Market position statements – mental health

Our aspiration is to continue to deliver good quality services that put people, communities, and assets at the centre, while keeping ahead of the challenges of a rapidly changing landscape. Luton’s collaborative all age mental health strategy will increasingly focus on what people are able to do for themselves and support individuals and communities to identify strengths and assets as part of a more preventative approach. We will also continue to recognise that some people will continue to need direct support from the council and here too we will be placing greater emphasis on choice and control and maintaining independence. Our overall vision, as laid out in the Adult Social Care Strategy 2022 to 2027 is that:

People in Luton with health and social care needs will lead a ‘good’ everyday life with the people they value in the community they call home; with an equal voice in planning their own care and support.

Luton 2040 vision is:

To be a healthy, fair and sustainable town where everyone can thrive and no one has to live in poverty.

Current estimates put the scale of the mental health challenge in the range of 3000 to 4000 people accessing mental health services and support in Luton.  Improving access to psychological services (IAPT) is a proactive approach to prevention.  Luton has a lower national average accessing IAPT.  We know the effectiveness of such interventions as Luton has high recovery rates for post traumatic stress disorder and obsessive-compulsive disorder, being in the top three nationally.

We aim to improve access to mental health supports by:

• ensuring people at risk of harm and abuse are safe
• creating resilient caring places and communities that support people to stay connected
• co-producing with individuals the early support they need to stabilise and maximise their independence to improve their wellbeing
• enabling people to live independently through strength-based practice, recovery led support, digital solutions and community-based options
• developing a highly skilled and resilient workforce to meet the needs of the community.
• working with people to create greater personal choice and control over how people achieve their long-term care and support options
• strengthening our partnerships and connections with internal and external partners to embed an all-age disability service

Prevention and early intervention and support

The council seeks to help people to recover from mental ill health, to manage without long term social care interventions through developing the skills to live and thrive independent of services.

For example, the SMILE project through its Community Link Workers will help people to avoid crises. This will be achieved through:

• pathways being creating to support people to move from hospital, residential care r supported living to live ordinary lives in the community
• an integrated staff team will have staff trained to focus on a person’s wellbeing. Working alongside and not for the person is the preferred approach
• support will be offered which is flexible, recognising that people might need more intensive support at times and less support when the person is doing well

Services for people with a mental health

Overview

As of June 2024, Luton Borough Council funded services that supported 246 adults with Mental Health Issues.

 Of those people:

• 57 were supported in community settings and 111 in supported living settings
• 12received a Direct Payment to choose their own care support.
• 70 people were 100% funded by LBC and 160 people were joint funded at varying proportions.
• 231 have been reviewed in the financial year 2023/24 period with 15 awaiting a review
• 5% of people who are in contact with secondary mental health services are in employment 

Alongside the wider Adult Social Care strategy, and in partnership with Health colleagues, we also continue to deliver the priorities in Living a Good Life in Luton, the Strategy for people with a learning disability and/or autism, 2019 to 2024:

• changing the conversation - protecting a person’s independence, resilience and wellbeing and their ability to make choices by using a strengths-based approach and recovery led Support, this means active support plans detailing the individual’s journey to recovery and maintained or reduced levels of support.
• furthering personalisation - working with providers from all sectors we will prioritise the development of support services that are designed and developed with, and around a person with a focus on prevention and increasing participation in the community. This means the individual has an active role in their support plan and ownership of those plans.
• reshaping our accommodation and support offer - ensure that people can choose where they live and who they live with, including reducing the reliance on residential care and out-of-area placements. Moving from traditional supported to living which often became stagnant where individuals simply ‘lived’ in accommodation, to a more progressive form of supported living that is not linked to the support provider but is independent and allows the individual choice in the support provider. A change of support provider no longer means a change in the individuals accommodation.
• building healthy, safe and fulfilling lives - supporting people to be active in their community and to be able to do things for themselves with their own friends and family, including ensuring that employment, meaningful occupation and leisure activities are made available for everyone irrespective of ability. This activity features in the joint individual and support/ care coordinator support plan as the individual progresses.

Current services

Support at home

Luton commissions 23 providers to support approximately 64 people with Mental Health issues.

Support at home includes a range of support services for individual adults in their own home. Support is personalised for people who have a range of support needs from low to complex and include behaviour that may be challenging. The services can support individuals through periods of recovery or enablement, reduce social isolation and provide support to carers. It aims to support people to do things for themselves and gain or regain skills and confidence that may have been lost following a crisis or ill health.

In April 2024, the council launched a new framework for support, which is planned to run for at least five years. The framework is currently closed but there are plans to reopen it during late 2024/25 to refresh the current arrangements.

Providers can move between lots, enabling organisations to build and maintain sustainable business, which in turn will contribute to Luton’s 2040 vision of a thriving local economy.

Supported living (including community support)

Luton’s framework for the support element of supported living is a graduated model, defining the support model across five Lots; with Lot 1 providing a low level of support to develop or maintain people’s independence to Lot 5 supporting people with very complex needs where support is likely to be 2:1 or higher:

• lot 1 – community support
• lot 2 – standard supported living with variable day hours
• lot 3 - standard supported living with variable day hours and night support
• lot 4 - enhanced/intensive supported Living with 24/7 support
• lot 5 - specialist/Intensive supported living

In lots 2 to 5, support is delivered in an accommodation-based service, where some support is possibly shared with other people living in the same house or within a cluster, or in another nearby property. People living there hold a tenancy with a housing provider, who is a different organisation from the company providing the support. Support can be up to 24 hours a day, seven days a week and may include night care.

