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Outcomes-based commissioning and public service transformation in Mosaic Clubhouse Lambeth

Change management

In 2010 Mosaic Clubhouse began negotiations with Lambeth Council about moving to new more central premises in Brixton and running an enhanced service. The new service specification was a potential threat to the well-established co-production values and principles enshrined in the Clubhouse Model.

There are 36 recovery and co-production standards that govern all Clubhouses and they include standards such as “membership is voluntary and without time limits.”  Performance against the 36 standards is assessed very closely by the international Clubhouse faculty and includes a lengthy self-assessment and a three day visit by a faculty staff and faculty member. This then gives a “licence to operate” for between 1 - 3 years depending on adherence to the standards.

As Mosaic Clubhouse is one of only 10 international training bases, it must always achieve 3 years accreditation. In the case of standard number 1 (above) commissioners were pressing for a “reablement” model, suggesting that it should be possible to offer anyone with a serious mental health condition an individualised twelve week programme that would enable them to set and achieve their recovery goals. This was not envisaged as being part of a Clubhouse programme, but as a separate 1:1 support. Standard 9 states “Clubhouse staff are sufficient to engage the membership, yet few enough to make carrying out their responsibilities impossible without member involvement”.

Standard 10 states “Clubhouse staff have generalist roles. All staff share employment, housing, evening and weekend, holiday and unit responsibilities. Clubhouse staff do not divide their time between Clubhouse and other major work responsibilities that conflict with the unique nature of member / staff relationships.”

Standard 13 “The Clubhouse is located in its own physical space. It is separate from any mental health centre and is impermeable to other programmes…”

These standards (and others) were at risk of being compromised by its new role as hosts of the Lambeth Living Well Partnership – that required the Clubhouse to offer space to other agencies; to deliver a 1:1 twelve week programme to individuals; and to run an information service open to the public five days a week as a drop-in, e-mail or telephone service (the so-called information hub). It was also expected to open an enlarged café to the public so that people could “drop in” for information food and drink and so that mental health professionals could use the café to meet their patients in a community setting. Finally, it was informed that the space identified for its education and employment department would be available for any other mental health organisations in the borough for use either for meetings, or running traditional drop-in activities, all of which fundamentally seemed to threaten the Clubhouse Model in the worst possible way.

However, the Clubhouse managed to agree on a wider co-produced service model which meant that the Clubhouse involved members in the design and delivery of the new services. As a result, Mosaic Clubhouse agreed to deliver the information service “side by side” and to integrate the new 12 week offering into the regular Clubhouse work.

Clubhouse members were also heavily involved in the discussions at all times when a £1million refurbishment was planned on an existing council (ex-day hospital) building. The building was adapted to meet the needs of a 21st century Clubhouse.  It is light and airy with open spaces in all departments to support members to see the work being done each day, thereby encouraging engagement and a recovery journey.

The move on 30th April 2013 gave staff and members time to work together to fully equip the new building, plant the garden, review all policies and procedures, carry out all necessary training (in particular, health and safety and food hygiene as the café and information hub are both open to the public). The expanded service meant recruiting six extra staff and ensuring that all staff and more members were trained in the Clubhouse Model. The information hub formally opened in September 2013 while the Clubhouse component was operational immediately.

About this case study
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Maresa Ness, CEO of Mosaic Clubhouse

Maresa Ness, Chief Executive of Mosaic Clubhouse, wrote this case study for Governance International in December 2014. 

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