North London NHS Forensic Collaborative

Key messages

• North London Forensic Collaborative (NLFC) is the largest specialist mental health collaborative in England covering a population of six million people across 19 local authorities.
• The aim of the collaborative is to ensure that people who access services experience high quality care, as close to home as possible, which is connected to their local community.
• Barnet, Enfield and Haringey Mental Health NHS Trust is the collaborative’s lead provider, with delegated responsibility from NHS England to lead on the strategy, finance, quality assurance and improvement of forensic mental health services for people who originate from North London. This is delivered through a commissioning hub team which facilitates the collaborative governance structure.
• The collaborative has staff professional and pathway groups with representation from each provider trust. A central element of their role is to problem solve as a system, by sharing best practice and learning.
• Patient involvement is central to how NLFC delivers its commissioning responsibilities. They have a patient council which represents the voices of inpatients and plays a leading role in the co-design of quality improvements and new service developments.
• The NLFC lived experience model is aimed at developing experts by experience in the community, representing the voices of the people who use community services, across the three specialist community forensic services.
• NLFC has a peer engagement worker team which includes five paid staff who have lived experience of forensic or inpatient mental health services, recruited to work alongside case managers in a quality assurance role.
• Since its inception in 2020, NLFC has delivered a programme of work aimed at achieving the national targets set out in the NHS Long Term Plan, with a specific focus on reducing the number of inpatient beds and creating specialist community services.
  This has resulted in a 60% reduction in the number of adult secure placements outside of London, and a 63% reduction in out of London placements for patients with a learning disability and autism).
• NLFC believes they have had the greatest impact in their community transformation work which has significantly reduced their reliance on inpatient beds, with a 12% reduction over the past three years. This has released funding which they have been able to reinvest into community services every year.
• NLFC has specialist forensic community teams across each integrated care system (ICS) for both adult secure patients and individuals with a learning disability or autism.
• By working from the ground up and staying true to their values and objectives, NLFC has engendered a culture of support and continuous improvement.
• Co-design and involvement of service users through the patient council and the peer engagement workers has helped ensure they are getting valuable feedback and getting things right.

Introduction

Area:

North Central London integrated care system (ICS), North East London ICS and North West London ICS.

Provider collaborative trusts:

North London Forensic Collaborative (NLFC) represents a partnership between the specialist forensic services of five NHS Trusts:

• Barnet, Enfield and Haringey Mental Health NHS Trust
• Central North-West London NHS Foundation Trust
• East London NHS Foundation Trust
• North-East London NHS Foundation Trust
• West London NHS Trust

NLFC also works with the Priory Enfield Hospital, an independent service provider.

NLFC Overview

NLFC is responsible for the commissioning and delivery of low and medium male and female secure inpatient services, male secure inpatient care for those with a learning disability and autistic people, in addition to the commissioning and delivery of community forensic services.

NLFC is the largest specialist mental health collaborative in England covering a population of six million people across 19 local authorities.

There are 652 low and medium secure inpatient beds within the provider collaborative. Specialist community forensic teams across all North London local authorities are aligned to the three ICSs in North London.

NLFC aims to ensure that people who access services experience high quality care, as close to home as possible, which is connected to their local community.

NLFC Strategic Priorities

There are four strategic priorities for NLFC:

• Ensure services meet the needs of the North London forensic population.
• Reduce reliance on inpatient services and invest in community-based models of care.
• Identify and address inequalities in access, experience and outcomes.
• Develop the NLFC governance structure devolving greater responsibility to staff, patients and carers.

Governance and leadership

Barnet, Enfield and Haringey Mental Health NHS Trust is the lead provider of North London Forensic Collaborative (NLFC) and has delegated responsibility from NHS England to lead on the strategy, finance, quality assurance and improvement of forensic mental health services for people who originate from North London. They employ a commissioning hub team which is a blend of clinical and non-clinical staff

The commissioning hub team facilitates the collaborative governance structure. This includes a partnership board, comprised of executive representatives from the providers and integrated care board representatives. The board is responsible for supporting NLFC to achieve its strategic aims, whilst ensuring joint ownership and alignment of its objectives between the individual provider trusts.

The board is supported by three sub-groups:

• Clinical and quality development group - comprised of the clinical directors from each provider trust. This focuses on quality improvements and service developments and has oversight of seven clinical networks.
• Finance and contract group – provides stewardship of the population-based budget and ensures compliance with provider standing financial instructions.
• Patient council - consists of inpatients from adult secure services in each of the five provider trusts.

Workstreams

Staff professional groups and pathway groups

North London Forensic Collaborative (NLFC) operates staff professional groups and pathway groups with membership from each provider trust. A central part of their role is to problem solve as a system, by sharing best practice and learning. This represents a significant shift in culture, where traditionally providers would work independently.

Professional groups and pathway groups identify and implement quality improvements and lead service redesign. A workplan is developed by each clinical network to deliver these changes which in turn, increases staff autonomy, supports team effectiveness and creates a sense of shared responsibility for addressing challenges at both a system and place level.

The professional groups and pathway groups include:

• psychological therapies professional group,
• allied health professionals group,
• nursing excellence and provider collaborative quality professional group,
• male clinical pathway group,
• women's clinical pathway group,
• learning disability and autism clinical pathway group,
• community clinical pathway group.

