Risk and reward: working with the NHS on higher acuity needs

Published: 10th October 2018
Our Director of Business Development and Innovation, Irmani Smallwood, weighs up what makes an effective and valuable partnership between a housing association and the NHS

Look Ahead’s customers are some of the most complex and vulnerable people in our society, and as an organisation we’re increasingly working with those at the higher end of the acuity scale within health and social care.

These are people who have often been let down by the system long before they come to our services – caring for them often comes with high levels of risk. It also involves working in partnership with health professionals who sometimes lack trust in social care providers’ approach to managing this risk. So, why does Look Ahead, as a specialist housing association, do it?

It has much to do with our mission and social purpose. Look Ahead was formed more than 40 years ago to provide homelessness services. Then, more than 20 years ago, we broadened our scope to include services for those with mental health needs, learning disabilities and autism, and young people, particularly care leavers.

We focus on working with individuals to make choices, achieve goals and take control of their lives. For us, this extends to everyone in society, including the hardest to reach.

Despite being not-for-profit, our business model does not involve general fundraising. We own around 2,500 properties, and, alongside that, we are mainly a contract-based business.

The contract business is tough, especially when your clients are public sector. In recent years our traditional contracts, through which we provided hostels, were severely cut, and we became concerned about staff and customer safety and well-being, as well as our organisation’s financial sustainability. Another reason we were attracted to working at the higher end of the acuity scale is that with risk comes reward.

Transforming Care
In 2014, just 11 per cent of Look Ahead’s income came from the NHS. This year, it accounted for more than a quarter (26 per cent).

Look Ahead now provides crisis houses for those experiencing crises in their mental health; forensic mental health services for those with high mental health needs and forensic histories; and Transforming Care services for individuals with complex learning disabilities, many of whom have spent years in secure private hospitals.

As well as achieving better outcomes for patients, NHS England is keen to progress its Transforming Care agenda, because caring for people within communities saves money.

Secure units for individuals with learning disabilities and mental health needs can be run by expensive for-profit providers. And, generally speaking, social care is cheaper than health care – so organisations like Look Ahead deliver significant savings to the NHS.

For example, one resident’s placement at Nimrod House, our Transforming Care service in Newham, London, is 17 per cent cheaper than his previous placement in a high security hospital, where he spent nearly 18 years, far away from his friends and family.

Caring for an individual in our forensic mental health service costs £2,972 less per week than the average cost of them staying in a medium-secure mental health inpatient service.

Meanwhile, a typical crisis house bed – accommodation and care within a community setting for an individual experiencing mental health crisis – is £200 a night. In an NHS setting, it’s £400 a night.

Even though the savings have been proven, it still takes vision and ambition to bring social care into a clinical environment, and in our experience it only works when driven from the top. Our most effective partnerships with the NHS are the ones led by commissioners with experience of social care.

Social care is more person-centred than tends to be the case within the NHS, with clinicians’ jobs being to ‘fix people’. Often clinical staff need to be convinced their patient will be able to cope within a community setting.

Despite an individual being identified as suitable for care and support outside of a hospital ward, and all of the necessary risk assessments being carried out, it can take up to 10 months to transfer them to their new home or placement.

This is a long time for service providers to hold a place open. The costs and risks associated with these void properties can be prohibitive, which is at least part of the reason why we’ve seen many organisations pull out of developing social care community services, particularly for those with complex needs.

At Look Ahead, we have the benefit of owning our properties, which means we are able to push ahead with caring for these customers.

We’re working closely with clinicians, inviting as many as possible into our services so they can see for themselves what care and support in the community can achieve. In the meantime, we continue to support our customers, getting to know them as people and trying to understand the factors that influence their behaviours.

Our work with the NHS is going from strength to strength because we often do have more success reaching out to the most vulnerable individuals, who once seemed to be unreachable.

Originally published in Social Housing, 9 October 2018