Hope & Horizon wider feedback

Feedback: Several comments raised a lack of funding available for mental health services overall and some were supportive of the Trust seeking additional funds from central government. Feedback was also received about the need for mental health care workers to receive a substantial pay rise and there was a suggestion of the Trust doing its own fundraising.

Trust response: Under the NHS Long Term plan, the Trust has received significant new investment into adult and children’s services over the last four years and we are finalising with the North West London Integrated Care Board the NHS Long Term Plan investment for 2023/24. The Trust is also able to actively seek funding through other means such as non-recurrent capital investment which can be utilised for investing in physical assets i.e. buildings, medical equipment, electronic devices or other IT hardware.

We can and do fundraise through our West London NHS charity – feel free to look into where those donations are used on the dedicated webpage.

The Trust is involved in national discussions regarding the national pay award and we offer our staff a wide variety of benefits and opportunities in order to provide further support.

Feedback: A number of comments suggested there is an increasing level of demand for mental health services in general. There were questions over why the thresholds for some services are so high, meaning some people with more moderate needs are not adequately supported and provided for.

Trust response: The modelling for the Ealing adult mental health beds proposals has included a forecast of demand to 2031. We estimate that even with additional population growth at 13.5% (mirroring the Hounslow growth, from 2011-2021) across all three of our boroughs (which considerable exceeds the growth over the last decade), we would still have an above average number of beds compared with our peers.

Under the NHS Long Term Plan we have seen considerable investment in our community services, both for children, young people and adults, in planned care and unplanned care (crisis). This has enabled us to either directly, or in conjunction with Voluntary, Community and Social Enterprise partners to extend access. Some examples of this include: expansion of access to talking therapies services for people with anxiety and depression (IAPT) and the investment in and development of mental health integrated network teams (MINT).

Feedback: Adding to the recognition that the proposal represents a perceived loss of service for Ealing residents, some noted that other services such as A&E, the urgent care centre and maternity department have also been moved out of Ealing, leaving people concerned over broader service available for the community.  

Trust response: We continue to invest in local mental health services in Ealing and for Ealing residents. We do propose making the move of Ealing adult mental health beds out of borough permanent but the availability of adult mental health beds for Ealing residents otherwise remains the same. There have been no cost savings from this exercise and the reinvestment schemes include investing in the provision of local step down beds for Ealing residents.

Outside of this specific engagement process, we are investing in other crisis services for local people, including our partnership with Mind which has resulted in the opening of a Safe Space in the Lido Centre in Ealing, and staff in-reaching into Ealing Hospital Emergency Department alongside our Liaison Psychiatry staff. So far in 2023 we have also opened the Circle – a new crisis café for children and young people on South Ealing Road, and commissioned Qwell to expand the availability of free, safe and anonymous mental health support.

The NHS Long Term plan has also provided considerable investment in and expansion of the mental health provision available in Ealing. This has focused on providing more crisis care in non-inpatient settings such as our Crisis Assessment Treatment Teams, as well as other community mental health services.

Issue: There were concerns about viewing this proposal in isolation, with calls for mental health services across North West London ICS to be treated as a whole when considering mental health provision and inpatient beds. It was noted that, in addition to this project, Central & North West London NHS Foundation Trust (CNWL) are looking at closing wards within the Gordon Hospital. Questions were raised around why there had not been a joint engagement process encompassing both sets of proposed changes.

Trust response: We understand the concern raised. Historically local residents have tended to access the adult mental health inpatient beds provided by their local provider and so unlike in the acute hospital service it would be very rare for a resident in the borough’s which West London NHS Trust serves to access a bed under CNWL NHS Foundation Trust’s provision. There are two local exceptions to this. Where we need to admit an individual who is also a Trust employee, or for female psychiatric intensive care beds (PICU), as the Trust’s own PICU at Charing Cross Hospital is for male patients only – for female patients we tend to purchase these beds from our neighbouring organisation CNWL (St Charles Hospital, RBKC).

From a North West London Integrated Care System (ICS) perspective, the ICS is currently finalising its Health and Care Strategy for North West London and alongside this is due to publish a paper outlining the North West London adult mental health care strategic context. The documents are intended to outline the cross-provider strategy for how as an integrated system NHS North West London and the eight local authority boroughs will support and improve the health and care needs of our communities, improve life expectancy, quality of life and reduce inequalities as well as the strategic context within which we are operating.

From a mental health perspective specifically, these documents describe how the strategic focus since the pandemic has been shaped by the North West London LikeMinded Strategy for mental health and more recently by the NHS Long Term Plan (accompanied by the substantial national investment). These documents describe the aim to ensure that we provide the highest quality and most appropriate mental health care for people who need it across our boroughs. This includes inpatient facilities that meet modern standards of acute mental health care, supporting patient dignity and privacy, with ease of access where required. As well as the principle that mental health care should be in the least restrictive setting and acute inpatient care should always be an absolute last resort. It is within this wider strategic context that the proposal for Ealing adult health inpatient beds has been developed.

Trust response: We agree. In part this is about an appropriate shift to providing more crisis care in non-inpatient settings – such as our local Crisis Assessment and Treatment Teams, and in supported beds outside hospitals such as Amadeus Recovery House in Ealing. But it also reflects an enhanced community-based model which is consistent with providing care in least-restrictive and non-stigmatising settings, and reflects national and international best practice.

Outside this current engagement process, the Trust is investing in other crisis services for local people, including our partnership with Mind which has resulted in the opening of a Safe Space in the Lido Centre in Ealing, and staff in-reaching into Ealing Hospital Emergency Department alongside our Liaison Psychiatry Staff. So far in 2023 we have also opened the Circle – a new crisis café for children and young people on South Ealing Road, and commissioned Qwell to expand the availability of free, safe and anonymous mental health support.

