MD3026 Mental Health Recovery Mission and Thrive LDN work programme

1.1    In 2021-22, working with partners including London Councils, the Mayor of London launched the London Recovery Programme including a Mental Health and Wellbeing Recovery Mission (MHWB Recovery Mission). This is to deliver a commitment that, by 2025, London will have a quarter of a million wellbeing champions, supporting Londoners where they live, work and play.  The longer-term aim is to work with partners to ensure Londoners have the skills, tools and resources to support one another, and to protect or promote mental health and psychosocial wellbeing. 

1.2    In March 2021, a decision was made through the Health and Social Care Leaders Group and London Recovery Programme Central Recovery Team for leadership and governance of the MHWB Recovery Mission to be conducted through the Thrive LDN Advisory Group, as part of the wider health and social care partnership arrangements and commitment to public mental health.

1.3    Additionally, the GLA Health Team published an updated Implementation Plan for the London Health Inequalities Strategy (HIS) in 2021.  The Implementation Plan details actions to be taken by the Mayor and partners, to tackle health inequalities, between 2021 and 2024. The five aims of the HIS (Healthy Children; Healthy Minds; Healthy Places; Healthy Communities; Healthy Living) remain the core framework for action, and the Healthy Minds goal has been updated to reflect the aims of the MHWB Recovery Mission. The plan states that Thrive LDN, as the delivery lead for the MHWB Recovery Mission, are working with partners to improve the mental health and wellbeing of Londoners.

1.4    In 2019, the London Health and Care Partnership published the Health and Care Vision for London,  which the Mayor’s HIS reinforces. The Health and Care Vision for London includes two further mental health commitments, with Thrive LDN and the Mayor supporting the delivery of actions against each commitment:

•    to improve mental health and progress towards zero suicides
•    to improve the emotional wellbeing of children and young Londoners.

1.5    In May 2021, the London Health and Care Leaders’ Group commissioned the Thrive LDN Advisory Group to undertake a comprehensive review of regional public mental health. In November 2021, the London Health Board endorsed ‘Towards Happier, Healthier Lives’ (2021)  as the overarching public mental health strategy across the London health and social care partnership. The strategy provides clarity around how different strategic priorities for public mental health in London align and intersect.

1.6    Thrive LDN is a public mental health partnership supported and funded by the Mayor of London, the NHS, London local government, and the Office for Health Improvement and Disparities London. This MD proposes £515,000 as the GLA’s contribution to Thrive LDN for 2022-23, with other partners identified above contributing additional funding. Thrive LDN has financial hosting arrangements in place with the Royal Free London NHS Foundation Trust. The majority of the team are based at Healthy London Partnership. Members of the GLA Health Team with mental health responsibilities also work collaboratively with the Thrive LDN team. The public mental health partnership is governed by the Thrive LDN Advisory Group, which reports directly to the London Health Board. Thrive LDN formally launched in July 2017, and previous MDs relating to Thrive LDN have been cited in the executive summary.

1.7    The table below gives a breakdown of the decisions being sought for 2022-23 expenditure for Thrive LDN. 

1.8    Expenditure will take the form of grant awards or payment for services procured, depending on the nature of the work concerned and in line with relevant GLA procedures including the GLA’s Contracts and Funding Code. This is set out in section 2.5.

MHWB Recovery Mission

2.1    By 2025, London will have a quarter of a million wellbeing champions, supporting Londoners where they live, work and play.

2.2    The Mayor wants to support the public mental health recovery from the pandemic; and thus to give every Londoner the opportunity to participate in, and feel empowered to make a difference through, their communities, workplaces and local democratic institutions. This will help to create a change in culture where Londoners feel more resilient and have greater capacity to cope with uncertainty and adversity.

2.3    Delivery of this objective will take a coordinated public health approach made up of programmes of work set out in the table below, at 2.5. These programmes will have the following overall aims:

• work in partnership with London’s Economic Wellbeing Forum to influence a pan-London response to the cost-of-living crisis, and mitigate its impact on Londoners’ mental health and wellbeing
• as part of this, embed mental health support, and access to tools and resources, across London’s response to the cost-of-living crisis 
• improve the mental health and wellbeing of people from intersectional and marginalised communities 
• increase public discourse and awareness around the impact of inequality on mental health and wellbeing
• build a London-wide infrastructure for wellbeing champions, enabling them to connect, access new opportunities, build and share knowledge, and catalyse widespread engagement across London; and, through this process, raise awareness of the role of the Mayor of London in supporting the programme
• improve individual and community access to culturally competent mental health and wellbeing resources, training and services that meet identified needs 
• increase community involvement in the production and dissemination of knowledge, leading to more effective interventions and prevention programmes
• improve individual and community resilience through access to culturally competent and trauma-informed resources and support
• work with partners to support improvements in the mental health of children and young people, parents and families; and in access to support that they may need
• work with London's workplaces to support good mental health – including scoping out opportunities to provide enhanced support to London's blue-light services 
• increase cross-sector partnerships with a focus on ‘mental health in all policy’ initiatives.