Lot 1, community support, is offered to people who need support but do not need supported accommodation, e.g. the individual lives with parents/carer; or is a tenant or owner in standard/general needs/mainstream accommodation.

The supported living framework was launched in 2023 and will run for at least five years. The framework has brought new support providers into Luton to help address gaps in provision for people with complex needs, improve the quality of support and improve choice and control for people requiring support.  

Residential and nursing care

Luton Council commissions residential care for about 52 people with a mental health issue from 20 providers. The Council also commissions nursing care from 4 providers for a very small number of people, currently 7.

Commissioning intentions

Support at home

We want to work with providers so that:

• we move from a ‘time and task’ to an outcome model where two distinct sets of outcomes are measured: Individual Outcomes and Service Outcomes.
• individuals are encouraged and supported to do things for themselves, so that people remain living with family, in their own home for as long as possible.
• providers have a greater understanding and role in the client’s basic daily support in tasks relating to living as independently as possible. This should include means and non means based benefits such as Universal Credit and Housing Benefits.
• providers are working parallel / in unison, with the voluntary sectors to enhance and compliment the support they provide and draw from the shared experience promoting greater client wellbeing.

Community opportunities and day services

We want to work with providers so that:

• all services are based around peoples’ own communities and the enablement of long-term relationships and friendships.
• meaningful activity or employment is a focus for all community-based services, including making the right links with educational and employment services.
• more services are available for disabled adults with positive behaviour support needs, and those with profound and multiple learning disabilities.
• models that were developed during the pandemic, including on-line activities and outreach services, are part of the wider offer and services consider increased flexibility, for example provision in evenings and weekends.

Supported living

We want to work with providers so that:

• people are connected to their communities, engaging in meaningful activities, and developing independent living skills. All providers should be considering how to support individuals to live completely independently where they can. Such support should include socialising and activities outside of the home and utilising the voluntary sector parties.
• have the knowledge of the range of welfare benefits available to clients and the providers role in supporting clients by assisting with the application and follow up of benefits like Universal Credit and Housing benefit. Recognising the crucial role such work and benefits in maintaining accommodation and ultimate wellbeing.
• supported living is operated on a recovery led pathway with preplanned step-down, including targets of achievement integrated into the support plan.
• additional providers who can support people with complex needs join the framework so that everyone with a mental health issue can be offered the security of accommodation and control over their support provider, which is core to supported living.
• there are suitable accommodation options available for people, including self-contained accommodation with support provided across the several types i.e. flats/bungalows.
• we recognise the need for more appropriate properties for supported living and are working with Housing colleagues, developers, and Housing Associations to build and redevelop accommodation suitable for people with the range of issues.
• providers that have developed their services and partnerships so that their accommodation is provided by another approved organisation (Housing Association) or is recognised for the purposes of eligibility for exempt or specified status under HB regulations.
• providers that can demonstrate their social value as a service.

Residential

We want to work with providers so that:

• residential services relate to their communities, supporting the people who live in them to have relationships and engage with the wider population.
• staff are suitably qualified and skilled to support the clients’ complex needs.
• providers have adequate training to keep staff appraised or current trends and support methods.
• all services are good quality; we will work with those providers rated Requires Improvement by CQC to improve and develop their provision.
• services offer flexible options, such as short-term respite or temporary stays, alongside long-term placements.
• providers involve and utilise the non-statutory and voluntary sector services to ensure clients have the best possible experience.
• that the social value of the provider is easily recognised.

Future of Luton Mental Health Services

The model of support for Luton is going to expand into a greater use of the FRAMEWORK model and less reliance on’ non-essential’ out of borough spot purchases that are often very costly.

All support going forward will be required to be recovery led, with support plans detailing the recovery pathway and timelines. Greater emphasis will be placed on service and client outcomes to ensure we achieve a healthy successful market serving our clients.

Demand is not expected to change significantly in Mental Health over the next five years, but remain on the current trajectory, as people are reviewed and moved through the system on a pathway leading to independent living or floating support. The current provision will migrate away from non-essential out of borough placements.

Value for money will be an essential tool in the service going forward as we all face challenging times financially. Luton BC believes in the adoption of the National Living Wage for support and Care staff and will continue to ensure it is a contractual requirement as Luton tackles the poverty issues in our community.

Luton Mental health services and commissioners will continue to work on developments and provision of supported living units as demand is faced. Such Units will be similar in style to the successful pilot of Jubilee Street in Luton.

Luton will want to work with providers who can be innovative, progressive and collaborative with partners and the third sector of experienced and skilled voluntary sector.

Inclusiveness is essential in the future of the service, ensuring families, friends and relatives are actively involved in the lives of our clients, not just by way of information, but with positive interactions. We will want our providers to demonstrate how they will achieve this with the support planning with clients.

Where we have clients with very complex needs or specialist provision of support, we will work with developers and providers to plan provision. Such provision could be better served with partnership arrangements with our neighbouring boroughs and Integrated Care Board. Luton works with the BLMK partnership, and the cross-boundary work will continue going forward.

Success in this joint working has resulted in a potential shared site provision for 2025 on the Luton Dunstable border.