MD3305 Grant funding to the Royal Free London NHS Trust to support the core enabling functions of Thrive LDN as London’s public mental health partnership in 2024-25

1.1.    This Decision relates to the mental health priorities of supporting and inspiring young Londoners, and reducing inequalities (which includes work in the Health Inequalities Strategy (HIS)).
1.2.    The Mayor wants to support Londoners’ mental health and wellbeing. The Mayor is particularly committed to ensuring that: children and young people have good physical and mental health; and all Londoners live in a city that supports their mental and physical health, and have access to a health and care system that supports them when they need it.
1.3.    Thrive LDN was launched in July 2017 by the Mayor of London and London Health Board partners. It is a citywide public mental health partnership established to ensure all Londoners have an equal opportunity to good mental health and wellbeing, regardless of who they are and where they live. As a partnership, Thrive LDN brings together organisations from across sectors to create an infrastructure for prevention, where public mental health is a collective responsibility and a common goal. Thrive LDN delivers a wide range of programmes that support the mental health needs of Londoners, and align with the strategic priorities of London’s health and care partners including the NHS and the Office for Health Improvement and Disparities (OHID). 
1.4.    Section 12 of the GLA’s Contracts and Funding Code provides that decisions to award grant funding should generally be made based on the outcome of a transparent, competitive application process. In this case, the GLA proposes to fund the Royal Free London NHS Trust (the Royal Free) directly as the responsible body for the Thrive LDN partnership. Thrive LDN has a unique role as London’s public mental health partnership. It was agreed at recent partnership boards, attended by the GLA, that Thrive LDN plays an integral role and should continue its work, with greater alignment across Transformation Partners for Health and Care programmes. Thrive LDN is also funded by the NHS, London local government, integrated care boards and OHID. 
1.5.    This MD relates to the GLA’s contribution (£300,000) toward the Royal Free’s delivery of the Thrive LDN project for 2024-25. 
1.6.    This MD includes the continuation of mental health programmes started in 2021-22, including resource for Thrive LDN. Decisions relating to spend in previous years are: MD2215, MD2265, MD2323, MD2439, MD2510, MD2631, MD2704, MD2852, MD3026, MD2930 and MD3141.
 

2.1.    This grant will fund the Royal Free as follows: 
•    £150,000 to deliver core enabling functions of Thrive LDN, which aligns with the outcomes-focused approach of London’s city-wide missions
•    £150,000 for additional objectives in line with the Mayor’s mental health priorities
•    this will be achieved via the Mayor’s mandated mental health priorities, the HIS, and the London Vision as overseen by London’s Health and Care Partnership.
2.2.    As the programme develops, activity and deliverables towards achieving these objectives will be refined and confirmed at key points in the delivery timeline. Monthly programme meetings will assure GLA oversight that: delivery is on track; and the GLA can demonstrate tangible impact and value for money. 

2.3.    Thrive LDN is particularly well placed to achieve the objectives listed at paragraphs 2.4-2.5, below. This is due to: 
•    experience in delivering targeted mental health and wellbeing programmes for the GLA
•    convening power within London’s health and care system
•    leadership in public mental health research (including the new £7m UK Research and Innovation consortium for Population Health Improvement)
•    a robust equality, diversity and inclusion (EDI) framework
•    strong links to the voluntary and community sector, education sector, and the NHS.
2.4.    Thrive LDN’s core enabling functions will deliver against the following objectives: 
•    Thrive LDN will convene partners from across London’s health and care system to support collaboration, and drive action and impact. This will include engagement with London’s Health and Care Partnership, and the voluntary and community sector; and a commitment to embed evidence and lived experience.
•    Thrive LDN will produce key data analysis, research and insight to support an evidence-led approach to delivering the Mayor’s mental health priorities. 
•    Thrive LDN will provide resources and upskilling to London’s communities, workforce and frontline staff; this supports the mental health and wellbeing of Londoners and aligns with Mayoral manifesto commitments.
2.5.    Thrive LDN additional objectives will deliver against the following objectives:
•    Once the GLA has published delivery plans against the Mayoral mandated mental health priorities supporting Londoners’ health and wellbeing, Thrive LDN will work with GLA officers to develop and deliver specific activities to support strategic outcomes.
•    As part of this programme, Thrive LDN will convene and support specialist organisations to support the Mayor’s mental health objectives and outcomes. This may include organisations from the voluntary and community sector; and specialist organisations supporting children and young Londoners.
 

