Best For You: an update from James Porter

Best For You is a new approach to mental health care designed for – and in consultation with – young people and their families. The programme is run in partnership by CW+, Chelsea and Westminster Hospital NHS Foundation Trust, Central and North West London NHS Foundation Trust, West London NHS Trust. It is being evaluated by Imperial College.

James Porter, Director of Campaigns and Major Programmes at CW+, shares his insights into the successes of Best For You so far and plans for the future of the programme.

What’s your role in Best For You?

I am the directorial lead on behalf of the Best For You partnership, so I support the whole programme to achieve its strategic goals.

Practically, that means working with clinical, operational and support service teams to deliver a whole range of projects – from building new things to developing new digital solutions and forming partnerships with other organisations.

I feel incredibly lucky to lead such a fantastic group of people who have come together to deliver Best For You.

What makes Best For You different?

I think from a health and social care point of view, the partnership that we formed makes Best For You different. We’ve come together as mental health trusts, acute trusts, a college and a charity, and worked together in a new way to deliver a programme. This may seem obvious and simple – but in the broader landscape of things, it’s actually quite unusual.

The second thing is the approach that we have taken in terms of trying to find and fill gaps with workable and young-people-driven solutions, as opposed to trying to solve existing known NHS problems. What I mean by that is that Best For You isn’t about trying to drive the operational performance of existing services or change the way that they work. It’s about the different and complementary things you can do alongside those services to help and support young people through a broader pathway.

Ultimately, I think that what we’ve done to date – in terms of our partnerships, our digital metrics, and the way that we’ve been working to achieve these things – proves that we are on to something.

Can you tell us a bit about how this partnership came about?

Best For You was born of an idea during a conversation over coffee, and the one thing that we (as CW+) knew that we couldn’t do was try to do something by ourselves.

That led us to think: ‘OK, who within our area of the UK would you ideally talk to in order to try and do something?’ And then, linked to that, was the sort of overarching challenge that if we could do something in our area of the UK, where else would or could we potentially do it?

Thinking about how we could create something that would be applicable beyond north-west London very quickly led us to think about how we would measure things and spread information and best practice. So the first conversation we actually had wasn’t with any of the NHS partners, it was with Imperial College. Through working in partnership, we brought on board their evaluation expertise but also their networks, specifically one called the Applied Research Collaborative, which is a UK-wide network of collaboratives that is designed to spread best practice and learning.

We knew it would be foolhardy to try and do a mental health programme without our mental health colleagues, so they were they were next on the list. And then, from talking to colleagues over at Chelsea and Westminster Hospital, it quickly became apparent that the young people’s mental health crisis was affecting their Children’s Accident and Emergency Department (and their inpatient children’s wards) as much as it was affecting the Children and Adolescent Mental Health Services provided by CNWL and West London NHS Trust, so we needed to think about that as well.

In terms of how everything came together, I think the approach that we’ve taken in terms of not trying to dictate operational running of things or change core delivery of services has been important.

What we always try to do is focus on the right things within pathways, and work with our colleagues so Best For You is a programme that fills gaps, not one that tries to reinvent wheels.

Have there been any particular challenges working in partnership with four large organisations?

I think the scale of these organisations is by its nature a challenge. Chelsea and Westminster Hospital NHS Foundation Trust is probably the biggest of the NHS partners, with 7,000 staff over two quite distant sites and various clinics. That means that, across everything that we do, the spread of information and how it penetrates down through organisations is sometimes challenging.

This can also be a challenge when you need to get things approved or agreed. We’ve had to develop mechanisms make sure that everyone gets what they need when they need it.

Best For You is a relatively small part of a much broader ecosystem, and there have been challenges when it comes to aligning with the right things and informing the right people in the right places.

But ultimately, I think the subject matter and the endorsement that we’ve had from the very highest echelons of our partner organisations has been fantastic and has allowed us a level of freedom to get on and do things. For example, the Chief Executives of our NHS partner organisations sit on the Best For You Oversight Board, as do some of the most senior clinicians within those organisations, which has been very important.

In terms of community partners, can you give us some examples of partners you’re working with and what you’re doing together?

We have about 75 partners in the broader community, and these are three good examples.

First, West London Zone is a charity that does a lot of work within schools. Schools are really important for Best For You – they’re obviously where young people spend a lot of their time, and they’re also where a lot of the problems that we’re trying to address through the programme often start to surface.

We knew that we couldn’t (and shouldn’t) try to go into schools and address those problems head on as a partnership. Instead, we needed to find the right partners that were already working in those environments and introduce them to Best For You. West London Zone has essentially become that partner for us. It has teams across most of the state schools in our area; all of those teams have been through the Best For You digital training programme and have the Best For You resources to use as part of their practice.

The second partner I want to mention is Word on the Curb. We’ve always been clear that what we don’t want to do is talk to a very small number of young people and base big, potentially costly decisions on a relatively small sample size.

