St. Bernard’s Hospital, where the Hope and Horizon wards are housed, is a listed Victorian building characterised by ward layouts that are not fit for purpose for the provision of modern mental healthcare services. We recognise that the physical environment in the Wolsey Wing, built more than 100 years before the NHS was founded, is not suitable for delivering modern health services. Our early conversations with staff, patients and service users reinforce the strong evidence that the wards struggle to meet the equality, accessibility and quality of care standards to enable the provision of safe and effective clinical care.

We are now considering the future of Hope and Horizon wards and how we can provide the best possible inpatient mental health care to patients and service users in all our boroughs.

On 26 March 2020, we suspended the use of the 31 beds at the Hope and Horizon wards to ensure safe staffing levels and rigorous Infection Prevention and Control (IPC) measures for patients and staff during the pandemic. Resources were diverted to open an 18-bed inpatient ward in Lakeside Mental Health Unit to provide dedicated care. The Lakeside facility better meets modern standards of acute mental health care, supporting patient dignity and privacy. Patients from Ealing who need adult inpatient mental health support are currently seen either at Lakeside or in Hammersmith & Fulham Mental Health Unit. You can find out more about the range of services at these two hospital sites here.

How have we engaged on the future of the Hope and Horizon wards so far?
We are having conversations about the future of the Hope and Horizon wards, and no decisions have been made regarding next steps.

Our aim is, and always will be, to ensure that we provide the highest quality and most appropriate care for people who need it across our boroughs. The purpose of this engagement process has been to listen to feedback and understand the concerns and issues of patients, service users, carers, residents, staff and others to help us develop our plans. We want to continue to involve as many people as possible to ensure every voice is heard.

Stakeholder engagement has been taking place since January 2022 with service users, carers and voluntary and community organisations, to provide a comprehensive insight into the issues experienced by patients, staff and carers on the Hope and Horizon wards. As part of the early engagement process, we have undertaken a range of engagement activities including:

• Speaking to over 140 individuals and reaching out to more than 20 organisations -informing them of the work of the programme, hearing experiences and thoughts on the future of services and arranging sessions to speak to those most impacted and interested in this work
• Attending and arranging over 10 events/ workshops to seek feedback from service users and carers and to update them on the project and impact of their feedback on our process
• Held a small number of 1:1 interviews with current/ recent service users
• Delivering three Service User, Carer and Community Options Development workshops
• Involving service users directly in the options appraisal process
• Using already available patient, carer and staff experience survey feedback to assess experience of Hope and Horizon Wards prior to suspension
• Reviewing and publishing local and national reports on access and experience of mental health services by specific equality groups.
   

What happens next?

There is more work to be done, and we are continuing our engagement with patients, service users, carers, and other stakeholders, and will continue this involvement across the lifespan of the project. The next phase of engagement will focus on reaching wider stakeholders and discussing potential solutions.

How you can get involved

We want to hear from people about these proposals. In particular, the impact of travel, what it means to patients and carers and what the key things are for us to consider.

If you would like to be involved or have comments you would like us to consider, please email us: Ealing.adultmhbeds@westlondon.nhs.uk

Hope and Horizon wards are based in a pre-Victorian building called Wolsey Wing on St Bernards site. Wolsey Wing was refurbished in 2013 for patient accommodation. The refurbishment scope of work did not include major infrastructure works, and therefore longevity of the building was set at 5 years.

The physical environment in the Wolsey Wing, built more than 100 years before the NHS was founded, is not fit for delivering modern health services. The wards struggle to meet the equality, accessibility and quality standards to be able to provide safe and effective clinical care.

There is an additional issue in terms of being able to provide emergency response to a site with only two adult mental health inpatient wards.

In September 2020, the Trust undertook Wolsey Wing Estates Review. This review showed key issues with the wards as below:

• Both wards have limited communal and dedicated individual space other than bedrooms for patients. This does not support a therapeutic environment and causes a number of issues:

• The lack of space means that one-to-one care has to be undertaken in patient bedrooms rather than a separate space, as there is no alternative
• Visitors will often have to see the patient in a busy communal area or in a corridor
• There is no dedicated space for activities or group work
• It can be frustrating for patients unable to leave the ward area.

• In the past, some incidents occurred due to blind spots on both wards, and there are ligature risks from the existing architecture
• Horizon has access to the ground floor level garden but this has also led to serious security breaches.
• Hope Ward is on the third floor of Wolsey Wing. Following an investigation into a serious incident in December 2018, it was identified that the layout of the building, including access issues due to an unsuitable size lift, and the position of Hope Ward contributed to a significant delay in getting the patient transported from the ward to the general hospital. For any medical emergency (patients, visitors or staff) the same risks would apply making this a significant clinical and health and safety risk for the service
• The seclusion rooms on both wards are not fit for purpose due to their location on the busy ward corridor and not being at all robust
• Both wards have a shared bathroom facility with no en-suite. The shower/bathroom space is not sufficient for the allocated beds and the washroom facilities are outdated and do not allow for patients to have even a reasonable level of privacy and dignity.

The review concluded that engineering and building infrastructure risks in Wolsey Wing limit the potential of providing safe and effective patient care on these wards.  We have estimated a cost of £3.35m to bring the building to a reasonable standard, should services re-occupy the building. These estimated costs only include works to maintain the current infrastructure and building fabric, and would not enable us to create a modern therapeutic environment. This would also only continue to be a medium term option.

