The voluntary sector – the secret weapon for integrated care?

Rethink Mental Illness' Beccy Wardle sheds light on Open Mental Health, an alliance of local voluntary organisations, the NHS and social care in Somerset working in partnership to ensure the residents get the support they need, when they need it.

When we think about the voluntary sector and its role in healthcare, it can sometimes feel quite different to the NHS and local authorities. But actually, it’s the voluntary, community and social enterprise sector’s (VCSE) breadth and diversity that make it a secret weapon for an integrated care system when addressing health inequalities at place level.

The joy of working in the voluntary sector is that no one organisation is the same as another and we all know our communities and cohorts of people so well. Getting the VCSE involved in delivering services on an equal footing is hard work, but the benefits are great.

Reaping benefits

In Somerset in 2019, we began discussing how we could improve the experience of people needing mental health services, planning care as a system across multiple organisations. Now, with the development of Open Mental Health, I simply can’t believe how far we’ve come.

Picture the scene: dozens of organisations attending meetings thinking of their own patients, residents or service users, own purpose and own aims and objectives. I like to think about it as each organisation having their arms held up around their models and ideas, as closely guarded secrets.

Now, no patient waits beyond four weeks for a mental health appointment and in that four weeks we ensure they are not left alone

And the scene now? Within Open Mental Health, we welcome one another like equals with collaboration rather than competition and the question of what will be best for the person on our lips – our arms are down. Now, no patient waits beyond four weeks for a mental health appointment and in that four weeks we ensure they are not left alone. They are always able to speak to somebody and have support any time of day or night.

From this point, the person can be cared for in many ways. It could be they need to be transferred through to the locality based Open Mental Health team, maybe even something more critical, or perhaps they need to go to one of our safe spaces, or maybe they need to speak to Age UK and organise some company if they feel lonely or isolated.

Tackling challenges

But getting to this stage was a long process. We had to join up NHS with council with multiple local charities and groups, with patient groups, GPs and all guided by people with lived experience of having to navigate these complex systems.

Here are some of the challenges we faced:

• The fragmented voluntary sector – as funding has historically been short term for voluntary and community sector groups, it has been quite competitive and commercially minded, not playing well into collaborative efforts.
• Culture – there are big differences between the VCS, health and social care sectors and this can lead to difficulty trusting and working together.
• Language – this has been a huge piece of work as we often use different words but mean the same things, and we have also found that traditional service language can end up driving a model and can be a block to transformation. For example, the word ‘referral’ speaks of barriers between different parts of the system.
• Honesty – coming back to shared principles has been key and where we have been able to let down our guard and share the good and the bad without blame we have had the best outcomes.
• Co-production – service users have been at the heart of everything we’ve done, with our expert by experience leaders group key to all our decisions.
• Information governance – this has been a big key to change as we are developing a shared record which all partners can access equally.

Feeling like a real partner

We wanted to aim for one shared digital plan for a person, including support and recovery planning. Using a digital platform called Black Pear, which integrates with Rio and EMIS, this shared patient record can be seen and contributed to by all partners. It’s been key to equity as it would have been much simpler to exclude the voluntary and community sector to read but not write status. Instead, we made a point of doing the extra work it took to allow the sector to work like and feel like a real partner.

With our Somerset Open Mental Health Alliance, we have the hardware of a contract but the software of an alliance

Another benefit has been getting the smaller local charities involved. Often entering an NHS contract may not be something a smaller charity feels comfortable with, but partnering with a larger charity who can take the financial responsibility enables them to take part. For the NHS it can be challenging to hold many contracts with smaller charities, but with our Somerset Open Mental Health Alliance, we have the hardware of a contract but the software of an alliance.

All partners have committed to shared guiding principles, including fostering a culture of openness, transparency and learning and agreeing that communication is the key to success. We have governance and agreements that underpin this, but it was important to ensure that we didn't inadvertently exclude smaller organisations by introducing lots of complicated governance structures right at the start. Relationships and building of trust have been crucial and a commitment to taking the time for this from NHS, VCSE and social care has been key to our success.

Doing our best for the people of Somerset

Between April and September, the support line took over 12,500 calls and we managed to stand up a 24/7 service in just eight days after COVID-19 struck. Our teams are currently mainly virtual, with discussions including psychologists, nurses, older person’s specialists, citizen’s advice, recovery and wellbeing workers, peer support workers, eating disorder specialists and many more.

We also have a realisation that mental health is not a one-off occurrence; a trip to the GP often won’t be enough. After a person is managing more independently, they’re likely to need more support to help keep them on track, whether that’s access to a friendly ear, an art class or a walking group. We call this the mental health ecosystem.

Our service isn’t perfect, and there will always be more work to do, but with the support of equals around us we’re doing our best for people in Somerset – we’re offering them not a series of individual offers but one offer with the best of everyone. We’re open for mental health in Somerset.

Becky Wardle is head of NHS Collaboration at Rethink Mental Illness. Follow her and the organisation on Twitter @Beccy_Rethink @Rethink_