Agenda and minutes

The Chair welcomed all participants to the meeting.

Apologies were received from Councillor Dr Mona Ahmed.

There were no declarations.

The minutes of the Meeting held on 11 December 2023 are submitted for confirmation.

The Chair observed that the minutes referred to an outstanding action in relation the award of £2.3 billion in 2018; specifically, how much had been allocated to each borough. The Executive Director of Strategy and Population Health (EDSPH) responded that they were unable to provide this information as the action had been ascribed to the Chief Executive of Central and North West London NHS Foundation Trust (CNWL) and not to the North West London Integrated Care Board (NWLICB). However, the EDSPH said that he had been informed of the action and would be able to provide the Committee with the required information at the next meeting of the Committee.

The Committee noted that, at the previous meeting, discussions had been taken place in regard to £50 million had been allocated to Grenfell recovery. The Committee acknowledged that providing a breakdown of expenditure would be challenging as the privacy of survivors and the bereaved could not be compromised. However following discussions with the local community, including survivors and the bereaved, they too were unable to give an account of the expenditure. The Committee therefore requested that this information be provided. 

Action: Executive Director of Strategy and Population Health at NWLICB

RESOLVED:

That the Committee agree that the minutes of the meeting of the Inner London Mental Health Services Reconfiguration Committee, that took place on 11 December 2023, be signed as a correct record.

The Committee discussed the report and concerns were raised that the consultation process was being rushed resulting in groups of residents, that were affected the proposals, who were not being consulted.

The EDSPH responded that the NWLICB and the CNWL were committed to consulting as widely as possible and, following further consideration, had extended the consultation deadline from 30^th January to 16^th February 2024 to facilitate this and to address previous concerns from the Committee. Resident groups had been invited to attend meetings with representatives from the CNWL and NWLICB to give their views on the proposals to reconfigure mental health services.

The Committee questioned whether the revised timescale was sufficient and noted that the homeless had still not been consulted; a group considerably affected by mental health issues. Additionally, the Committee disclosed that contact had been made with service partners and expressed concern that many of these partners had not been contacted. Service users had also not been contacted including those who suffered from severe mental health issues. The Committee cited examples of insufficient consultation including;-

·         A lack of signposting for residents on where to attend consultations; and

·         Low number of attendees; and

·         Attendees feeling that they could not speak up.

The EDSPH said they would provide a list of groups that had been consulted and those who had been invited to participate. The Chief Strategy and Digital Officer (CSDO) at CNWL, explained that throughout November and December 2023, work had been undertaken with homeless networks including those who work with them including GPs. However, the EDSPH said that some groups were difficult to reach out to. The EDSPH and CDSO acknowledged that more work could be done and would be undertaken. The Committee was invited to provide suggestions and ideas on how to improve and widen the consultation.

Action: Executive Director of Strategy and Population Health at NWLICB

The consultation report would be published on 29^th March; this would be during the pre-election restricted period which comes into force on 19^th March. The EDSPH anticipated that the Committee would not hold any meeting during the pre-election period relating to elections to the Greater London Assembly and the London Mayoralty. The EDSPH highlighted that a further extension to the consultation deadline would still result in the consultation report being published during the pre-election period.

The EDSPH anticipated that the Committee would hold a meeting in May after the elections have concluded. The NWLICB planned to hold a meeting on 16^th July where it will take a final decision on the proposed reconfiguration of mental health services. The EDSPH understood that the Committee would like to hold a meeting to discuss the decision of the NWLICB. However, the school summer holidays begin on 19^th July and the Committee had indicated that they would like to avoid holding meetings during this period.

The EDSPH stressed that the dates had not been finalised suggesting that further discussions between the Committee, the NWLICB and CNWL would  ...  view the full minutes text for item 5.

The Cabinet Member for Adult Social Care, Public Health and Voluntary Sector (CM) at Westminster City Council (WCC) addressed the Committee and claimed that the quality of the consultation documents was poor and biased.

The CM emphasised that the present system was sufficient and only required minor adjustments to improve outcomes. WCC had consulted with social workers and housing officials, among others, who agreed that there was no need for major reform.

