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Acute mental health consultation

This puimage.pngblic consultation is now closed

The consultation ran from 24 October 2023 - 16 February 2024. Please see outcomes from the consultation.

We asked local people’s views about proposed changes to acute mental health services for residents in Westminster and Kensington and Chelsea.

Formal consultations submissions can be found here.

The documents of the related documents are below.

Archive of what we asked.

We are asking for local people’s views about proposed changes to acute mental health services for residents in Westminster and Kensington and Chelsea.

We would like to hear what you think about our proposal to:

  • Expand the mental health crisis assessment (MHCAS) service (previously piloted at St Charles) and move it to the Gordon Hospital. 
  • Keep 67 inpatient beds at St Charles (as now), supplemented by the MHCAS at the Gordon Hospital with room for 12 patients, including space for 4 patients to be admitted overnight alongside a full range of community-based services.

Before we make any decisions, we want to hear your views about our proposal and how it could affect you, your family, your loved ones, or someone who you are caring for. Your views will help make sure that we can provide the best possible care and support for residents in Westminster and Kensington and Chelsea with serious mental health needs.

These proposals have been developed with the help of residents with lived experience of mental health issues, clinicians, and partners from across health and social care - including local authorities, the police, and representatives from voluntary organisations.

We firmly believe that caring for and supporting people with severe mental health needs in community settings, closer to family and friends, helps people recover quicker, stay well for longer and live independently as part of their community. We recognise there are times when hospital admission is necessary and, on these occasions, we believe people deserve timely treatment in high quality hospital facilities.

These pages explain why changes are needed, summarises the consultation proposal, and tells you how you can find out more and have your say.

After the public consultation ends on 16 February 2024, all responses, comments, and feedback will be collated and analysed by an independent organisation.  

The results will be published as a post consultation report on the ICB website. The link for the report will be sent to anyone who gave us their contact details when they filled in our questionnaire. The report will also be shared widely with service user and local community groups who took part.   

To arrive at a final decision, the ICB will consider feedback from the public consultation as well as other information about mental health services at a board meeting held in pubic.

We want to provide the best care and support possible for people with serious mental health care needs in Westminster and Kensington and Chelsea. Our proposed changes are an opportunity to transform local mental health care in line with national policy and best practice. The changes are also in response to what we have heard from patients.

We believe that change is needed because:

  • Mental health care is changing – we know that supporting people to recover and stay independent in the community brings better outcomes.
  • At times, some people need inpatient care - so, especially during times of crisis, effective routes into assessment and admission are essential.
  • We know that some people would like us to simply to reopen wards in the Gordon Hospital that were closed during the pandemic.  But this would mean having inpatient facilities that do not meet modern standards and the cost would mean we would have to close some of the community-based support which is now up and running.

As the impact of the pandemic lessens, we need to decide what is the best thing to do for the future. 

You can read more about the reasons why services need to change in the Case for Change section of the consultation document and Pre-Consultation Business Case (PCBC) (see Downloads section).

In developing proposals for the way forward, we looked at a wide range of options including the best balance to strike between care in the community and hospital admission, and the best places for care that will meet local patients’ needs in a good quality environment.

Together with patients, clinicians, voluntary sector representatives and stakeholders we looked at a range of possible options. These include returning inpatient beds to the Gordon Hospital as well as some new approaches to community-based services.

We continually refined our ideas in response to feedback from our partners about the importance of the Gordon Hospital to the community and to local mental health provision, limited support for local people in mental health crisis, difficulties in making referrals to local services, and the consequent pressures on other public services.

Our preferred option for consultation enables us to improve the care and health outcomes we can provide for local people with mental health needs within the amount of money we have available to us.

You can read more about how we developed proposals in the consultation document and Pre-Consultation Business Case (PCBC) (see Downloads section).

We looked at options with different combinations of inpatient beds and community services (set out below).  Having assessed all three options, we do not believe Options 1 and 2 are deliverable or provide the best solution for patients.

Option 1. 2019 model

This option is closest to the service that existed before temporary closure of wards at the Gordon Hospital.

