Report reveals cost savings achieved through new model of care in forensic mental health

Published: 18th January 2018
A new report launched today suggests that savings can be made and better resident outcomes achieved through a new approach to community forensic mental health provision delivered by care, support and housing provider Look Ahead.

Key findings from the report

Service provides a step-down from secure mental health inpatient services and enables residents to live in the community and move towards greater independence and eventually to their own home

A third of original residents moved to independent tenancies with floating support (support provided by trained workers in the community) within three years. Some residents had previously spent several years in expensive in patient or residential accomodation

First two years of Tabard Forensic Service resulted in total savings for health and social commissioners in Tower Hamlets of approximately £750,000**

£2,972* cheaper per person per week than the average cost of a medium-secure mental health inpatient service in the UK

These are the key findings in an independent report by the Housing Associations’ Charitable Trust (HACT) measuring the outcomes of Tabard Forensic Service, in Tower Hamlets, London.

The service was pioneered in partnership with East London NHS Foundation Trust (ELFT) and the London Borough of Tower Hamlets (LBTH). It supports 19 male residents aged 18 to 74 who are affected by serious and enduring mental health issues and have significant offending histories.

The report highlights that it is possible for police, clinicians and other agencies to work effectively in partnership delivering safe services to patients with a forensic history within the community, while also protecting public safety.

It reveals that this innovative and integrated model of intensive accommodation-based support is £2,972* cheaper per person per week than the average cost of a medium-secure mental health inpatient service in the UK.

It is £2,412 cheaper on average compared to low-secure mental health inpatient service, and £377 cheaper than the average cost of a local authority residential care service, reflecting the cost of often expensive out-of-area placements.

Before moving to Tabard Forensic Service ten of its 19 residents had previously been in out-of-area placements following lengthy stays in secure inpatient services. Their move to Tabard has saved health and social care commissioners £3,777 per week per service user in residential care placement costs.

Meanwhile, seven had been in psychiatric/acute hospital units – their placements at Tabard saved health and social care commissioners £2,639 per service user per week in residential care costs.

Tabard Forensic Service provides a step-down from secure mental health inpatient services and enables residents to live in the community and move towards greater independence as part of their recovery, and eventually to move on to their own housing with support.

One resident describes the service: “Here they seem to be monitoring you so that you get released and to be independent. In residential they monitor you so that they can keep you there forever.”

Before it opened in April 2014, there was no specialist local accommodation able manage the complex needs and high levels of risk presented by these residents, limiting their access to support networks and placing a strain on local budgets.

Look Ahead invested £500,000 to refurbish and adapt its existing building, working with ELFT clinicians and joint commissioners to co-design a psychologically informed environment.

HACT’s evaluation found that by autumn 2017, almost one third (31%) of the original 19 residents had moved to their own independent tenancy assisted by floating support in the community.

A further 21% had stepped-down from high-support accommodation to low-support accommodation within the Tabard Forensic Service.

Almost two thirds (63%) of residents were engaged in structured community activity and 10% were in work or volunteering.

All residents self-reported lower substance misuse since moving into Tabard Forensic Services, with 45% actively involved in substance use reduction programmes in the community.

Chris Hampson, Chief Executive, Look Ahead, said of the evaluation’s finding:

“The report we’ve launched with HACT today demonstrates how multi-agency partnership working is critical to the successful design and implementation of local forensic mental health pathways. At Tabard Forensic Service, Look Ahead and ELFT pooled their complementary expertise to co-design the service model from the outset.

“Its innovative, joined-up approach puts our partners in including ELFT, LBTH and the CCG, at the forefront of realising NHS England’s objective to address existing fragmented pathways in secure care and to trial new co-commissioning funding and service models.

“I really hope that the content of this report helps to encourage similar partnerships to be formed in other parts of the country so that people currently living in very secure facilities can go on to be more independent and live more fulfilling lives.”

Andrew Van Doorn, Chief Executive, HACT, said:

“We are delighted to publish this important report. At HACT we believe that collaboration between housing, health and social care are crucial and nowhere is this more clearly demonstrated than at Tabard Forensic Service. Through collaboration people can be stepped-down sooner into community provision from secure mental health settings potentially releasing millions of pounds for reinvestment into health and care services. Not only this, but outcomes for people are greatly improved with their ability to live independently in the community properly supported.”

Paul Gilluley, Interim Chief Medical Officer at East London NHS Foundation Trust (ELFT), said:

“New models of care in forensic mental health are allowing us to review patients’ pathways into, through and out of secure mental health services.

“This report provides us with important data on what works and what ‘good’ looks like. It also crucially shows how integrated working between forensic mental health services and specialist housing providers can lead to a safe and secure transition of individuals back into the community where they can have a high quality of life with the support they require.”

Cllr Denise Jones, Chair of Tower Hamlets Health and Wellbeing Board and Cabinet member for Health and Adults Services, said:

“I am particularly pleased that the report highlights the importance of partnerships between London Borough of Tower Hamlets and organisations including the Tower Hamlets CCG, East London NHS Foundation Trust, Look Ahead, Police and Ministry of Justice. These alliances are vital to people’s well-being and recovery and aim to put Tower Hamlets at the forefront of mental health care provision nationally.”


*These figures are based on the reference costs of services per user within the most recent publication of the Personal Social Services Research Unit’s Unit Costs of Health and Social Care 2016 (PSSRU 2016)

** Figures provided by Commissioners based on actual cost savings.


Clare Wilson, Head of Communications, Look Ahead, 0207 368 4884 or 020 7368 4850 for further information.