New Statutory body as an alternative to the NHS for mental health and hidden disability

TheCatWoman has raised an example of what the service might look like a few days ago 

Thanks for bringing it to attention :-) I see it's actually named Hope Haven. I've spent a bit of time on this forum before exploring the topic of "Pandora's box" with respect to the topic of hope being something that is necessary to resolve problems... So—a bit more Sunday morning debate... :-)

Here's an "executive summary" (AI generated) of the personal research and answer that follows it:

My longer text:

A bit more research and I find that this is one of six "pilot studies" with the intention to expand to 250 in the "ten year plan". They've apparently been set up to get over the hurdle of people actually getting access to direct support and services. The evidence is that they are getting over the hurdle of actually getting people to them, and there are signs of success for the one outlined.

However, as other good people including yourself have pointed out in this thread, there's the headache of actually finding and having enough skilled staff. Then there's the headache of the staff involved coming from separate "silos"—e.g., healthcare, social care, local government, etc.—and importantly, being able to work together as a cohesive, combined system. They all have different budgets, IT systems, working hours, and different "lenses" and biases (and, to a certain extent, "buck-passing" credentials, I add somewhat cynically based upon experience).

Then there is the problem of "estate"—there apparently are problems with the organisations actually having buildings and physical infrastructure that is fit for purpose.

In short, the pilot studies have proved the thing can work. But I've observed such organisations and people "coming together" before in practice as spin-offs from successful pilot studies—the planning and training meetings are endless and, in my personal experience, they wander off and carry on doing what they were doing before (albeit with less time because they have had to attend all those meetings). It is something that has been dubbed "pilotitis". Brilliant, agile pilots wither and die the moment someone tries to formalise, committee-manage, and standardise them into a national rollout.

Early-stage pilots usually attract a self-selected group of highly motivated, innovative staff who are willing to work across boundaries because they feel part of an exciting experiment. They'll chat over coffee and in the corridor or similar and get stuff worked out that way, rather than another layer of managers and blooming committees trying to standardise EVERYTHING to mitigate the risks they foresee. The focus shifts from actually helping people to the weaponisation of compliance—the policies, data-sharing agreements, and governance frameworks. On a personal basis, this experience led me well and truly up the burnout path and actually needing mental health help!!!!! By the time staff have actually negotiated this, they are no longer motivated nor supported to actually do the job in my personal experience.

Add into this that the separate parts of the "hub" have different fundamental structures and means. The NHS is heavily risk-averse, hierarchy-driven, and "clinical". Social care and local councils are cash-strapped and are bound by statutory duties without enough resources to meet them. Charities are very deeply values-driven and, again, cash-strapped. So when these all come together, people—I observe—get really fed up with the administrative friction and wander off back to doing stuff on their own again.

The idea behind the 10-year plan is that the money is all ring-fenced for the task. So, because of this, all the different parts of the organisation working on achieving it will have to stick together to get it done. Yet, despite the legal and financial frameworks, national evaluation reports highlight that several of the original pilot sites are heavily struggling against systemic regression, with the individual parts wandering off back to doing stuff on their own again.

So what are the solutions???

Is it "rip it up and start again"? Well, no—because that'd just start another 5-year-plus round of committee meetings... The failure isn't the idea of such hubs; it's the flipping bureaucracy that springs up around it!!!

Stop trying to make separate organisations "partner up". Instead, create a completely separate, single legal entity for the hubs. Each one has one boss, one IT system, and one locally appropriate means to resolve locally appropriate problems.

Fund the infrastructure—the buildings and IT, not just the "project" (trying desperately hard here not to get caught up in the NHS estate and infrastructure issue... maybe that's for another time...).

Get rid of the short-term funding for "projects" where grants run out and then staff and services disappear. Legally mandate that once a neighbourhood hub is established, its budget becomes a statutory baseline—meaning it cannot be clawed back or defunded by an Integrated Care Board to cover overspends in acute hospitals.

As I outlined in previous responses, this means going back to the same community-based structures that existed before the behemoth of the NHS expanded to be such a wallowing money sink.

So to come back to the OP—ironically, I think there is a place for a centralised organisation. Its role should be to facilitate these community hubs, and by this, I don't mean the bureaucratic choking of them!!!