We decided to go out and find the right partner to support us with this, and that’s where Word on the Curb came in. We can talk to their community, which is made up of over 10,000 young people from a very broad and diverse range of backgrounds. Through our work with Word on the Curb, we’ve asked young people questions, from ones about the way that our digital offer should look and behave through to ones about how our physical spaces are designed. They give us actionable feedback, which we use to make informed decisions.

And third, as part of our community programme, we have a really great set of relationships with some of the football clubs in north-west London, including Chelsea Football Club. We’ve been to various events that the clubs and their foundations have put on in order to promote Best For You and to reach and support young people where they are.

More practically, the clubs are involved in two initiatives. One is a mentoring program for young people currently on waiting lists for NHS treatment. The NHS clinician who assesses them can refer them into this programme if it’s suitable. Young people taking part are matched with a mentor from one of the football clubs who supports them for a fixed period. The overarching programme is supported by one of our mental health partner trusts, which supports the mentors and makes sure that young people are safe.

The other Best For You initiative with football clubs is a social prescribing programme around physical activity. The football clubs provide the activity side of the offer for young people who are referred, while our mental health trust partners provide peer mentors and overarching care and support for the programme.

Can you tell us all about Best For You Denmark?

Best For You Denmark is relatively new. For quite a while now, I’ve been working with a foundation in Denmark to support them in some of their planning around mental health by sharing everything we’ve done through Best For You.

That has now formalised into a partnership and they have launched Best For You Denmark, which is more or less the Danish version of our programme. In the UK, our starting region was north-west London, and their starting region in Denmark is an area called North Jutland, with their programme centred around the city of Aalborg.

We’ve met with a team of clinicians, academics and health professionals from Aalborg hospitals and universities, and over the course of the next few years we will work with them to support what they want to do over there. Part of that, we think, will be access to some of our digital offer, but it may be that in the fullness of time we choose to do other things together as well.

But Denmark is just the start. We have increasing numbers of people visiting our digital offer from all over the UK and world. Quite a few areas of the UK are actively interested in Best For You – Oxford and Manchester are probably the cities where we’re furthest ahead with conversations.

And we also have some interesting connections outside of the UK, both from relationships we have, and from publications that the evaluation team has produced. Most recently, we presented to large hospitals in Madrid (La Paz, the biggest hospital in Spain) and Toronto (Toronto SickKids). We’ve had interactions with hospitals and various academic establishments from the US too.

What’s it like talking to people about Best For You?

My background is in health operations, strategy and transformation. As part of that, I’ve done various regional-level pieces of work across multiple health systems and organisations.  Best For You is far and away the one which gets the most favourable response, not only from clinical teams or operational teams, but also from families, carers, and service users.

In some ways, it is a bit of a double-edged sword. It provides great opportunities for us to go out and do some of things that we have done, including our community partnerships. But it also means that we have to be very strategic and targeted in who we say yes to, so that’s something that we spend quite a lot of time thinking and talking about as a broader team.

I am very clear in my head, and I try to be clear when talking to people, that all of the successes we’ve had with Best For You so far have only happened because of the people who help shape and deliver this programme – it’s very much a collaborative effort.

Big integrated care projects like this – and this is a big and very complicated integrated care project that would not have been possible four or five years ago – require a whole bunch of people. They can only happen with a lot of individuals wanting to (and making a very conscious decision to) change how they do things. Of everything that I’ve done of a similar ilk, Best For You stands out as a pretty singular success story – and that is 100% down to everyone involved the programme.

What is the ultimate goal for Best For You?

When we started Best For You, the challenge that was put to us was that we should try and develop a model that was scalable, that could work not just in north-west London, but in most places in the UK and beyond.

In that sense, ultimate success would look like other places using and adopting various elements of Best For You and learning from things that we’ve done. And I think we’ve ticked that box (and you could argue that we’ve gone beyond that goal) with developments like Best For You Denmark.

But at the same time, the ultimate success of Best For You will be seen in individuals, the care that they receive, and the support that their families and carers and networks get.

It’s tempting to talk in very ambitious macro terms when it comes to programmes like Best For You. But actually, if we can improve the care of patients as people on the ground, that’s what this should all be about.

If a young person who has questions comes across the Best For You digital offer and finds something that can practically help them, then that is as big of a success as Best For You Denmark.

If someone who is struggling as an inpatient in north-west London can be safely moved to Arc Day Programme and receive care and support that’s more appropriate for them and their family members or carers, then that is as important as Best For You starting in Manchester (or wherever it might be).

One of our Clinical Directors tells a brilliant story about when he was at one of the football clubs promoting Best For You. There was an individual who kept on walking by, standing and looking at the Best For You stall, but not wanting to come over. Each time, they’d get closer and then walk away – but eventually, they did come over, have a conversation about mental health, and pick up a leaflet and take it away. That’s the important stuff in all of this.

And I think that the effect of Best For You on individual young people and their loved ones is something that we, as a programme and as a set of teams, try to think about in everything we do.