Thrive LDN partnership foundation programmes

2.4    Thrive LDN’s core activities, funded and supported by health and care partners for London (as described in paragraph 1.6), include a range of activities. These activities also serve as foundations to the delivery and impact of the MHWB Recovery Mission. They will have the following overall aims:

• improve regional infrastructure and fora for public mental health communications and campaigns
• increase Londoners’ understanding of the importance of mental wellbeing
• improve the resilience of individuals, communities, and systems in London
• increase brand awareness, recognition and understanding of Thrive LDN, and Mayor of London’s support for the programme
• improve the representativeness of available data and evidence on the factors that impact mental health and wellbeing
• increase uptake and improve standards for participatory action research regionally
• embed feedback loops from research to communities
• expand the evidence base for public mental health. 

2.5    The table below gives a breakdown of deliverables for this programme, and the decisions being sought for proposed 2022-23 expenditure.

2.6    Total approval being sought for the MHWB Recovery Mission is £515,000. 

3.1    Under section 149 of the Equality Act 2010, as a public authority, the GLA must have ‘due regard’ of the need to: 

• eliminate unlawful discrimination, harassment, and victimisation
• advance equality of opportunity and foster good relations between people who have a protected characteristic and those who do not. 

3.2    The Mayor’s Equality, Diversity and Inclusion (EDI) strategy sets out how the Mayor will help address the inequalities, barriers and discrimination experienced by groups protected by the Equality Act 2010. This strategy includes objectives relating to mental health that are reflected in our mental health work programme. The GLA Health Team provides regular updates on their work for the EDI action plan, which feeds into the Mayor’s Annual Equality Report (MAER). Publication of the MAER is a legal requirement. It outlines the arrangements put in place by the GLA over the past financial year, in order to demonstrate that due regard has been paid to the principle that there is equality of opportunity for all people in the exercise of the Mayor’s general powers.

3.3    An Integrated Impact Assessment, which included an Equality Impact Assessment (EIA) within its scope, was conducted as part of the development of the HIS. This identified major positive and negative impacts of the programme for groups protected under the Equality Act 2010; and proposed ways to strengthen benefits and mitigate negative impacts, and to identify issues concerning the four cross-cutting themes under the GLA Act 1999. The HIS was adopted in October 2018, and a refreshed Implementation Plan was published in 2021. 

3.4    All activities within the Thrive LDN work programme and the MHWB Recovery Mission recognise the socio-economic and political factors that contribute to inequality, unfair outcomes, and poor mental health. In response to this, they aim to drive action on equity; enable and sustain active participation of Londoners; and improve the factors shaping the conditions in which we live, work, and grow. All Thrive LDN activities are developed using an EDI framework, and an EIA template, to ensure opportunities to reduce health inequalities and advance equity are identified from the outset. Thrive LDN is committed to building coalitions to challenge injustice and scale prevention to give everyone an equal opportunity for good mental health and wellbeing. 

3.5    In 2022-23, an EDI framework for Thrive LDN and accompanying EIA template have been developed to more clearly demonstrate how they meet the requirements of the Public Sector Equality Duty; align more explicitly with the Advancing Mental Health Equalities Strategy, and the Patient and Carer Race Equality Framework; and ensure Thrive LDN delivers accessible, inclusive and responsive activities to Londoners and their communities, including those from minority groups (including ethnic minority groups). 

Major risks and issues

4.1    Risks are assessed and managed on a programme basis. Cross-cutting and major risks are reported quarterly through the GLA’s corporate performance management process. At the time of writing, the major risks are as follows: 

Links to Mayoral Strategies and priorities

4.2    The GLA health programme is directly related to delivery of the Mayor’s HIS, a statutory duty under the GLA Act 1999. 

Impact assessment and consultations
4.3    Impact assessments have been conducted on the key elements of the programme, as detailed above.

4.4    Participation is the driving force of Thrive LDN, and the partnership regularly publishes insights from outreach and engagement work with Londoners. In 2020-21, more than 685,000 people participated in Thrive LDN activities and events. In 2020, Thrive LDN published Thrive Together,  which summarised findings from community engagement. In 2021-22, Thrive LDN co-produced several community participatory action research projects with different communities and groups in London. These projects include support for Londoners with HIV and for the Hong Kong community in London, and Pandemic Stories.  

4.5    There are no known conflicts of interest to note for any of those involved in the drafting or clearance of this decision.

Subsidy Control

4.6    This MD is a continuation of work the Mayor of London has previously funded.  We have identified the need to continue to provide a pan-London mental health prevention programme. There is a specific and increasingly high-priority need to provide dedicated / peer support to communities facing the greatest inequalities.

