The Plymouth Alliance

The neighbourhood

Plymouth is a coastal city on the south coast of England, 93 per cent of the population are white British, inequality is a significant challenge in the city, with life expectancy being over four years lower in some of the most deprived areas of the city compared to the least deprived areas.

Plymouth is a city of approximately 260,000 people, while the homeless population of Plymouth is estimated to be roughly 1,000 people. The model described here uses neighbourhood working to support the homeless population, but the individuals themselves may be mobile across a set of neighbourhoods.

The model is focused on supporting individuals with needs in relation to substance misuse and homelessness, mental health, offending and risk of exploitation. The Plymouth Alliance exemplifies how neighbourhood interventions can reach a demographic which is so often underserved by services that are not integrated.

The assets driving this model are the partners themselves, who have the levers required to resolve specific issues, but without alignment, they cannot support individuals in a holistic way.

The context

The vision of the Plymouth Alliance is to improve the lives of people with complex needs, supporting the whole person to meet their aspirations and to participate in and contribute to all aspects of life.

The alliance responds to multiple challenges in Plymouth, this case study focuses on increasing levels of single homeless people with complex needs in Plymouth, substance misuse and a lack of statutory services that can effectively work with these individuals.

The complex needs of this population requires a more integrated and holistic approach than is achievable through statutory or non-statutory services working alone; one which wraps services and community around an individual to resolve multiple concurrent issues.

The model

The work is commissioned by Plymouth City Council, and the alliance leadership team reports into Plymouth City Council. Sitting underneath the alliance leadership team is a wider integrated team and delivery teams.

The model is informed by extensive consultation with over 450 residents, service users, community leaders and statutory service leaders. It is a model thoroughly co-designed with the community and co-design sessions are revisited regularly.

The alliance structure involves community, NHS and local authority stakeholders. In decision making the council and NHS can and do get outvoted on some issues.

Participants in the model include local mental health services, housing services, GP practices, alcohol rehabilitation and VCSE organisations. The model is intended to break down the silos between these organisations.

The model is built upon three key principles: being connected, being asset-based, and listening. The person using the service is in control and will be listened to, the service will build from assets rather than deficits and the service connects itself around the individual being supported.

The alliance’s approach is founded on human learnings systems, which highlight the importance of allowing public sector staff to establish relationships with the people they serve as individuals, rather than relying on standardised processes.

Individuals can self-refer or be referred through multiple alternative referral routes.

Each user of the service receives a comprehensive asset-based needs assessment and the mobilisation of all partners to improve their health and wellbeing.

What makes this effective and resilient

The effectiveness and resilience of the model is underpinned by working as a team to wrap provision, support and services (both statutory and non-statutory) around an individual – based on the understanding that no one service can address the complex needs of the individuals served by the alliance.

The Plymouth Alliance is a radically different way of commissioning which is required to resolve complex issues with a person-centred, long-term and holistic approach.

The alliance is funded through a ten-year contract which began in 2019, ensuring the sustainability of the work up to 2029 and providing assurance to invest in building connections between partners.

The model has sustained multiple changes of leadership and has remained resilient through these, the relationships underpinning the alliance are strong and thoroughly embedded.

The constituent community groups of the alliance are united by a shared purpose and have fully adopted working as an alliance towards common goals.

The model holds building relationships, trust and learning from communities as paramount – this keeps the interventions and activities of the alliance firmly based on the needs of individuals they support rather than other priorities.

What makes this challenging

Inertia is the key barrier, a willingness to break out of existing areas of influence or budgetary control and work together to achieve outcomes is needed.

Current statutory service structures are not aligned to deliver for those with complex needs and it therefore takes time to adjust to a different way of working together.

Using centrally established quantitative proxy targets as the sole measure of what is 'good' can distract from the long-term outcomes.

Impact and outcomes

The alliance has a detailed list of performance measurements at an individual, population and wider system (impact on wider health and care infrastructure) level.

The most important measure is whether someone feels better or worse and this is the guiding principle of impact measurement.

In addition:

• 149 households were supported to access privately rented accommodation. 
• 127 customers accessed night shelter provision.
• 111 learners have achieved accredited qualifications. 
• 1,646 customers have had structured treatment plans.