Trust response: Our proposal to make permanent the suspension of Ealing adult mental health beds also include proposals to make permanent the temporary crisis pathway augmentations that were put in place to support the suspension. The Trust has diverted the resources made available through the suspension to provide dedicated staffing for the Hounslow and Hammersmith & Fulham Health Based Place of Safety (HBPoS) which support the pathway for people under section 136. These now have a dedicated 24/7 staffing team and additional capacity. There are now four suites available to residents from all boroughs, offering dynamic risk assessments and supporting bed flow/capacity.

Resources were also diverted to appoint additional staff to mental health crisis helpline. This service is available 24/7 to all residents in Ealing, Hammersmith and Fulham and Hounslow.

Issue: As well as the lack of adult inpatient beds in Ealing, the Ealing Save Our NHS petition also focussed on the non-existence of beds, in Ealing, for children in crisis. With the suggestion that some young adults (aged 16/17) had been admitted to adult wards, which was felt to be unacceptable. One respondent wanted clarity on where these service users should be seen. Also highlighted was the lack of Paediatric Intensive Care Unit (PICU) beds for female patients, with concerns that these service users are being sent out of the tri-borough area. Additionally, some comments suggested there are a lot of young people in hostels who are not getting the support they need - preferring to stay out on the streets due to feeling scared or lonely once admitted. A perceived lack of service provision and long timescale to get support mean some young people are less likely to seek help.

One respondent was keen to understand what support is available/ being set up in schools and colleges. They recognised that identifying mental health issues and intervening before it reached crisis is important. Others felt CAMHS beds/services remain a significant challenge in Ealing and surrounding boroughs.

Trust response: As part of the NHS Long Term Plan priorities for mental health the Trust was one of the initial trailblazer sites which in January 2019 began setting up Mental Health Support Teams which are based in schools. These services have continued to develop and expand in subsequent years.

We work in partnership with CNWL NHS Foundation Trust through our CAMHS Provider Collaborative to commission and provide CAMHS beds for children and young people in North West London. These included the dedicated Lavender Walk Adolescent Mental Health Unit. Our plans to develop crisis alternatives for children and young people continue to develop and as an example so far in 2023 we have also opened the Circle – a new crisis café for children and young people on South Ealing Road.

Trust response: Thank you for your feedback. This is one of the guiding principles behind the development of Mental health integrated network teams where we want to make services easier to access, better designed to meet individual needs and better connected to the community. Alongside the work we are doing as the NHS, we commission and work closely in partnership with local Voluntary, Community and Social Enterprise organisations to achieve this.

Trust response: We have clarified this with the individuals who raised this matter. The Hope and Horizon wards are provided by West London NHS Trust and are located on a Trust site called St Bernard’s Hospital. This is adjacent to the Ealing Hospital site which is provided by London North West University Health NHS Trust.

Trust response: Our new Trust Strategy for 2023-2028 includes “Putting people first” as one of our five identified priorities for the next five years. This builds on the work we have done to date and states our aim to attract, develop and retain talented people, promoting an open, fair and inclusive culture with a commitment to the health, wellbeing and experience of our staff. Within this aim we recognise the importance of our role as a local employer, for local residents.

Issue: Several comments focussed on the specialist forensic mental health unit in the Tony Hillis Wing, and the fact that it is a similar environment to Hope and Horizon. However, services there are set to remain and are presumably regarded as safe. Several respondents were unclear about how services within the same building could be in such different condition. Comments pointed out that funding had been found and improvements had been made to these wards. The suggestion was that this could be undertaken for Hope and Horizon wards as well.  

Trust response: We acknowledge that there are also wards in the adjacent Tony Hillis Wing, occupied by Low Secure Forensic Services, which the Trust is aware do not meet 21^st century mental health standards, although the nature of these services are different from Hope and Horizon wards with different staffing ratios, lower numbers of admissions, considerably longer length of stay and more detailed longitudinal risk assessment and management, meaning that some of the risks present in acute mental health wards may be mitigated. Nevertheless, the Trust is actively exploring investment, including through application to the current Government’s New Hospitals Programme, to find a safer long-term solution.

The advice we have received (outlined in the Case for Change document at section 6.3) is that full renovation of the two wards in the Wolsey Wing would initially require £16m of capital funding, without being able to address the key deficiencies related to the nature of the building. Any refurbishment of this scale would only be possible by significantly delaying other schemes for upkeep and improvements across our many other sites.

Further issue: some cited the John Connolly Wing and the PICU as an example of misused resources – where these buildings was built and then demolished to make room for more forensic beds. There was a feeling that forensic beds are being prioritised over inpatient beds. Some commented that, when these changes were being made, no mention was made that Hope and Horizon wards needed refurbishment.

Trust response: The choice to replace the John Connolly Wing was approved through local, regional and national business cases, and successfully attracted £60m+ of new capital investment for the Ealing Hospital site and the construction of our new hospital, Thames Lodge, which opened in 2016, securing the future of these services for some of the Trust’s most vulnerable service users. The Wolsey Wing, where the Hope and Horizon wards are located, was refurbished around that time at a cost of £3m+ to provide alternative facilities for local residents. Despite this, it was criticised by the CQC and is no longer considered suitable for the delivery of modern mental healthcare.

Trust response: We have attempted to understand from the individuals who raised this what their specific issues were. We have shared the general feedback with our Older People’s Mental Health Services. Under the NHS Long term plan we have also invested in developing our Older People’s Mental Health Services, particularly the community-based services such as Specialist older adult mental health service (SOAMHS) which provide assessment and treatment for people over the age of 70, who are experiencing severe and enduring mental health difficulties.