Agenda item

This report from West London NHS Trust provides the following information for the Committee to consider:

·      A summary of West London NHS Trust’s enhanced engagement process on Ealing adult acute mental health beds.

·      Feedback received during the enhanced engagement process and the full feedback report (Appendix 1).

·      The Trust’s emerging response in evaluating the feedback from all of the engagement activities to date. The Trust has determined that there are three realistic options, upon which a Public Meeting of the West London NHS Trust Board will be invited to make a recommendation.

The learning from the enhanced engagement process has been shared with West London NHS Trust Board in a private session, further opportunities for scrutiny of the engagement activities and emerging response are proposed in all Boroughs before the Trust Board makes its decision at a future Public Meeting. The paper presented here in the Trust’s preferred format may be amended in light of further feedback received but will largely form the final decision-making paper.

Dr Christopher Hilton (Chief Operating Officer - Local and Specialist Services at West London NHS Trust), Helen Mangan (West London NHS Trust), and Catherine Murray (West London NHS Trust) presented the report which provided:

• A summary of West London NHS Trust’s enhanced engagement process on Ealing adult acute mental health beds.
• Feedback received during the enhanced engagement process.
• The Trust’s emerging response in evaluating the feedback from all of the engagement activities to date.

Dr Hilton said the Trust had determined there were three options upon which a public meeting of the West London NHS Trust Board would be invited to make a recommendation. Those options were:

• Reverse the temporary provision, including reopening two wards and closing provision that had been funded with the reinvested revenue.
• Continue with the temporary provision, further delaying any final decision.
• Make permanent the current arrangements and put in mitigations to address concerns. This was the Trust’s preferred option.

Councillor Amanda Lloyd-Harris asked for the details about the investments mentioned in the report to be circulated to the Committee.

ACTION: Dr Hilton

Councillor Lloyd-Harris asked for answers in writing to the PAC’s questions from the previous meeting.

ACTION: Dr Hilton

Councillor Lloyd-Harris asked if the consultation responses had been weighted based on whether respondents had experience of the services in question or not. Catherine said the feedback hadn’t been weighted.

Councillor Genevieve Nwaogbe asked what the impact of opening the beds back up would be. Dr Hilton said the biggest impact would be on staffing capacity. They would have to move staff from community services back into the bedded units.

Councillor Nwaogbe asked if it was possible to hire dedicated staff rather than closing beds. Dr Hilton said they made the change because it wasn’t possible to provide safe care in the old facilities, but they wanted to ensure they were reinvesting the money saved into crisis pathways.

Jim Grealy commented that there should be a strategy across the whole of North West London looking at need, financing, and resourcing. He noted that members had been told no closures would proceed until a strategy had gone out to all stakeholders for consultation, but this closure and other similar closures in neighbouring boroughs were moving forward.

He noted that, according to the report, only 10 percent of people agreed with the proposals but they seemed to be going ahead regardless.

The Chair agreed and said it was concerning to see proposals seemingly made in isolation, without a clear strategy looking at the bigger picture.

Councillor Ben Coleman (Deputy Leader and Cabinet Member for Health and Social Care) commented that the ICB had said there wouldn’t be any bed closures until a mental health strategy covering all eight North West London boroughs was in place. Dr Hilton said he was not a part of that meeting, but he said the Trust recognised the feedback about needing a strategy and they were contributing to that now.

Councillor Coleman asked if the commitment not to close beds without a strategy in place had been communicated to him. Dr Hilton said it hadn’t.

Councillor Daniel Crawford (Vice Chair of the North West London Joint Health Overview and Scrutiny Committee) addressed the Committee said his members were very disappointed with the lack of formal public consultation. This was a substantial change that jeopardised people who needed access to mental health services.

Merril Hammer (Hammersmith & Fulham Save Our NHS) noted that the current proposals were based on pre-Covid papers and statistics when it had been agreed that any plans should be based on local, up-to-date data.

The Chair said the Committee could put forward a formal request not to go forward with any bed closures until an agreed strategy was in place.