TheCatWoman has raised an example of what the service might look like a few days ago 

Thanks for bringing it to attention :-) I see it's actually named Hope Haven. I've spent a bit of time on this forum before exploring the topic of "Pandora's box" with respect to the topic of hope being something that is necessary to resolve problems... So—a bit more Sunday morning debate... :-)

Here's an "executive summary" (AI generated) of the personal research and answer that follows it:

My longer text:

A bit more research and I find that this is one of six "pilot studies" with the intention to expand to 250 in the "ten year plan". They've apparently been set up to get over the hurdle of people actually getting access to direct support and services. The evidence is that they are getting over the hurdle of actually getting people to them, and there are signs of success for the one outlined.

However, as other good people including yourself have pointed out in this thread, there's the headache of actually finding and having enough skilled staff. Then there's the headache of the staff involved coming from separate "silos"—e.g., healthcare, social care, local government, etc.—and importantly, being able to work together as a cohesive, combined system. They all have different budgets, IT systems, working hours, and different "lenses" and biases (and, to a certain extent, "buck-passing" credentials, I add somewhat cynically based upon experience).

Then there is the problem of "estate"—there apparently are problems with the organisations actually having buildings and physical infrastructure that is fit for purpose.

In short, the pilot studies have proved the thing can work. But I've observed such organisations and people "coming together" before in practice as spin-offs from successful pilot studies—the planning and training meetings are endless and, in my personal experience, they wander off and carry on doing what they were doing before (albeit with less time because they have had to attend all those meetings). It is something that has been dubbed "pilotitis". Brilliant, agile pilots wither and die the moment someone tries to formalise, committee-manage, and standardise them into a national rollout.

Early-stage pilots usually attract a self-selected group of highly motivated, innovative staff who are willing to work across boundaries because they feel part of an exciting experiment. They'll chat over coffee and in the corridor or similar and get stuff worked out that way, rather than another layer of managers and blooming committees trying to standardise EVERYTHING to mitigate the risks they foresee. The focus shifts from actually helping people to the weaponisation of compliance—the policies, data-sharing agreements, and governance frameworks. On a personal basis, this experience led me well and truly up the burnout path and actually needing mental health help!!!!! By the time staff have actually negotiated this, they are no longer motivated nor supported to actually do the job in my personal experience.

Add into this that the separate parts of the "hub" have different fundamental structures and means. The NHS is heavily risk-averse, hierarchy-driven, and "clinical". Social care and local councils are cash-strapped and are bound by statutory duties without enough resources to meet them. Charities are very deeply values-driven and, again, cash-strapped. So when these all come together, people—I observe—get really fed up with the administrative friction and wander off back to doing stuff on their own again.

The idea behind the 10-year plan is that the money is all ring-fenced for the task. So, because of this, all the different parts of the organisation working on achieving it will have to stick together to get it done. Yet, despite the legal and financial frameworks, national evaluation reports highlight that several of the original pilot sites are heavily struggling against systemic regression, with the individual parts wandering off back to doing stuff on their own again.

So what are the solutions???

Is it "rip it up and start again"? Well, no—because that'd just start another 5-year-plus round of committee meetings... The failure isn't the idea of such hubs; it's the flipping bureaucracy that springs up around it!!!

Stop trying to make separate organisations "partner up". Instead, create a completely separate, single legal entity for the hubs. Each one has one boss, one IT system, and one locally appropriate means to resolve locally appropriate problems.

Fund the infrastructure—the buildings and IT, not just the "project" (trying desperately hard here not to get caught up in the NHS estate and infrastructure issue... maybe that's for another time...).

Get rid of the short-term funding for "projects" where grants run out and then staff and services disappear. Legally mandate that once a neighbourhood hub is established, its budget becomes a statutory baseline—meaning it cannot be clawed back or defunded by an Integrated Care Board to cover overspends in acute hospitals.

As I outlined in previous responses, this means going back to the same community-based structures that existed before the behemoth of the NHS expanded to be such a wallowing money sink.

So to come back to the OP—ironically, I think there is a place for a centralised organisation. Its role should be to facilitate these community hubs, and by this, I don't mean the bureaucratic choking of them!!!