Improving patient flow programme

NLFC is pioneering a patient flow programme to prevent unnecessary delays to admission, enable patients to receive the right treatment at the right time and to reduce barriers and delays to discharge. The programme follows the Institute of Health Improvement model for quality improvement to address flow issues including admission processes, treatment pathways and barriers to discharge

Voluntary, community, faith, and social enterprise (VCFSE) sector small grants programme

The NLFC small grant programme for VCFSE groups based in North London offers funding to voluntary sector, faith, and grassroot organisations, to build relationships and work together to tackle inequalities and improve quality outcomes for forensic service users. VCFSE providers can request funding for up to £5,000 to deliver projects that will improve health and wellbeing, promote recovery and inclusion, and enhance quality of life for individuals accessing forensic services in the community.

Patient Grants Programme

The NLFC Patient Grants Programme is being launched in April 2024 in collaboration with the Allied health professionals group.

Grants will be offered to individuals in forensic services who have recently been discharged from inpatient adult secure services or are in the process of preparing for discharge to the community. The grants aim to help those who may need additional financial support to manage the transition and support better integration to the community.

Lived experience and co-production

Patient Council

Patient involvement is central to how North London Forensic Collaborative (NLFC) delivers its commissioning responsibilities. The patient council represents the voices of inpatients and plays a vital role in the co-design of quality improvements and new service developments.

Patient council members are provided with training and supervision, which can lead to a career pathway into peer engagement worker paid roles within the commissioning hub, as well as further expert by experience roles within the community.

A key achievement of the patient council has been the design and implementation of a patient led 'Speak up campaign' to support service users in raising concerns, to feel empowered to speak up and confident that any issues raised are taken seriously. A consultation took place to understand what could be done to support service users in the process of raising a concern and a key outcome of this has been the design and implementation of patient empowerment boxes, which are secure feedback boxes that will be visible on all our inpatient wards.

Peer Engagement Workers

The collaborative has a peer engagement worker team which includes five paid staff who have lived experience of forensic or inpatient mental health services, recruited to work alongside case managers in a quality assurance role. The team has recently been expanded to include a community peer engagement worker to extend this role across all inpatient and community services.

Using their lived experience, peer engagement workers build rapport with service users and gather important insights from wards. They also provide a strong communicative link between service users, providers and the commissioning hub. They are present on wards and in community teams speaking directly to patients about their care experience, to ensure that the voice of service users is central to all aspects of quality improvement and service development. Peer engagement workers also assist with reviews of restrictive interventions, conduct service reviews and report into contract meetings.

What their patient council and peer engagement workers say:

Learning disability and autism lived experience model

NLFC works in partnership with service users, providers and staff in its adult secure services to design, deliver and embed a user involvement model that empowers and elevates the voices of people who use services, ensuring that they are central to the way services are commissioned and quality assured.

By building on its existing expert by experience model within adult inpatient secure settings, NLFC is creating a lived experience model for learning disability and autism inpatient and community services. To support this process, the commissioning hub is working collaboratively with a multi specialist partnership of organisations offering a depth of experience in designing and delivering peer roles, leading national best practice in co-production and embedding lasting transformation in the NHS that centres on lived experience.

Learning events

NLFC encourages continuous professional learning and development of its workforce. Staff professional groups and pathway groups hold one learning event per annuum to share good practice, evidence-based research on delivering forensic mental health services, and innovative approaches for supporting the differing needs of its service users. Patients and experts by experience are also supported to co-present their work and achievements at learning events.

The learning events are consistently popular with an attendance of 450 plus forensic mental health staff during the last year.

Positive change and impact

Reducing inpatient bed use and out of area placements

Since its inception in 2020, North London Forensic Collaborative (NLFC) has delivered a programme of work aimed at achieving the national targets set out in the NHS Long Term Plan with a specific focus on reducing the number of inpatient beds and creating specialist community services.

This has resulted in a 60% reduction in the number of adult secure placements outside of London, and a 63% reduction in out of London placements for patients with a learning disability and autism.

NLFC leadership team believe they have had the greatest impact in their community transformation work which has significantly reduced their reliance on inpatient beds, with a 12% reduction over the past three years.

This has released funding which they have been able to reinvest into community services every year. As a result, NLFC now has specialist forensic community services across each integrated care system (ICS) for both adult secure patients and individuals with a learning disability or autism who are in the system.

Other areas of impact

Further examples of the impact of NLFC include:

• Creation of 150 new posts working with more than 600 service users in specialist community forensic teams.
• Three new community forensic learning disability teams creating 70 new posts.
• A new ward of 16 beds for prison admissions to address waiting times.
• System-wide review in response to Edenfield leading to an improved standard of in person advocacy available on every ward every week.
• Creation of a voluntary, charity and social enterprise grant scheme, which aims to advance equalities and deliver employment opportunities.
• Investment in a physical health model of care aiming to reduce health inequalities focusing on obesity, smoking, substance misuse and cardiovascular diseases.
• Collaborative research network to build an evidence base, evaluate services and conduct epidemiological research.

Enablers for success

• A lived experience and co-production model that ensures services users and carers are at the centre of service developments and improvements.
• The leadership and commissioning role that Barnet, Enfield and Haringey Mental Health NHS Trust holds and the added value it brings to North London Forensic Collaborative (NLFC) as lead provider.
• A governance system that includes a patient council and staff clinical professional and pathway groups.
• A refreshed brand identity that embeds a collective sense of identity for the provider collaborative, with a shared vision and strategic priorities.
• An organisational culture and ethos that welcomes new ideas and encourages staff to work and act innovatively.
• Learning events to create a shared sense of ownership within the whole staff group and encourage the sharing of best practice.
• Development of a culture focused on system collaboration and the greater good with patients at the centre.
• Building and nurturing strong relationships amongst trust leaders, clinical teams and with system partners at all levels, based on honesty and transparency.