The CM questioned the claim by CNWL that monthly admissions had dropped by 30% noting that this may be the result of a reduction in the number of beds. The CM drew the Committee’s attention to WCC data that showed that assessments had increased and there had been a corresponding increase in demand for acute hospital care. The CM also noted that there had been a rise in the number of suicides in both boroughs.

WCC held its consultations and the CM reported that;

·         staff at St Mary’s Hospital A&E described the long waits experienced by patients who required mental health beds which had a knock-on effect on the A&E resources; and

·         The police disclosed that they spent more time having to deal with people with mental health issues and the distress this caused patients; and

·         Increasing use of out of borough services by CNWL meant that WCC social workers had to travel longer distances to see clients which reduces the time available to other clients; and

·         Look Ahead Housing said it was difficult to hold patients who required admission for long periods of time and the recounted the distress it causes.

The CM questioned the consultation documents, in particular the use of wording claiming that they gave prominence to CNWL and NWLICB’s preferred option and used negative, imprecise, and biased language against the other options.

The CM conceded that staff at the Gordon Hospital had said it was a difficult environment to work in, but that it did not mean that it was a poor environment for patients, adding that this could refer to staffing levels for example. The CM contrasted the rooftop garden at the Gordon Hospital with the facilities at St Charles where only one ward has an outside space. The other wards had balconies though the CM pointed that the safety mesh restricted their use and could not be substitute for an outside space.

The CM also conceded that the use of shared bathrooms was not ideal, but that their use was not uncommon. Additionally, supported accommodation for mental health patients had shared bathrooms and patients could stay in this accommodation for up to two years.

The Lead Member for Adult Social Care and Public Health (LM) at the Royal Borough of Kensington and Chelsea (K&C) then addressed the Committee.

The LM indicated a preference for Option 1 which envisaged the restoration of two in-patient sites, one at St Charles and the other at the Gordon Hospital. The LM stressed that this was not ideal but that it was the best  ...  view the full minutes text for item 6.

The Committee raised concerns conveyed by St Mary Abbots Rehabilitation and Training (SMART) that nobody had contacted them in regard to the impact of the Gordon Hospital and they had asked for data relating to the impact the closure had on service users but had not received any response. The Committee questioned whether CNWL and NWLICB had adequately publicised the consultation.

The Chief Strategy and Digital Officer (CSDO) from CNWL responded that they had consulted as widely as possible and regretted that SMART had not been contacted and would seek to address this.

A resident expressed their concern on the state of acute mental health services claiming that there a disconnect between the claims being made by CNWL and NWLICB and the reality. The consultation had been poorly publicised in certain areas illustrating a north/south divide in terms of consultation. The locations for consultation meetings had not been dispersed across the boroughs and had been selective. The resident also noted that, whilst the Voice Exchange was well intentioned, it consisted of a small select number of people and was not representative of service users.

Certain communities had been effectively excluded including the Chinese and Indian communities as well as the homeless. No consideration had been made to the needs to these and other groups. The resident also stated that the treatment of residents out of the borough was not a recent issue but had been longstanding. Patients with mental health issues, who did not receive prompt intensive care from MHCAS, had deteriorated. The resident listed situations where patients have come to harm, family members have been distressed and the third sector have often shouldered the burden. 

The MD disputed the claim that MHCAS did not provide intensive support highlighting that it had more staff than a ward. In relation to people transferred out of the CNWL system to receive care, the MD pointed to statistics showing that there were higher levels of out of system care under pre-Covid-19 arrangements than there was now. The MD acknowledged that the new arrangements, over 2021/22, were challenging and the number of patients being transferred out of system during this period was unacceptable, but figures had since improved.

The MD responded to further comments made by residents, as well as the Deputy Leader and Cabinet Member for Communities, Children and Public Protection at WCC, pointing out that MHCAS operates 24 hours, seven days a week and this would continue under the CNWL’s proposals. The MD cautioned that MHCAS was an expensive model and the CNWL could not afford to duplicate it by maintaining MHCAS sites at the Gordon Hospital and the St Charles Centre.

The Committee concluded the discussion.

There was no other business.