The Inner West London Mental Health Services Reconfiguration Joint Health Overview and Scrutiny Committee met to scrutinise proposals for the reconfiguration of NHS mental health services. Key discussions focused on the adequacy of the public consultation process, the clinical case for change, and the impact of proposed service model changes on patients and partner organisations. The committee heard concerns about the consultation's reach and bias, and debated the merits of different options for future service provision, particularly regarding inpatient bed numbers and community-based alternatives.

Mental Health Services Reconfiguration Consultation

The committee discussed the ongoing consultation regarding the reconfiguration of acute mental health services in Westminster and Kensington and Chelsea. Concerns were raised that the consultation process was being rushed, with significant groups, including the homeless and various service partners, feeling inadequately consulted. Councillor Gillian Arrindell, Cabinet Member for Adult Social Care, Public Health and Voluntary Sector at Westminster City Council, described the consultation documents as poor and biased, arguing that the current system was sufficient and only required minor adjustments. She highlighted data from Westminster showing increased assessments and demand for acute hospital care, alongside a rise in suicides in both boroughs. Councillor Lorraine Dean, Lead Member for Adult Social Care and Public Health at Kensington and Chelsea, expressed a preference for Option 1, which would restore inpatient services at both St Charles and the Gordon Hospital, citing increased out-of-borough placements and travel times for residents.

Representatives from North West London Integrated Care Board (NWLICB) and Central and North West London NHS Foundation Trust (CNWL) defended the consultation process, stating it was designed to be as wide-ranging as possible and had been extended to February 16th, 2024, to allow for further input. They acknowledged difficulties in reaching certain groups but committed to providing a list of consulted organisations and continuing outreach efforts. The Medical Director of Jameson Division at CNWL, Dr Gareth Jarvis, stated that reopening the Gordon Hospital with its current limitations would be unaffordable and unsafe for patients, and that the preferred option focused on community-based care aligned with national best practice.

The committee also heard from Professor Jill Manthorpe, Emerita Professor of Social Work at King's College, who noted the lack of detailed financial information in the consultation documents and questioned the reliance on pilot schemes rather than proven models. She also raised concerns about the clarity of the Mental Health Crisis Assessment Service (MHCAS) model and its legal basis. The Healthwatch representative highlighted the need for stronger links between inpatient staff and homelessness support workers, and reiterated concerns about the consultation's focus on Option 3, limiting meaningful discussion on alternatives.

CNWL clarified that the MHCAS is highly staffed and provides intensive care, and that the number of out-of-area placements had been minimised. They also explained that the consultation document's preferred option was based on clinical evidence favouring community-based care and the least restrictive setting.

Debate on Service Models and Facilities

A significant portion of the meeting was dedicated to discussing the proposed options for the future of mental health services, particularly concerning the balance between inpatient beds and community-based alternatives, and the use of facilities like the Gordon Hospital.

Councillor Arrindell advocated for maintaining community services, reopening the Gordon Hospital, and reforming the MHCAS, arguing that this would provide adequate local provision. However, the Chief Operating Officer at CNWL, Graeme Caul, stated that this preferred option was unaffordable and that the Gordon Hospital's building was not safe for the type of patients requiring inpatient care, requiring significant and costly upgrades.

The Executive Director of Strategy and Population Health at NWLICB, Toby Lambert, rejected claims that the consultation was biased, emphasizing that the proposals were based on the principle of treating patients in the least restrictive setting appropriate for them, citing evidence from the Royal College of Psychiatrists. He also noted that additional funding from the NHS Long-Term Plan was ringfenced for community services and would remain regardless of the chosen option.

Concerns were raised about the impact of inadequate care on the local community, including anti-social behaviour and increased police intervention. The Medical Director stressed that provision had increased to meet demand and that acute mental health beds would be provided where needed, but that the decrease in admissions was due to expanded community care.

The committee questioned the framework for the proposed options, with Councillor Anne Cyron highlighting the lack of comparative data on A&E waiting times before and after the Gordon Hospital's closure, making it difficult to definitively link changes in waiting times to the reduction in acute beds.

The EDSPH conceded that statistics on waiting times prior to 2018/19 were insufficient for a direct comparison, but stated that current A&E waiting times were too high and needed to be reduced. He explained that the MHCAS aims to improve patient flow and reduce waits by treating more people intensively earlier, allowing them to be moved into community settings.

Concerns were also raised about the potential relocation of the MHCAS from St Charles Centre for Health and Wellbeing to the Gordon Hospital, particularly in light of the Grenfell Tower tragedy and the potential trauma associated with the Gordon site for North Kensington residents. CNWL stated that the Gordon Hospital site was not suitable for long-term inpatient care due to its physical limitations but could be adapted for a crisis assessment service.

Work Programme and Future Timelines

The committee discussed the work programme, with concerns raised about the consultation process being rushed. The NWLICB extended the consultation deadline to February 16th, 2024. However, the publication of the consultation report on March 29th falls within the pre-election period, meaning the committee's review of the report would likely be delayed until May. The NWLICB plans to make a final decision on July 16th, with further discussions needed to schedule a committee meeting to discuss this decision, avoiding the school summer holidays.

Outstanding Actions

An outstanding action from the previous meeting regarding the breakdown of the £2.3 billion award spent in each borough remains unfulfilled. The EDSPH committed to providing this information at the next meeting. The committee also requested a breakdown of the £50 million allocated for Grenfell recovery, acknowledging the difficulty in obtaining this due to privacy concerns.

RESOLVED DECISIONS

• The minutes of the previous meeting held on December 11th, 2023, were agreed as a correct record.
• The Work Programme Report was agreed.

ACTION POINTS

• The Executive Director of Strategy and Population Health at NWLICB will provide information on the breakdown of the £2.3 billion award spent in each borough.
• The Medical Director (MD) of Jameson Division at CNWL will respond in writing to concerns raised by the Lead Member for Adult Social Care and Public Health at K&C regarding the consultation.
• The Chief Operating Officer at CNWL will provide a definitive response on the time required to refurbish the Gordon Hospital site for MHCAS.
• The EDSPH will provide a list of groups that have been consulted and those who have been invited to participate in the consultation.

The meeting was held on Thursday, 11 January 2024, and concluded at 8:45 pm.