The Inner West London Mental Health Services Reconfiguration Joint Health Overview and Scrutiny Committee met to discuss the proposed reconfiguration of NHS mental health services. Key discussions included concerns about the consultation process, the quality of consultation documents, and the impact of proposed changes on local residents and services. The committee also reviewed the pre-consultation business case and heard contributions from residents.

Concerns Over Consultation Process and Document Quality

A significant portion of the meeting was dedicated to concerns raised by councillors and residents regarding the consultation process for the mental health services reconfiguration. Councillor Concia Albert, Cabinet Member for Adult Social Care, Public Health and Voluntary Sector at Westminster City Council (WCC), described the consultation documents as poor and biased, arguing that they presented the current system as adequate and only requiring minor adjustments. This view was contrasted with the experiences of WCC's social workers and housing officials, who reportedly did not believe major reform was necessary.

Concerns were also raised about the accessibility and reach of the consultation. Councillor Albert highlighted that many groups, including the homeless, had not been adequately consulted, and that service partners had also expressed that they had not been contacted. Residents also reported issues with consultation meetings, including a lack of clear signposting, low attendance, and a feeling that attendees were not able to voice their opinions freely. The Chief Strategy and Digital Officer at Central and North West London NHS Foundation Trust (CNWL), Ross Graves, stated that they would provide a list of consulted groups and acknowledged that more work could be done to reach certain demographics.

The Executive Director of Strategy and Population Health at North West London Integrated Care Board (NWLICB), Toby Lambert, confirmed that the consultation deadline had been extended to 16th February 2024 to address these concerns. However, the timing of the consultation report's publication, scheduled for 29th March, falls within the pre-election restricted period, meaning the committee would likely not meet to discuss it until May.

Impact of Reconfiguration on Local Services and Residents

Councillors and residents voiced significant concerns about the potential impact of the proposed reconfiguration on local services and residents. Councillor Albert presented data suggesting an increase in the need for acute hospital care and a rise in suicide rates in both Westminster and Kensington and Chelsea. She also highlighted difficulties faced by A&E departments at St Mary's Hospital, increased time spent by police dealing with mental health issues, and the strain on social workers due to increased travel distances to see clients.

Councillor Gillian Arrindell, Lead Member for Adult Social Care and Public Health at the Royal Borough of Kensington and Chelsea (K&C), expressed a preference for Option 1, which would involve reopening both St Charles and the Gordon Hospital. She detailed how the closure of the Gordon Hospital had led to a significant increase in K&C residents being treated out of borough, causing inconvenience and distress to patients and their families. She also noted a decline in K&C residents being admitted to St Charles due to competition with Westminster residents.

Concerns were also raised about the potential withdrawal of community services under some of the proposed options, which was seen as counterproductive given the increasing need for such support. The impact on vulnerable groups, including the homeless and those affected by the Grenfell Tower tragedy, was a recurring theme, with residents and councillors questioning whether their specific needs had been adequately considered in the proposals.

The Pre-Consultation Business Case and Service Models

The pre-consultation business case and the proposed service models were scrutinised. Councillor Albert questioned the claim of a 30% drop in monthly admissions, suggesting it might be a result of reduced bed capacity. She also argued that additional investment in community services should not be contingent on closing inpatient facilities.

Graeme Caul, Chief Operating Officer at CNWL, responded that reopening the Gordon Hospital would be unaffordable and that the building was not considered safe for the types of patients requiring inpatient care. He explained that the current financial envelope necessitated difficult choices about service configuration. The EDSPH reiterated that the proposals were based on evidence favouring treatment in the least restrictive setting, citing the Royal College of Psychiatrists' view that patients recover faster closer to home.

The Medical Director of Jameson Division at CNWL, Dr Gareth Jarvis, addressed concerns about the Mental Health Crisis Assessment Service (MHCAS), stating it operates 24/7 and is more highly staffed than a typical ward, allowing for intensive support. However, he cautioned that reopening the Gordon Hospital for MHCAS would be an expensive model that CNWL could not afford to duplicate.

Addressing Staffing, Compassion, and Community Links

The meeting also touched upon staffing, compassion in care, and the importance of community links. Councillor Anne Cyron highlighted accounts from the Voice Exchange report detailing a lack of compassion and empathy from some staff, and instances where family members felt excluded. Dr Jarvis acknowledged these concerns and outlined initiatives such as the Open Dialogue pilot programme in South Westminster, which focuses on family systemic approaches and involving key individuals in a patient's life. He also mentioned trauma-informed care training and the Triangle of Care commitment, which involves a Carers Council holding CNWL accountable.

The Healthwatch representative emphasised the need for stronger links between inpatient staff and homelessness support workers, noting that these links had previously existed with staff at the Gordon Hospital. They also reiterated concerns about the consultation process, particularly the overemphasis on Option 3 and the lack of meaningful discussion on alternative options.

Specific Concerns Regarding the Gordon Hospital and Grenfell

The proposed relocation of the MHCAS from St Charles Centre for Health and Wellbeing to the Gordon Hospital site was met with strong opposition. Councillor Arrindell and others highlighted the ongoing trauma experienced by residents in North Kensington following the Grenfell Tower tragedy, arguing that moving a mental health service to the Gordon Hospital site would be insensitive and inaccessible for those affected.

Data and Information Gaps

A recurring theme throughout the meeting was the perceived lack of data and information provided by CNWL and NWLICB. Councillors and residents repeatedly stated that they had requested specific data on expenditure, impact assessments, and consultation attendance, but had not received satisfactory responses. This lack of transparency contributed to frustration and a feeling that the process was not being conducted fairly.

The meeting concluded with a reminder of the next scheduled meeting on 23rd January 2024.