4.7    The Royal Free London NHS Foundation Trust (the Trust) is the financial host for Thrive LDN, which is a project focused on preventing people's mental health escalating to the point where they need more acute treatment services. Via Thrive LDN, the Trust provides services such as training for members of communities to support peers at a local level and suicide prevention programmes amongst others which are described above. Thrive LDN also aims to alleviate the pressures felt by London’s health and care services.

4.8    In addition to the Mayor of London, the Trust receives funding for Thrive LDN from the National Health Service, several of the London boroughs and the Office for Health Improvement and Disparities London.

4.9    Thrive LDN is not a core NHS service and, without funding provided by the GLA, it would not be possible for the Trust to deliver Thrive LDN including the planned activities and objectives as discussed above.    

4.10    The funding will pay for specific and dedicated services and resources as set out above which are beyond any core service delivery, resources or staffing. The programmes to be delivered have been costed for the sum total being agreed through this MD. The Trust has an established level of expertise in the area of work, which is unmatched by any other organisation.

4.11    A similar project could not be delivered by a local borough, as the spatial level is sub- and pan-region. The Trust would not be able to deliver this service without the grant as it is outside of the scope of the Trust’s grant from NHS England.  

4.12    We have assessed that there is not a competitive market for this work and there is no risk of undercutting any other private sector body. The service recipients are people, who are most affected by poverty and deprivation. Accordingly, they would be unable to afford to pay for a service at all.  We would not expect to see any negative effects on domestic competition or investment and international trade or investment. The policy objectives are local to London and focus on vulnerable Londoners, who would not otherwise be able to access such services.

4.13    There is no other service model like this in the UK and no mainstream funding is available at this time to address this need.

5.1    Approval is sought for receipt of £15,000 grant funding income from the Baring Foundation as contribution towards the World Mental Health Day festival 2022.

5.2    Approval is sought for expenditure of £515,000 for the Mental Health Recovery Mission and the Thrive LDN Work programme as detailed in the below table.

5.3    Of the £515,000 expenditure; £15,000 will be funded by grant funding income from The Baring Foundation, and the remaining £500,000 will be funded by the Thrive LDN (£350,000) & Mission Development (£150,000) budgets held within the Health Unit.

5.4    This is in line with the Health Unit budget allocations for 2022-23 financial year.

6.1    The foregoing sections of this report indicate that the decisions requested of the Mayor concern the exercise of the Authority’s general powers and fall within the Authority’s statutory power to do such things considered to further or which are facilitative of, conducive or incidental to the promotion of social development within Greater London and in formulating the proposals in respect of which a decision is sought officers have complied with the Authority’s related statutory duties to:
•    pay due regard to the principle that there should be equality of opportunity for all people
•    consider how the proposals will promote the improvement of health of persons, health inequalities between persons and to contribute towards the achievement of sustainable development in the United Kingdom
•    consult with appropriate bodies.    

6.2    In taking the decisions requested, the Mayor must have due regard to the Public Sector Equality Duty; namely the need to eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010, and to advance equality of opportunity between persons who share a relevant protected characteristic (age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation) and persons who do not share it and foster good relations between persons who share a relevant protected characteristic and persons who do not share it (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to section 3 (above) of this report.

Funding and Subsidy Control

6.3    In decision 1 above, the officers are seeking approval of a £465,000 grant to the Trust. The grant will partially fund the Trust’s own project; Thrive LDN. The beneficiaries of Thrive LDN are vulnerable Londoners, who are affected by inequalities and may be affected by mental health problems. To that end, the funding of the Trust by the Authority may be viewed as grant funding rather than a contract.

6.4    Given that the value of the grant exceeds the subsidy control threshold, the Authority must satisfy itself that the grant comply with the subsidy control principles in the Trade and Cooperation Agreement 2020 (the “Principles”). To that end, the officers have set out at paragraphs 4.6 to 4.13 how the proposed grant meets the Principles. In particular, the officers note that the activities, which comprise Thrive LDN, are not core NHS services. Moreover, they are not funded by the Trust’s grant from NHS England. Accordingly, the Trust would not undertake the activities but for the grant.  Furthermore, the officers point out that the services are provided to Londoners, who are subject to poverty and deprivation. This group of Londoners would not have the financial capacity to seek mental health assistance on the open market. To that end, the grant may be viewed as neither having a distortive effect on trade as between the regions of the United Kingdom nor as between the United Kingdom and its international trading partners.

6.5    In decision two above, officers are seeking approval to receive £15,000 grant funding from the Baring Foundation. The officers must ensure that they comply with the conditions attached to the said funding.

Procurement

6.6    Officers are reminded to comply with the requirements of the Authority’s Contacts and Funding Code where they are procuring services, supplies or works in furtherance of Mental Health Recovery Mission, Thrive LDN and World Mental Health Day 2022.

7.1    A detailed business plan for the work of the Health Team will be developed. This will set out the full range of programmes, policy and advocacy work the team plans to undertake in 2022-23, alongside a timeline for each specific deliverable.