The Inner West London Mental Health Services Reconfiguration Joint Health Overview and Scrutiny Committee met to discuss the decision made by the Integrated Care Board (ICB) on 8 April regarding mental health services in West London and Kensington and Chelsea. The committee scrutinised the ICB's decision to endorse a plan that includes a reduction in inpatient mental health services, alongside the establishment of five step-up crisis beds and five step-down beds in the south of Westminster, jointly funded by Westminster City Council and the ICB. While committee members acknowledged the need for community mental health services, concerns were raised about the adequacy of the proposed model to meet the current demand and the impact on vulnerable residents.

Mental Health Service Reconfiguration

The main topic of discussion was the ICB's decision regarding the reconfiguration of mental health services, specifically the balance between inpatient and community services across Kensington, Chelsea, and Westminster.

Toby Lambert, Population Health representative for the ICB, explained that the decision followed a 16-week consultation and considered various options, including restoring services to pre-pandemic levels, reducing community services, or concentrating mental health beds at St Charles Hospital. The ICB decided to endorse the option presented in the decision-making business case, which includes the establishment of five step-up crisis beds and five step-down beds in the south of Westminster, alongside the redevelopment of the Gordon Hospital as a community-focused facility.

Councillor Iman Les, speaking on behalf of Councillor Butler, expressed Westminster Council's continued position that reopening the 51 acute mental health beds at the Gordon Hospital would be the best option for residents. While welcoming the proposal for 10 new beds, Councillor Iman Les stated that it did not go far enough to address the current levels of demand, especially given the challenges in accessing timely inpatient support and the increased demand for acute mental health support. Councillor Iman Les also raised concerns about the suitability of the community-based model for those experiencing homelessness and called for a mechanism to regularly review and scrutinise the long-term impact of the proposed new model.

Councillor Concia Albert echoed the concerns of Westminster Council and emphasised the need to ensure that the five step-up and five step-down beds open in 2025, without further delays. Councillor Concia Albert also raised concerns about the potential impact of the Grenfell Tower's demolition on the mental health of the wider community and stressed the need to ensure that the Mental Health Crisis Assessment Service (MCAS) at St Charles Hospital is adequately resourced to address these concerns.

Professor Amanda, reflecting on the history of the Gordon Hospital, noted that few hospitals have closed so suddenly and had their future debated for so long. She emphasised the importance of archiving the data and debate surrounding the closure for future policymakers and researchers. Professor Amanda also highlighted the need to ensure the sustainability and development of community services and the importance of close working relationships between adult social care, social housing, and mental health services.

Councillor Mona Ahmed asked where else in the country has closed or drastically reduced inpatient beds for mental health and severe mental health and then transitioned to community-based care. Gareth Jarvis, Medical Director of Abel Mental Health Services across Westminster, Cassie and Charlton, responded that he was not sure he could answer that.

Gareth Jarvis stated that CNWL was one of the highest bedded trusts anywhere in the country of head of population before the closure, and now sits just slightly above average. Graham, Chief Operating Officer at St. WL, clarified that residents of Westminster do have access to acute care, and that when the acute bed base across London is benchmarked, it is still over the average number of beds for the population that it serves.

Adequacy of Proposed 10 Beds

Councillor Lucy Knight asked how confident the panel felt that the 10 beds are really enough to meet the need, and what the trigger is for increasing that number if it is felt that the need is not being met.

Gareth Jarvis responded that there are currently about 35 patients across the bed base who are clinically ready for discharge, including 12 in Westminster. He stated that these individuals could be moved through, which would give more capacity in the inpatient units.

Expansion of the MCAS

Councillor Lucy Knight asked if the ICBs are still committed to the expansion of the MCAS service, what the next phase of development looks like, and if there is a risk of those plans being downgraded or diluted given the current financial pressures within the organisation.

Toby Lambert responded that the ICB has a medium-term financial strategy that envisages spending an ever-increasing share of its budget on mental health and community services, and a decreasing share on acute sites. He stated that the MCAS is a high-value service and that the ICB is still finding funding to establish another one.

Gareth Jarvis added that the ICB is really looking at the model of care that it delivers in crisis intervention and has doubled the number of people using the service through winter. He stated that the ICB is considering whether there are other spaces within the St Charles site that could potentially be used for the MCAS. He also mentioned that the ICB is working on how to put one on board between Hilo to Hiling and Hounslow, and that he is leading a piece of work across London to think about how to work to every locality, having access to some sort of service similar to this.

Timing for the Beds

Councillor Patricia McAllister asked about the timing for the beds. Toby Lambert responded that the ICB is still committed to opening them up during this fiscal year, by March 2026, and is hopeful that it can be done before that. He clarified that the decision to be made is between sites where the beds might be located, not about whether to proceed or not.

Impact of Gordon Closure on A&Es

Councillor Patricia McAllister raised concerns about the impact of the Gordon closure on A&Es and the pressures they have been seeing there. She noted that Leslie Watts, the CEO of Charleston Westminster, raised serious concerns about the impact on her trust at a recent ICB meeting.

Toby Lambert responded that Leslie Watts is one of the ICB's board members and endorsed the proposal as in the decision-making business case. He also pointed out that she has two A&Es, and the pressure is greater on the West Middlesex site at the moment than it is on the Chelsea and Westminster site. He stated that the triage at the front door of the hospital is having a material effect and removing patients who do not have a physical health need.

Costs of the 10 Beds

Councillor Lorraine Dean asked about the initial costs of the 10 beds, the running costs per year, and whether these beds will be reserved solely for Westminster residents.

Toby Lambert responded that the running costs are about £120,000 per year per bed, and that the initial cost depends on where they go. He stated that the ICB is looking at what is currently the car side nursing home, which is not currently placing residents into it because it has had CQC concerns. He confirmed that the beds will be reserved for Westminster residents, but that it would be unethical to deny a patient from somewhere else care if the care was available.

Services at the Gordon

Councillor Lorraine Dean asked about the services at the Gordon, and whether it would be possible to have sexual health services and substance misuse services based there as well.

Toby Lambert responded that it is certainly within the realm of possible, and that there is definitely no reason why not. He stated that each service requires a certain amount of space, and that the ICB can replace the BS of the services which make much sense to provide.

Impact on Health Inequalities

Councillor Anne Cyron raised concerns about the negative aspects of inpatient treatment, stating that it can be very restrictive and coercive and be traumatising. She stated that the thing that makes them be restrictive and coercive is because people are allowed to deteriorate for a very long time, and that by the time that they are qualifying for a bed, they are in crisis and therefore likely to need those really traumatising, coercive measures that we would be hoping to avoid. She also raised concerns about the impact that this is going to have on health inequalities for black people in particular, and especially for black people with severe and enduring mental illness.

Gareth Jarvis responded that the trust strives at every point to make inpatient care as comfortable and as therapeutic as possible. He stated that through these changes, the trust has doubled the amount of contacts that it has in the community for people, which has massively widened access to help supporting people more in the community than it used to be able to do.

Toby Lambert added that the trust has not seen an increasing share of people with black heritage coming through and being admitted as a result of these changes.

Rationale for 5+5 Beds

Councillor Patricia McAllister asked about the rationale for the five plus five beds, how the ICB considered how the five plus five would lessen the stress on St Charles, and why not 20.

Toby Lambert responded that the number of people who are waiting for housing is equivalent to about five. He stated that the step-up beds for the homeless provision is slightly more finger in the air around modelling, but that it is based on how many homeless people were admitted to the garden back when the beds were open.

Financial Impact

Councillor Patricia McAllister asked how the ICB is planning to pay for its half of the funding for the beds, and whether it is going to come out of the community support that it said that it has moved to.

Toby Lambert responded that it does not come from the existing services in Chelsea, Westminster, and that the ICB has been increasing the amount of money which has been going into its mental health services across the path. He clarified that it is new money, but that money that the ICB is spending on these beds cannot be spent on something else.

Involvement in Bed Replacement

Councillor Patricia McAllister asked if the committee can be involved in the replacement of the bed.

Toby Lambert responded that it is up to local authority colleagues to say how they wish to be involved in it, and that David is already very closely involved in this.

Future Proofing

Councillor Lucy Knight asked what future proofing looks like for the offer of five step-down beds and five crisis beds, and how the ICB knows that this is what is needed.

Toby Lambert responded that the severe and enduring mental illness or prevalence rate in Kensington, Chelsea and Westminster has actually been remarkably stable for quite a number of years. He stated that the ICB has modelled forward a projection of its mental health strategy with various scenarios, and that its mental health board looks regularly at the pattern of demand which it is seeing, matching what it has in the projections in order to give it time to respond.

Co-Location

Councillor Lucy Knight asked why the ICB would not consider the Gordon as the main location for the beds, knowing that co-location of all staff and all residents would be a good thing.

Graham responded that the Gordon is a very institutional building, and that in terms of helping people feel like they are transitioning back into the community, being part of the community, and a less stigmatising environment, the ICB is not sure that that actually represents the best place that it could be.

Reconciliation of Data

Councillor Lucy Knight asked how the ICB is going to get the reconciliation of data right to avoid the dispute that it still has, and to ensure that whatever it is working on is data that it both agrees on from the beginning.

David responded that the trust and the local authorities record information in a slightly different way, but that this has actually improved. He stated that there is very good joint work between the two councils and the trust on how they can improve that further moving forward. He added that the ICB is committed to doing the reconciliation of the data month by month, so that it can actually look through it again and know who that patient is and what actually happened to them.

Housing

Councillor Lucy Knight asked where housing sits in terms of the development of this proposal.

David responded that the interface with the local authority housing colleagues has been seen slightly more with the local authority colleagues than it has with the trust. He stated that Claire Fernie has been the to the point person interacting with the housing, and that he is personally not totally up to speed in where she has got to.

Ealing Harnslo MCAS

Councillor Lucy Knight asked where the money is coming from for the Ealing Harnslo MCAS.

Toby Lambert responded that it is part of the increase of the money that is getting into mental health, and that every year the ICB increases the amount of money which it spends on mental health in real terms.

Monitoring

Lucy asked how the committee will monitor this, and how it will ensure that it does not just take its finger off the pulse on this and is keeping an eye on what the model looks like, what the results are, and whether it is witnessing areas which it needs to have raised concern about.

The chair responded that this committee was set up for a specific purpose, which was to scrutinise the decision that has now been made, and that this is the final meeting of the committee because it has fulfilled its purpose. She suggested that if the committee wanted to continue to be involved, it would be through the Borough Social Care and Health Scrutiny Committee, not this committee, because it is not within its limits to continue to meet.

Closing Remarks

In closing, representatives from CNWL and the ICB thanked the committee for its scrutiny and support, acknowledging the challenging conversations and the progress made towards a compromise. They expressed commitment to working together for the betterment of residents and acknowledged the contributions of Councillor Aaron Dole, especially around homelessness.