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 Public Sector Equality Duty requires the identification and evaluation of the likely potential impacts, both positive and negative, of the decision on those with protected characteristics (age, disability, gender reassignment, pregnancy and maternity, race, sex, religion or belief, sexual orientation).
3.3.    Reducing inequalities in health, and promoting health equity, underpins the work of the health and wellbeing team. Health inequalities are differences in health that are unnecessary, avoidable, unjust and unfair. They often exist between groups of people who have protected characteristics, and who experience poverty and socioeconomic deprivation.
3.4.    The Mayor’s EDI strategy sets out how the Mayor will help address the inequalities, barriers and discrimination experienced by groups protected by the Equality Act 2010. The above work programme aligns with the Mayor’s EDI strategy objectives (2022). In particular:
•    objective 12 commits to addressing the reasons for health inequalities that cause some groups to experience poorer physical and mental health outcomes
•    objective 14 commits to ensuring London's diverse communities have the knowledge, networks, and volunteering opportunities they need to thrive. 
3.5.    All activities within the Thrive LDN work programme 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. 
3.6.    In 2022-23, an EDI framework for Thrive LDN, and accompanying Equality Impact Assessment template, were 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
•    ensure Thrive LDN delivers accessible, inclusive and responsive activities to Londoners and their communities, including those from racialised and 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. The major risks with this funding agreement (at the time of writing) are summarised below:

4.2.    This work has the following links to Mayoral strategies and programmes:
•    The GLA health programme is directly related to delivery of the Mayor’s HIS, a statutory duty under the GLA Act 1999. 
•    In December 2021, the Mayor published the HIS Implementation Plan 2021-24, setting out GLA and partner commitments. 
•    The Thrive LDN mental health work programme will be directly responding to two Mayoral mental health priorities: supporting and inspiring young Londoners; and reducing inequalities, which includes work in the healthy children, healthy minds and healthy communities aims of the HIS.
Impact assessment and consultations
4.3.    There are no known conflicts of interest to note for any of those involved in the drafting or clearance of this decision. 
4.4.    As the delivery timeline is developed in line with the activity table and programme milestones, impact assessment and consultation will be conducted at key points as and when necessary. 
Subsidy control
4.5.    The Thrive LDN programme, hosted at Royal Free, is a London-wide mental health project. It is part of London’s health and care infrastructure, with leadership from, and accountability to, the London Health Board. It also has its own independent advisory board, which has broad, cross-sectoral membership from across London. The Thrive LDN programme is uniquely placed, in its relationships across London’s health and care infrastructure, to undertake the work; and achieve the aims and objectives set out above. The Royal Free is the only body currently hosting and resourced to support a pan-London programme of this nature. We do not believe there is any other organisation similarly well placed and able to undertake this work and meet the objectives set out.

4.6.    In decision one above, the officers are seeking approval of up to £300,000 funding to the Royal Free. The grant will partially fund the Royal Free’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 Royal Free by the GLA may be viewed as grant funding rather than a contract.

4.7.    This MD is a continuation of work that the Mayor of London has previously funded. We have identified the need to maintain 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.

4.8.    The Royal Free 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 Royal Free 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.

4.9.    In addition to funding from the Mayor of London, the Royal Free receives funding for Thrive LDN from not only the Mayor of London, but also the NHS, several London boroughs, and OHID London. Thrive LDN is not a core NHS service; without funding provided by the GLA, it would not be possible for the Royal Free 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, that 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 Royal Free has an established level of expertise in this work area that 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 Royal Free would not be able to deliver this service without the grant, as it is outside of the scope of the Royal Free’s grant from NHS England.
4.12.    The funding is not considered a subsidy for the purposes of the Subsidy Control Act 2022, in line with the four-limbed test. The funding will not have, and is not capable of having, an effect on i) competition or investment within the United Kingdom, ii) trade between the United Kingdom and a country or territory outside the United Kingdom, or iii) investment as between the United Kingdom and a country or territory outside the United Kingdom. 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 currently available to address this need. 
 

5.1.    This Decision seeks approval for the expenditure of £300,000 in 2024-25, for the Thrive LDN work programme to deliver core enabling functions and additional deliverables that support the Mayor’s mental health commitments. This will be awarded, by a grant, to the Royal Free and serves as the GLA’s financial contribution to Thrive LDN for 2024-25. 
5.2.    This expenditure would be funded from the Thrive London programme budget within the Health and Wellbeing team in 2024-25.

5.3.    There is sufficient budget within the Health and Wellbeing team to meet the expenditure of £300,000 in 2024-25.
 

Power to undertake the requested decisions
6.1.    The foregoing sections of this report indicate that the decisions requested of the Mayor concern the exercise of the GLA’s general powers, and fall within the GLA’s statutory power to do such things considered to further, or that are facilitative of, or conducive or incidental to, the promotion of social development within Greater London. In formulating the proposals in respect of which a decision is sought, officers have complied with the GLA’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 UK
•    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, and foster good relations, 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 (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to section 3 (above) of this report.
Grant funding
6.3.    The proposed grant of up to £300,000 to the Royal Free may be viewed as a conditional gift rather than a contract for services and supplies. Section 12 of the GLA’s Contracts and Funding Code provides that decisions to award grant funding should generally be made based on the outcome of a transparent, competitive application process. To this end, officers have set out in paragraph 1.4 (above) how they have met that requirement. Officers are also reminded to put in place an appropriate funding agreement between the GLA and the Royal Free before any part of the funding be paid.
Subsidy control
6.4.    The Subsidy Control Act 2022 requires that grant funding be assessed in relation to its four-limbed test. Officers have made this assessment at paragraphs 4.5 to 4.13, above, and have a concluded that the proposed funding does not amount to a subsidy, as it does not satisfy Limb D of the four-limbed test.
 

7.1.    The project will be delivered according to the following timetable: