Our priority outcome: To increase the number of people able to live independently.
Our approach is to support people to live in the community as independently as they are able. This means keeping down the time they are in hospital or places with full-time supervision to the minimum required, and only when they really need this much support
What we offer
The whole Alliance system is working to help people with enduring mental health challenges to live independently as soon as they possibly can.
Community Liaison and Support Service (CLaSS)
Our Community Liaison and Support Service (CLaSS) works with our inpatient staff and peers (people with lived experience) who work with people in wards to build confidence and identify and resolve any issues that may prevent them from moving on once they are well enough. This includes housing and financial issues and tackling practical issues such as hoarding.
Culturally Appropriate Peer Support and Advocacy (CAPSA)
Our pioneering Culturally Appropriate Peer Support and Advocacy (CAPSA) service provides support (including on wards) for those from our Black communities to reduce the inequalities in access, experience and outcomes of these communities.
Living Well Centre: Short-Term and Focused Support Teams
Our Living Well Centre Short Term and Focused Support Teams regularly review those they support, to ensure they are receiving the right level of care.
PCAN (Primary Care Alliance Network)
PCAN (Primary Care Alliance Network) involves GPs, Mental Health Practitioners and other community based health specialists meeting with Alliance Living Well Centre staff, on a fortnightly basis, to support more people in their homes and communities. Our innovative Staying Well offer works alongside PCAN to provide practical support for more people to live independently.
Supported Accommodation
We buy a large number of ‘supported accommodation’ services. These range from a few hours a week supporting someone in their own home (for example to ensure medication is taken) to 24 hour supported specialist accommodation for those with greater needs. We have recently refreshed many of these contracts to improve the support provided and make it more relevant to the needs of those we support.
Home First
We introduced a ‘Home First’ service in 2024/25, to provide more intensive support to people and make it easier for them to go straight back to their own homes rather than into supported accommodation or other less independent settings. Home First supported 185 people in its first year.
Our impact
As the chart shows, 2024/25 saw the highest use of Lambeth acute beds since the Alliance began, with an average of 97.7 beds used against just 81 beds available. This is the equivalent of an extra 18-bed ward, and means a significant reliance on expensive private bed spaces to compensate. This is 15% more beds used than the previous year.
As the second chart shows, long length of hospital stays in acute beds fell. 28% fewer patients spent more than 100 days in a bed, whilst 4% fewer spent more than 200 days in a bed.
Our three, area based, Living Well Centres (LWCs) provide community mental health services through two integrated teams: Short Term Support and Focused Support. In total 2,136 people accessed our LWCs in 24/25 compared with 1,417 in the previous year, a 34% increase.
Our next steps
We recognise we need to reduce the number of people experiencing long-term hospital stays. We’re continuing to improve the way we work so people can have greater independence sooner by:
- reviewing how we make referral and discharge decisions, finding and addressing anything that may be preventing someone from being discharged sooner.
- improving supported accommodation services,
- developing and expanding our Staying Well approach,
- developing roles such as community reablement workers, mental health practitioners in GP surgeries and transitions workers for children and young people turning 18.
Case study: JW, Promoting Independence
JW had a long stay in an acute hospital, followed by admission to inpatient rehabilitation in 2019. Progress was slow, and after a transfer to another rehab hospital, JW’s recovery plateaued. The clinical team advocated that hospital care should continue indefinitely which was challenged by the Complex Care Funding Panel.
Through strong joint working between JW’s care coordinator and social worker, and despite JW’s resistance to change, a plan was developed. In an unusual but bold move, notice was given to the inpatient rehab placement—even though JW did not agree—because a suitable step-down option had been identified. JW moved to residential care at the end of April 2025. Since then, JW has settled in well and is continuing to do well.
Can you help us?
We have a short survey that anyone who use our services will be invited to complete (online or on paper). It will take less than three minutes and will tell us how well we are doing and what we need to improve.