Update on adult inpatient mental health services in Ealing - what happens now?

West London NHS Trust provides a total of 239 adult inpatient mental health beds across several sites in Ealing, Hounslow and Hammersmith and Fulham.

The proposed changes concern 31 suspended beds at the Hope and Horizon wards at St Bernard’s Hospital in Ealing.

As part of our new model of care, we are proposing to make permanent the interim measures put in place since this suspension which includes the re-provision of 18 beds on Robin Ward at Lakeside Mental Health Unit in Hounslow, dedicated staffing at the Hounslow and Hammersmith and Fulham Health Based Places of Safety and an extra 9 ‘step down’ beds, to support people in their recovery back to independent living. We also have further enhancements including a travel scheme, and enhanced crisis and community services.

The proposals do not affect our other wards and services on the St Bernard’s Hospital site in Ealing – where we will continue to deliver regional specialist forensic mental health and older peoples’ mental health services (272 beds) in separate facilities.

You can watch this video to get an idea of the issues faced in that healthcare setting.

St. Bernard’s Hospital is a Victorian listed structure constructed in 1829 and Grade II listed in 1985. The Hope and Horizon wards are isolated on this site and provide antiquated environments that did not meet many of the requirements of contemporary care standards. There is poor ventilation, limited access to outdoor space and unsafe design elements, which could be used to cause harm.

In December 2021 the Trust began looking at the long term future of the Wolsey Wing. The Wing was built more than 100 years before the NHS was founded, and has been deemed by The Care Quality Commission as not fit for delivering modern health services. Therefore, we are looking at what options can provide the best quality care possible in the future.

We are in regular dialogue with local residents, service users, and community organisations to work with us on the longer term plan for adult inpatient mental health care.

Specifically, on this project we reached 12,856 people through promotional activities. In total 1,993 service users were identified as potentially directly impacted by the change including those admitted to Hope or Horizon wards in the 18 months prior to suspension; and service users who have accessed crisis teams (CATT) during the last 12 months.

A summary of responses to our 18-week engagement period was:

• 712 direct responses (attendance at events/survey responses/ letters/emails)
• 940 signatures in a petition presented by Ealing Save our NHS (collected over a period of time longer than the enhanced engagement)
• 26 events attended/held
• 448 responses to the engagement survey (301 collected via Healthwatch, 147 via West London Trust website)
• 13 emails/letters received
• 3,703 interactions with social media content (like/share/retweet/click link/view video/social apps)
• 1,993 letters written to users of the services affected
• Proactively informing officers and members in the three local authorities
• Attendance at the scrutiny processes for all three boroughs and the North West London Joint Health Overview Scrutiny Committee
• Proactively contacted 121 organisations including Ealing and Hammersmith & Fulham Save our NHS, Healthwatch and organisations working with target groups identified in the equality impact assessment: homelessness services, BAME, carers, those with learning disabilities, physical disabilities and deprived communities.

The enhanced engagement period found the following issues and opinions mattered most to people:

• Feedback from the enhanced engagement phase recognised that Hope and Horizon wards are not fit for providing modern acute mental health care for service user​​​​​​​
• Over 68% of survey respondents and the majority of qualitative responses indicated that people are not supportive of the closure of beds in Ealing and re-provision of 18 beds at the Lakeside Unit and other crisis pathways​​​​​​​​​​​​​​
• Feedback was received from across Ealing, Hounslow, Hammersmith & Fulham with a focus on the loss of beds within Ealing and the impact of the changes on service users, carers and families across the three boroughs. Overall, circa 80% of respondents had not used inpatient mental health services​​​​​​​​​
• The majority of respondents (59%) agreed that the proposed travel scheme would support Ealing residents to visit people admitted to reimburse carer travel fares to travel to and from Mental Health Units (outside home borough) for patients who would previously have been supported within either Hope or Horizon wards by private taxi or public transport.​​​​​​​

The feedback can be grouped into a number of themes:

• Ward environment
• Impact of the proposal
• Financial queries
• Enhanced engagement process
• North West London Mental Health Strategy
• Travel reimbursement scheme

In evaluating the feedback from all of the engagement activities to date, the Trust has determined that there are three realistic options:

1. Return to previous service model – i.e through re-opening 31 inpatient beds previously located on Hope and Horizon wards at St Bernard’s Hospital site in Ealing and decommissioning 18 beds in Lakeside Mental Health Unit and taking away money invested in additional services in Hammersmith & Fulham and Hounslow.

2. Continue with temporary suspension on Hope and Horizon wards and the provision of 18 beds in Lakeside and investment in additional services in Hammersmith & Fulham and Hounslow pending further public engagement / consultation, or the publication of a North West London Mental Health Strategy which supports this approach.

3. Make permanent the suspension of beds in Hope & Horizon wards and re-invest in acute inpatient beds (at Lakeside), crisis alternatives and step down beds.

We updated the Trust board in a public meeting in early May and intend to reach a final decision at the Trust board in a public meeting in September.

You can access the board paper that was discussed here.

There is also a full evaluation report on the enhanced engagement and a section on the website that covers issues outside the scope of this work, but were raised by people in our conversations with them.  

We discussed our emerging response at an extraordinary meeting of the Hammersmith & Fulham Health, Inclusion and Social Care Policy and Accountability Committee in April which you can watch here. We will be doing the same at Ealing’s Health and Adult Social Services Scrutiny Panel in July and are liaising with the Hounslow Overview and Scrutiny Committeeto finalise their preferred arrangements in the coming months.

If you have any questions or want to find out more information about this issue, please go to:

Trust website: https://www.westlondon.nhs.uk/ealingmhbeds  

Email: Ealing.adultmhbeds@westlondon.nhs.uk

Phone: Patient and advice liaison services 0800 064 3330 (10am to 4pm except on Bank Holidays)