The Inner Sydney Urban Partnership for Health and Wellbeing

The Inner Sydney Urban Partnership is a Collaborative Impact Initiative (CII) bringing together a network alliance of consumers, carers, health, social service providers and local community organisations determined to address the complex needs and adverse trajectories of a vulnerable inner city populations affected by drug and alcohol, mental illness, physical co-morbidities, housing instability or homelessness.

The Urban Partnership has bought together people, practitioners and leaders across a local network of care, to support the co-design and co-development of alternative community based systems that will not only reduce barriers to health and support but will create the driving force to shift from the current dependence on crisis care through ambulance, police, ED attendances and inpatient admissions, that are expensive in resources and ineffective in addressing the complex situations and drivers of people’s health and wellbeing.

The Urban Partnership has been an important innovation by placing St Vincent’s Hospital, one of Australia's major tertiary health services, at the centre of an integrated mental health care partnership with a full range of community organisations, enabling the skills of a large hospital to be available to support smaller mental health organisations and those providing care in the community, who can touch and make a difference to the individuals involved.

For St Vincent’s this is a return to its heritage of ‘curb-side care’ - a return of mental health care to the homes, places and communities where people live, rather than in hospital. It provides the opportunity to redevelop the network and model of care for people who are frequent users of crisis and ED services by supporting a shared care capability across primary care, community based mental health and social care and hospital based mental health, alcohol and drug support.

We have used a collaborative system design approach to shape the Urban Partnership, firstly as a relationship and trust building process to create a shared understanding of the role of individual services and capacity available through the partner members of the network and how these can be linked and coordinated through a shared model of care at a system level. We are moving from there to shared training and practice approaches for practitioners and finally a shared person centred plan to support integration at an individual level.

These are supported by a UP network infrastructure:

- A quality improvement and coordination capability to ensure alignment, quality, coherency and impact is achieved by the individual services and providers.

- A resource coordination and allocation capability to reorient resources currently consumed in crisis care towards building community based alternative capacity, using social investment approaches sponsored by state and national government.

- A shared data driven learning and performance development infrastructure to enables the Urban Partnership to understand the patterns and journeys through the network that frequent crisis users are making, to focus improvement and measure impact.

- An Urban Partnership Stewardship capability that includes leaders from across the network and local community to provide ongoing governance of the Urban Partnership as a whole.