Agenda and draft minutes

No apologies for absence were received.

The Chair, Councillor Ketan Sheth (Brent Council), declared a non-pecuniary interest that he was the Lead Governor at Central and North West London NHS Foundation Trust (CNWL).

The minutes of the meeting held on 18 July 2023 were confirmed as a correct record and signed by the Chair.

There were none.

The Chair invited Jane Wheeler, Acting Deputy Director (Mental Health), NHS North West London, to introduce the report and the following points were made:

1.      The proposed model of care had been co-produced.

2.      Currently, not all boroughs in North West London provided the same offer of palliative care for residents within their own homes. The support for support residents received from out-patient services was also inconsistent.

3.      There was currently some unmet need for people that needed to be in bedded provision which is therapeutic and provides access to a specialist team.

4.      Engagement was ongoing and would progress to engagement over the options of delivery and commissioning, prior to formal consultation on the new model of care.

The Committee were then invited by the Chair to ask questions and Committee Members:

1.     Questioned whether the new model of care would ensure that there would be sufficient capacity for inpatient beds in the future. Jane Wheeler shared that they had completed detailed modelling on future demand, and it showed that there were approximately 3,000 residents that needed specialist services, not bedded care. Unmet need had also been modelled and projections showed that capacity would be sufficient for seven years.

2.     Asked for an update on the Pembridge Hospice and whether it was considered to be part of the inpatient capacity in the future. Jane explained that consideration of Pembridge would happen at the next stage, where options for delivery would be considered. Most of the changes were about services not in bedded units. Consultation on options for delivery, including Pembridge, would happen through the winter months.

3.     Sought assurance that palliative care specialists would be recruited and retained to enable successful delivery of the model. In response, Jane shared that providers had been working closely together on workforce and had been sharing approaches. Plans for workforce would be phased and there was a multi-year plan to bring in the proposals on workforce and organisational development. The modelling and plans took into account current activity across the boroughs and unmet need.

4.     Queried how engagement would involve diverse communities. Jane shared that the engagement had included working across North West London, individual boroughs, and specific demographic groups. Outcomes of the initial work with specific groups had been published on their website, including a table of different conversations and groups. They had gone back to groups to see if the proposed model addressed issues raised initially. The key message had been about the importance of personalised care. Jane felt that the 24/7 advice line responded to that and the issue of not knowing who to call.

5.     Questioned the criteria for determining the appropriate length of stay at each stage and how stepping up and down would be facilitated. Jane explained that the majority of patients would need little bits of all of the service. In the new model, the care coordination function would be enhanced, with a single person for a patient to go to and would help with stepping  ...  view the full minutes text for item 5.

At the Chair’s invitation, Carolyn Regan, Chief Executive, West London NHS Trust, introduced the report raising the following points:

1.     Data analysis was being completed to assess need, prevalence and demand and would be available by the end of September 2023. There was a Working Group which included representation from all boroughs and there had been some engagement events.

2.     The approach was building on Joint Strategic Needs Assessments and setting out key principles.

3.     The first phase was only looking at adult services, and children and young people would be brought in at phase two.

4.     The ambition was for the first draft to be shared with stakeholders in October 2023.

The Chair then invited questions from the Committee. Committee Members:

1.     Queried why a phased approach was being taken. Carolyn clarified that it has been decided to approach it in bitesize pieces and from speaking to service users, it was clear that there were key differences between adults and young people. The next phase would focus on the transition period for 16- to 25-year-olds.

2.     Expressed concern that the Strategy duplicated the work of their borough’s Health and Wellbeing Strategy and suggested that the Strategy should include a greater focus on ensuring sufficient community provision for mental health patients. Carolyn shared that there were differential ways of managing the beds across North West London, with one of the limiting factors in some places was supported housing.

3.     Sought to understand what work was being undertaken on neighbourhood population health and questioned if the team was working with primary care networks to address where need was greatest. In response, Carolyn explained that the work was currently taking place to map community mental health teams against primary care networks and third sector partners. Gareth Jarvis added that there was variation of provision, and they were trying to find best practice examples. Gareth encouraged all boroughs to provide the data that had been requested for the analysis.

4.     Asked whether the Mental Health Crisis Assessment Service (MHCAS) would continue and if additional MHCAS would be established elsewhere in North West London. Gareth Jarvis responded that it had been successful, despite originally starting as a temporary winter measure. However, there was limited funding and lots of moving parts to consider as part of the consultation. The Member emphasised the importance of communication of the MHCAS. Carolyn explained that there were alternative options to accident and emergency in all boroughs but only 50% of advance calls asked where alternative provision was located, and the NHS would like to increase this. They were exploring setting up an MHCAS in the West of North West London. Rob Hurd acknowledged that communication had been a recurring issue and it was something that they needed to continue to work on.

5.     Shared that Hillington Council were completing a review of children’s mental health services and enquired whether the two phases could run in conjunction, as a lot of the work needed to be done together. Katie Horrell  ...  view the full minutes text for item 6.

Toby Lambert, Director of Strategy and Population Health, North West London Integrated Care Board (ICB), introduced the report and explained that it was solely about the future of acute mental health services for adult residents of the Royal Borough of Kensington and Chelsea and Westminster City Council and where to allocate mental health investment.

There were four options which had come out of the workshops, which included:

1.     To return to the status quo in 2019 (prior to the closure).

2.     To continue with the current provision, with inpatient services only available at the St Charles Centre for Health & Wellbeing.

3.     To move the Mental Health Crisis Assessment Service to the Gordon Hospital and keep everything else the same as current arrangements.

4.     To reopen some beds at the Gordon Hospital, at a smaller scale than previously.

It was yet to be decided which options would be included in the formal consultation but the ICB and Central North West London NHS Foundation Trust’s (CNWL) were committed to a discussion about all options.

On invitation from the Chair, Committee Members:

1.     Noted that it was concerning that the report incorrectly stated that Kensal Town was an area of high deprivation in the Royal Borough of Kensington and Chelsea, as Kensal Town was located in Brent. Toby Lambert apologised for the error and shared that they had conducted considerable work on understanding where the patients who used Gordon Hospital had come from and where they were currently going to.

2.     Enquired as to what the feedback had been from service users of the Gordon and families who had supported patients. Gareth Jarvis confirmed that service users and carers of those who had used the Gordon in the past had been part of all workshops. There had been a range of views, some of which had not been aligned with CNWL’s views, whilst others did align. They all expressed that they felt heard through the process. The core demographic was previous service users of the Gordon Hospital. The Committee requested to see the feedback and the numbers of those individuals who attended the workshops. Toby confirmed that they could provide commentary and output of workshops (which was also available online), the specific engagement events with service users and carers, 2019 reports from service users of the Gordon Hospital, and the full consultation plan.

3.     Enquired whether there was historical demographic data of Gordon Hospital service users. Toby confirmed that they could provide data broken down by age, ward, and ethnicity. They also had data on those who were attending St Charles Centre for Health and Wellbeing who would have previously attended the Gordon Hospital and the associated travel time.

4.     Asked whether the voices of other residents in North West London had been heard. Toby explained that 85 to 90% of the service users were residents of the Royal Borough of Kensington and Chelsea or Westminster City Council. The next largest group was Brent Council whose residents accounted for almost all of the  ...  view the full minutes text for item 7.

A Committee Member suggested adding two items to the Work Programme:

1.     Oversight of the review of the Better Care Fund.

2.     The national programme for Integrated Care Systems to reduce overhead costs and the associated impact on local NHS commissioning.

There was none.