- What is an alliance contract?
An alliance contract is a contractual arrangement between commissioner(s) and a group of organisations who deliver a project or service. There is a single contract between all parties, which means that everyone works to the same outcomes and success is judged on overall performance rather than the performance of individual parties.
For more information on alliances, see http://lhalliances.org.uk/
- Why are we using alliance contracting in Lambeth?
There are a number of reasons why we think that alliance contracting will benefit Lambeth and why it is suitable for mental health services. These include:
- Alliancing aligns providers on outcomes. In an alliance structure, providers are collectively accountable for delivering the contract outcomes, with financial risks and rewards shared based on collective performance. This means that all parties are encouraged to focus on what is best for the system and the user, rather than what is best for each individual provider.
- Alliancing gives an equal role to all partners. Alliancing uses ‘unanimous decision making’, which means that all partners within the alliance – whether commissioner or provider, large or small – have an equal role. Structures like this, which recognise and value the contribution of all members, have been important in driving change in Lambeth, such as through the Lambeth Collaborative.
- Lambeth has already tested out the use of alliancing through the Integrated Personalised Support Alliance (IPSA). The IPSA initiative has used an alliance contract for mental health rehabilitation services in Lambeth. This has been a positive experience, encouraging collaboration between providers and allowing for the development of a radical service model that has had marked benefits for service users. This would not have been possible without the cultural and behavioural changes that were driven by an alliance structure. Lambeth now wants to apply the learning and experience from IPSA across a broader scale.
- How many providers will be members of the LWN Alliance?
Lambeth CCG and Council envisage that the LWN Alliance will be made up of 7 – 8 members, including the Council and CCG as commissioners. This means that 5 – 6 providers are expected to become members of the LWN Alliance.
- What is the proposed contractual term?
The contract term will be for 7 – 10 years. This is a major change from the annual contract negotiations or short 2 – 3 year contracts to which providers are often accustomed. This longer contract term should allow the partnerships between providers to mature so that they are able to focus on delivery of the outcomes and innovation in transforming care.
- What will the contractual value be?
The large majority of investment in adult mental health across the CCG and Council will be included in the LWN Alliance. This means that the proposed total funding for the first year of the contract in 2018/19 will be within the range of £62million – £65million. Over the rest of the contract, this yearly total will change, as it is expected that there will be an overall reduction in the annual funding envelope of the order of 15% over the lifetime of the contract.
- What services will be included?
As the large majority of investment in adult mental health will be included in the LWN Alliance, most adult mental health services in Lambeth will be included, such as:
- Mental health information and advice provision
- Adult mental health secondary care services provided in Lambeth, including all inpatient and community care
- Living Well Network Hub service
- Improving Access to Psychological Therapies (IAPT)
- Enhanced primary care offer (GP Plus)
- Mental health rehabilitation services (Integrated Personalised Support Alliance)
- Mental health social work
- Supported housing services and domiciliary care
- Supported employment services
- Crisis support
- Peer support
- Early discharge services
Mental health advocacy services will not be included in the alliance as it is important that these remain independent service provision.
- What about Children and Young People’s services, Older Adults’ services and Addicitions services?
Children and Adolescent Mental Health Services (CAMHS), Older Adults’ services and Addictions services are currently not planned to be included in the LWN Alliance. However, we recognise that there are significant interdependencies between these services and adult mental health services. As such, the LWN Alliance will be expected to work closely with these services in order that people moving between them receive a co-ordinated and joined up care offer. Furthermore, we expect the services included in the LWN Alliance to change and develop over time, therefore there may be scope to include these services in future if it is possible and deemed beneficial.
- What will be the role and responsibilities of LWN Alliance members?
Members of the LWN Alliance will enter into an alliance agreement for a period of 7 – 10 years. Alliance members will have a broad range of responsibilities, which include:
- Joint accountability for delivering outcomes
- Shared responsibility for service delivery
- Shared risk for financial performance
- Commitment to alliance principles
- Individual service contracts (statutory NHS requirement) which refer to alliance agreement scope and overall funding – ie. do not detail each member’s scope of work and remuneration
- Joint development and sign off of Service Operational Manual (policies and processes), delivery and financial plans and division of scope of work between alliance members
- What will be the role and responsibilities for other providers in Lambeth?
Mental health providers within the Living Well Network who are not alliance members will be network providers. We expect all network providers and their workforce, even though not part of the co-ordinating LWN Alliance, to share the alliance values and be connected and involved with developments. However, network providers’ roles will be different from those of alliance members, as outlined below:
- In time, network provider contracts novated or renewed as subcontracts to one of the LWN Alliance provider members
- Accountable for delivery of scope of work within their contract
- Set commercial and financial arrangements
- Adherence to the Alliance values and behaviours
- Meet standards for Alliance services as determined by the Alliance
- Input into whole system design activities
- What will happen to existing service contracts?
Living Well Network provider contracts are in the process of being extended until 31 March 2018 at a minimum, with the LWN Alliance expected to commence in April 2018. Once the Alliance is live, it will be expected to review the contracts for all services within its remit. Where appropriate, and agreed by all including the commissioners, contracts will be novated or renewed as subcontracts to one of the LWN Alliance provider members.
Over the lifetime of the LWN Alliance, there are likely to be requirements for new services and discontinuation of others. This may involve increasing investment in certain services and reducing spend in others, depending on performance. The LWN Alliance will have collective responsibility for decisions, acting at all times to maximise achievement of the outcomes and in accordance with the Alliance principles.
- When will the procurement process for the LWN Alliance take place?
We have commenced a procurement process to identify the provider group to join with Lambeth Council and Lambeth CCG to form the LWN Alliance. We expect to identify a preferred provider group by November 2017, with the contract set to go live in April 2018.
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