The future of acute mental health services for adult residents in the Bi-Borough

About The Consultation 

Together with Westminster City Council and Kensington & Chelsea Council, the North West London Integrated Care Board (ICB) has led consultations supported by the Central and North West London NHS Foundation Trust – the NHS branch that provides mental health care for the population of the bi-borough.

The consultation period started in October 2023 and terminated in February 2024. Its main aim was to understand local people’s views about the proposed changes to acute mental health services for residents in Westminster and Kensington and Chelsea, following the closure of acute mental health services at the Gordon Hospital. You can read the full report here.

Three main options were proposed:

Option 1.

This option would comprise of establishing 118 inpatient beds across two sites, divided between St Charles Hospital (67 beds) and the Gordon Hospital (51 beds). However, the Gordon Hospital facilities would meet “safe” standards but not “desired” standards, due to the constraints of the building. There would be less additional capacity created in Brent than in the preferred Option 3, so some of the beds at St Charles would still be used by Brent residents. Community and crisis services developed since March 2020 would be cut, with these being reduced or stopped entirely.

Option 2. 

This option involves distributing 80 beds across two sites: 67 at St Charles and 13 in a single ward in the Gordon Hospital. This option would result in a significant reduction of community and crisis services, including the closure of the Mental Health Crisis Assessment Service (MHCAS), as staff would have to be redeployed to support inpatient care. Voluntary sector partnerships would remain in place and the Community Access Service would continue. There would be less additional capacity created in Brent than in the preferred Option 3, so some of the beds at St Charles would still be used by Brent residents.

Option 3. (the preferred option)

This option is closest to the current service, with 67 inpatient beds at St Charles (as now), supplemented by the MHCAS service expanded and relocated to the Gordon Hospital with capacity for 12 patients, including the capability for 4 patients to be admitted overnight. Additional capacity in Brent would free up seven beds at St Charles. This option retains the community and crisis services developed since the Gordon Hospital wards were closed, voluntary sector partnerships would remain in place and the Community Access Service (CAS) would continue.

Contribution from Healthwatch

We made a formal response to the consultation and hosted an online engagement session. Healthwatch Kensington and Chelsea and Healthwatch Westminster also conducted various meetings and events between June–September 2023, allowing a total of 133 service users, staff and stakeholders to share their views. The overall consensus was that while preventive and community-based interventions are valuable, they do not make up for a lack of acute mental health beds and are not sufficient to meet Westminster’s urgent and unique mental health needs.

MHCAS

The Mental Health Crisis Assessment Service (MHCAS) provides a therapeutic alternative to attending Accident and Emergency (A&E) for anyone over 18 years old experiencing a mental health crisis. The consultation found that there were mixed views on the MHCAS. 

Option 3 proposed the relocation of MHCAS to the Gordon Hospital which was felt by some to be an unacceptable loss of services for people in north Kensington. Others who lived close to the Gordon Hospital feared that anti-social behaviour, disturbances, light pollution and traffic around the Gordon Hospital site would return as a result of MHCAS.

Positive views included that having MHCAS services at the Gordon Hospital would result in shorter A&E stays for people in a mental health crisis and it would benefit service users who felt traumatised in hospitals.

Homelessness

People said that since the Gordon Hospital’s inpatient mental health services closed, the care that had been provided there has been lost along with the expertise in homeless healthcare. 

The location of the Gordon Hospital meant that local people sleeping rough were supported by a team well connected with local and trusted agencies. Removing this was said to have led to people being discharged before assessment, a lack of continuity of care and a loss of trust from rough sleepers, resulting in them being lost from the system.

Future steps

Overall opinions are polarised. Over half of those completing the questionnaire either agreed strongly or disagreed strongly with the preferred option.

Suggestions were made for improving MHCAS services:

• Clarity on routes into the MHCAS service and better communication for health professionals, service users and support services 
• Having MHCAS services at both St Charles Hospital and the Gordon Hospital 
• Having therapeutic services in MHCAS, including peer support workers and psychologists
• Clarity on how safety of staff and patients will be ensured by demonstrating a safe staffing model and a clear response plan 
• It was suggested that this should include security staff trained to manage service users in mental health crisis and a new access point for staff.

There was broad agreement that a bespoke service is needed to support people sleeping rough to better reflect their needs, such as:

• The challenge of accessing services and attending appointments 
• Greater likelihood of reaching crisis point before they engage with services 
• Additional trauma through experiencing crisis on the streets 
• The need for respite from chaotic lives and to have some stability and safety to enable recovery
• The need for a holistic service providing rest, nourishment and access other health and care support.