It would comprise 118 inpatient beds across two sites, St Charles (67 beds) and Gordon Hospital (51 beds).  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 our 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.  Partially transformed model

This option involves 80 beds across two sites: 67 at St Charles and 13 delivered as a single ward in the Gordon Hospital.

Community and crisis services would be reduced, including closure of the MHCAS service, with its staff moving to support inpatient care.  Voluntary sector partnerships would remain in place and the Community Access Service (CAS) would continue. 

There would be less additional capacity created in Brent than in our preferred Option 3, so some of the beds at St Charles would still be used by Brent residents.

Our preferred option for consultation is

Option 3. Transformed model – plus enhanced crisis assessment service

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.

We believe Option 3 is the best option because:

It offers high-quality clinical care

  • In the past, too many people were cared for in a restrictive inpatient hospital setting, and we did not have the right services in the community to fully support people with severe mental health needs fully.
  • The 67 inpatient beds we have at St Charles provide the right number of inpatient beds for the minority of people who really need to be admitted to hospital.
  • Since the temporary closure of the Gordon Hospital, we have been spending much more of our money on community-based mental health services. Overall, we are spending £11m more on mental health services supporting the residents of these boroughs with 193 additional staff.

It offers high quality inpatient facilities

  • All admitting inpatient beds are at the St Charles, which offers a better environment than the Gordon Hospital and meets most modern standards.

It allows us to treat more people

  • The expansion of our community services (reusing the money that funded the beds at the Gordon Hospital) allows us to treat more than twice as many residents as we did previously.

It offers better patient experience

  • When they have a choice, most people prefer to receive appropriate care and support in a community setting rather than as an inpatient in hospital.
  • This proposal to expand the mental health crisis assessment (MHCAS) service (previously piloted at St Charles) and move it to the Gordon Hospital, along with the community-based support introduced since the pandemic, provides a better range of services to meet people’s needs.

It is affordable within the funds and resources available 

  • Expanding and moving the MHCAS service to the Gordon Hospital can be paid for out of current financial resources.
  • The NHS is not likely to be able to find enough money to improve and update the Gordon Hospital wards so they could be appropriate for modern healthcare. 

You can read more about how we developed our preferred option in the consultation document and Pre-Consultation Business Case (PCBC) (see Downloads section).

Bob's Journey: How Community-Focused Care Makes a Difference

Bob's Story in 2019/20

Bob is a young man living at home. Bob starts feeling very unwell and is taken to the hospital's A&E department by family members. There, the liaison psychiatry team checks on him within an hour.  They decide Bob needs short term support away from home but as there are no intensive community-based alternatives, Bob has to be admitted into hospital. 

Bob ends up staying 36 days because the family members he was staying with feel unable to cope and don’t want him to return home. They have reported that family life at home has been less stressful and more peaceful since Bob has been away. The team organise a family meeting. 

After negotiation with family (including arranging a deep clean of his room), Bob is then discharged. Bob sees a consultant on discharge and is followed up by keyworker in the Community Team. 

Bob's Story in 2023/24

Bob is a young man living at home. He starts feeling very unwell and he is taken to the hospital's A&E department by family members. There, the Liaison Psychiatry team checks on him within an hour.  The team recognise he doesn't need a long hospital stay but could benefit from a more support away from his home environment. The liaison team recommend him for a short stay at the Mental Health Crisis Assessment Service (MHCAS) to receive some initial treatment, including support from the British Red Cross. 

The British Red Cross support helps Bob understand and start to resolve issues with his family as relations have become strained during his illness. They also invite key family members to come in and discuss Bob’s needs to facilitate his return home. At the meeting with family, the team also does a Carers Assessment to see what support family members will need to be able to care for and support Bob effectively. 

The MHCAS team also realises that Bob’s room needs deep cleaning, so they arrange for him to stay in a step-down bed while his house is cleaned. During his stay there, Bob can come and go as he pleases, staying connected to his family and community.  

After five days, his room is clean, and Bob is discharged with a referral to his local Community Mental Health Hub. The team checks on him within 3 days and assesses his needs. After a period, Bob's main care is transferred back to his GP and the community organisations who have been made aware of Bob’s needs. 

Bob and his family know they can go back to the hub if Bob’s mental health gets worse. Bob and his family feel well supported. 
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