At Camden and Islington NHS Foundation Trust (C&I) we have worked in partnership with not-for-profit housing and support provider One Housing (OH) for more than six years. Our work together has developed some creative and ground-breaking responses to challenges faced by providers of complex mental health support services, both in terms of improving service user outcomes and as employers.
Our newly opened joint service with OH is a 24-bed residential care service for adults in Camden called Lime Tree Gardens (LTG). The service has been designed to meet the needs of service users coming from long-term inpatient wards and other more restrictive services, people who are vulnerable and have very complex mental, physical and social needs. The 24-hour on-site team consists of four C&I employed nurses sub-contracted, like a secondment, into a co-designed structure of housing and support staff directly employed by OH and further C&I-provided psychiatry, psychology and therapeutic expertise. Structuring the team in this way has enabled OH to overcome the difficulty that residential and nursing care providers have in recruiting nurses directly, which has made schemes offered by some providers elsewhere unviable. Our model is one possible solution to this challenge that the wider sector could consider and, at LTG, has resulted in a unique offer to service users – a move to independent accommodation while maintaining levels of contact with C&I’s high quality clinical, therapeutic and care services that best meet their needs.
The integrated team at LTG offer interventions, such as working to involve service users in groups and developing social networks, that have a strong focus on social inclusion, goal setting and developing life skills in steps. C&I have a commitment to helping our service users connect in the local community to support their recovery. Our strong alliance with OH at LTG is a good practical example of how we are working to achieve this goal. Though still very early days for LTG (the service officially opened in November 2017), 11 patients have either been discharged or are on leave there from C&I’s inpatient wards and rehabilitation units. Of this group, six service users had been in their most recent C&I placement for an average of over 3.5 years. Being able to move these individuals safely to LTG, which employs an ethos and staff team with significant C&I input, is prompting the Trust to consider further reconfiguration of our service pathways.
C&I’s strategic decision to expand our housing and support sector partnership into new, and larger-scale services like LTG has been informed by the positive service user outcomes, staffing, bed space and financial benefits of our Care Support Plus model services, also developed and delivered with OH. The first such service, Tile House in King’s Cross, opened in 2012 and has been widely recognised as offering an innovative approach to patient care that achieves excellent outcomes, most recently from the NHS Confederation Mental Health Network. They highlighted the service in their December 2017 ‘Innovation in housing, care and support’ briefing.
Tile House consists of 15 purpose-built one-bedroom flats, each fully equipped with a kitchen, bathroom and lounge area. There is a high-intensity level of staffing, with a 24/7 on-site presence, tailored to meet the specific needs of Tile House residents, many of whom have complex needs and face real challenges to living independent lives after many years of regular admission to mental health inpatient wards. What this means in practice is that the team supports services users to achieve their recovery goals and develop life skills, within their local community, when they’re doing well and respond to immediate clinical needs when they’re not doing so well. Key to the success of Tile House is that the multi-disciplinary team is fully integrated and managed under a shared governance framework. This ensures joint decision making about residents’ care and supports clinical confidence. The team comprises housing support staff and a clinical lead employed directly by OH, embedded clinical staff sub-contracted from C&I and further visiting C&I clinicians. Like LTG, this service structure has enabled OH to overcome any direct challenges of recruiting clinical staff and enables them to work with people with more complex needs than mainstream supported housing services can meet.
For service users, Tile House offers a safe alternative to people who might otherwise have long stays in hospital or other more restricted placements. In the wider mental and physical health economy, Tile House provides a less expensive alternative to, for example, long stays in hospital beds. Importantly, it reduces delayed discharge – or ‘bed blocking’ – of more acute services, ensuring these beds are available for people who need them. In 2016 we extended the same model into a second 12-bed new building on the King’s Cross site called Cliff Road, significantly expanding the capacity of our Care Support Plus services in response to local need.
Finally, from April 2018 a new service from the Highbury Grove Crisis House will be delivered with Look Ahead Care and Support, a new partner and another leading provider of specialist care, support and housing services. They already provide four other Crisis Houses in London and support over 6,500 people with diverse needs. At Highbury Grove, service users in a mental health crisis will be supported in a safe, therapeutic environment that offers a genuine alternative to hospital admission and step down from inpatient care. Service users will be supported to explore mental health treatment options and develop coping strategies and support networks to underpin their onward recovery journey. Peer-led activities, integrated with other community services in Islington will also be integral. As a short-term service, there will be a maximum stay of two weeks, with up to six weeks of aftercare in the community. C&I will be contracted to provide clinical input and gatekeeping to help ensure the service is accessed by, and meets the needs of, local people who will benefit most from the short-term services provided. Our role will also be to enhance linkage between the crisis house and local C&I-led services, sharing knowledge between clinical professionals and housing support staff to enhance everyone’s capacity to safely support users of the service. We anticipate that by working in close partnership with Look Ahead, this new service will reap some of the benefits outlined earlier, particularly around more efficient use of local bed space.
Housing sector providers are just one group of a number of partners that C&I is working with to improve our offer to patients and to link with a wider range of community services. For example, we also embed Hillside Clubhouse staff members on our sites to offer targeted employment support and in our experience, partnership has provided some effective responses to the challenges faced by users and providers of NHS mental health services. In the context of the continued financial, staffing and bed space pressures faced by the NHS, we also see partnership as a key element of addressing the challenges to come.