery.
He was also keen to highlight that, whilst the SLP has worked well together when it comes to finances and resource allocation, their focus on targeting new investment to underfunded areas should not be a substitute for addressing any fundamental underfunding of services. Matthew tells us, "some services in South London have a threefold difference in per patient funding depending on the borough, and you can see the impact of this on the time people have to wait to access the care and support they need, and their outcomes."
More broadly, he is concerned about the risks of imposing a lead provider collaborative model onto areas as a "one size fits all model" where it may not make sense or have the right ingredients in place.