Dr Hilton said the Trust recognised the concerns and were engaged in developing a strategy. He said he would seek clarity from Rob Hurd and Penny Dash about this issue. He noted that the paper submitted to the Committee included the findings of an engagement process and a case for change document had been shared previously that looked at demographic and population changes. He said the Trust were committed to joint working across North West London but for historical reasons, the NHS had managed beds separately hence the different approaches.

The Chair asked when the Committee could get clarification on this issue and, given the concerns raised, she asked if the final paper to the Board would change. Dr Hilton said he would seek clarification tomorrow (on 27 April). The feedback received would inform further iterations of the paper before the Board’s decision.

Victoria Brignell (Action on Disability) asked if waiting lists had gone up or down. Dr Hilton said there weren’t waiting lists for these services but there was little change to the ‘time to admit’.

Councillor Patricia Quigley asked how much co-production with disabled people had taken place. Catherine Murray said co-production work with 280 people had taken place in the pre-engagement stage.

Councillor Quigley highlighted some outdated language in the consultation report such as ‘wheelchair bound’ and ‘help to walk’ rather than ‘walking aids’. She said it should have been co-produced with disabled people to avoid these errors. Dr Hilton said the document had been produced by an external organisation and the Trust would provide feedback to them.

ACTION: Dr Hilton

Councillor Coleman asked what the difference was between Central and North West London’s consultation on Gordon Hospital and the enhanced engagement done by North West London Trust. Dr Hilton said there were not a lot of material differences.

Councillor Coleman asked why the Trust was not doing what 80 percent of respondents said they wanted in the consultation. Dr Hilton said some people may not have believed the rationale given. He said the Trust had made efforts to explain what they were trying to do and address people’s concerns. The feedback had resulted in some changes and informed their thinking.

Councillor Coleman asked if the Trust needed the 13 acute beds they planned to close. Dr Hilton said he didn’t think they needed them given the service had been able to manage for the past three years without them.

Councillor Coleman asked if there was too much capacity before, or if fewer people needed them now. Dr Hilton said they were on the higher end before and benchmarking illustrated that. He noted that modern mental health pathways suggested using less restrictive provision, preferring to support people in virtual wards. Councillor Colemans asked why not close all 31 beds in that case. Dr Hilton said the Trust could manage with 13 fewer beds.

Councillor Coleman said there needed to be a detailed discussion about whether the beds were necessary, and partners needed to learn from that before the final decision was taken. He suggested pausing and looking at the Westminster outcome before any changes were made.

The Chair asked members if they supported the recommendation to continue with the temporary suspension until further information was gathered (Option 2). Members agreed the recommendation.

Merril Hammer asked if there had been any change in the pattern of re-admissions. She also asked if there was any analysis of which communities they came from. Dr Hilton said they were looking at re-admission data, but he wasn’t sure it was broken down by ethnicity. He said he would take it away and provide a written response with the figures requested.

ACTION: Dr Hilton

Jim Grealy asked how the Trust planned to keep in touch and update respondents. He was concerned there would be a loss of trust and said they needed to find a way to re-engage.

Dr Hilton agreed that the Trust needed to provide further feedback and explain their thinking to the community. There should be more conversation through Healthwatch and community champions.

The Chair summed up the discussion and noted the following actions:

• Questions from the previous meeting should be responded to in writing.
• The Committee sought clarification about the commitment not to close beds until the Mental Health Strategy had been finalised.
• The Committee asked that feedback from this meeting, including their recommendation to continue with the temporary suspension until further information was gathered (Option 2).
• The Committee asked the Trust to be more mindful of the use of inclusive language and co-produce future consultations with disabled people.
• Members requested a breakdown of re-admission data by ethnicity.
• Members requested a plan to re-engage the people who participated in the engagement exercise.

The Chair thanked members, officers, and guests for their contributions.

RESOLVED

1. That the Committee noted and commented on the report and the Trust’s emerging response to the enhanced engagement activities.