Estimates indicate that £15m-20m may be required to fully refurbish the building to a standard that would enable us to bring the wards up to a modern standard that could be maintained and used on a long-term basis. The Trust does not have access to such a level of investment at present. 

We have a duty to ensure that we provide services that are best value for your money but this proposal isn’t about saving money. The Trust is using the money made available through suspension of the beds on Hope and Horizon wards to:

• open an 18-bed inpatient ward in Lakeside Mental Health Unit which better meets modern standards of care dignity and privacy
• provide dedicated 24/7 staffing and expansion of the Hounslow health-based place of safety (HBOS)  additional mental health care beds which have been added in supported living settings.

If a decision is made to permanently close Hope and Horizon wards, the money would continue to be reinvested, either in these services or in another service model.

We are protecting and reinvesting the funding released by the temporary closure of the two wards into a range of acute crisis and community services across the three boroughs. These build on those already in place in Ealing (such as Amadeus Recovery House, the new Ealing Safe Space and Mental Health Integrated Network Teams) and those currently under development, such as additional step-down capacity. This means that patients are seen in the most appropriate beds for them, including care for patients following discharge from the hospital and before people move back to their own communities.  

In the current arrangements, patients have access to a modern, fully staffed ward. 

From 2013 to March 2020, adults of working age living in Ealing in need of inpatient mental health care were admitted to a ward in any of the three boroughs in which the Trust delivers services. There will be no change to this model.

Over the year running up to February 2020, a total of 552 people resident in Ealing were admitted to adult inpatient mental health care, of whom 38% were treated in Ealing, 23% in Hammersmith & Fulham and 39% in Hounslow. We estimate that about 200-225 patients a year would be affected by this change. These patients would in future receive care in much better and more appropriate therapeutic environments in Lakeside and Hammersmith & Fulham Mental Health Unit (MHU).

You would continue to have access to all of Trust’s mental health services.

Other services in Ealing will not be affected. These are:

In-patient services

• 246 beds at St Bernard’s Hospital; Specialist forensic, low and medium secure mental health beds
• 38 beds for older people and those with dementia at Jubilee Ward and the Limes
• 17 beds at Amadeus Recovery House beds
• 70 Community Rehabilitation (Physical care) beds at Clayponds Hospital

Other mental health services

• Mental Health Safe Space
• Mental Health Integrated Network Teams (MINT)- provide community based care and treatment.
• Mental Health Community Rehab Team - service to help people recover from longer-term mental health problems
• Community Assessment Team – provide community-based assessment, rehabilitation and prevention services
• Early Intervention Team - dedicated to the assessment and management of people who have presented to specialist mental health services with a first episode of psychosis
• Amadeus Recovery House
• Ealing Hospital – provides psychiatry, psychological services, Electroconvulsive therapy (ECT) and clinics for medication
• Specific older peoples mental health service and in-patient ward
• Psychological Therapies (IAPT).

Specific Child and Adolescent Mental Health Services (CAMHS).

As a Trust we focus on managing our services so that people who need an inpatient bed have access to one within our three boroughs. This means we have had no inappropriate out of area placements (ie outside the three boroughs), for over three years, even when wards are closed to admissions due to outbreaks of Covid-19.

We work to ensure that we can move patients from an inpatient bed to appropriate care in their local communities as soon as it’s clinically safe for them to do so.  This includes investing in more ‘step down’ beds which provide care following discharge from the hospital and before people move back to their own communities.  We have developed more community-based mental health services, enabling people to receive care in their home or a local clinic as much as possible. This means that the traditional pattern of long admissions to mental health hospitals has changed and with it, the number of inpatient beds needed.

Although the demand for mental health care is increasing, we are confident that we can continue to ensure appropriate and high-quality care for people who need it. We continue to invest in better services closer to people’s homes and to ensure that people receive the most appropriate care in the most appropriate setting for them. We will work to ensure that any changes we potentially make will enable us to continue to provide better care, both for people in crisis, and those who need support to enable them to leave hospital (for instance through ‘step-down’) beds.

We are currently considering a long list of potential options, some of which would mean that adult inpatient mental health beds, which were previously housed within St Bernard’s Hospital, would be moved out of the borough. This is currently the case with the temporary services we are providing.

We are committed to providing a wide range of services across Ealing, including on the St Bernard’s Hospital site.  Currently, our inpatient services in the borough consist of the following:

• Specialist forensic, low and medium secure mental health beds – St Bernard’s Hospital (246) – this does not include Wolsey Wing beds, which are currently suspended
• Older people and dementia beds – Jubilee Ward and the Limes (38)
• Amadeus Recovery House beds (17)
• Community Rehabilitation (Physical care) beds – Clayponds Hospital (70)

This is in addition to 276 beds in Ealing Hospital.

St Bernard’s Hospital would continue to provide all others services as it currently does. The Wolsey Wing is unsuitable for patient care and would be reutilised for non-patient facing activities or left closed (‘mothballed’) until we are able to secure funding to fully update the site.

The scope of the refurbishment project for B Block was designed and installed to provide accommodation to patients from John Connoly Wing (JCW) for a period of 5 years. The project scope did not address long term building infrastructure issues as the Trust intention, through a strategic estate master plan, was to re-provide new modern accommodation for Local Services patients within a 5-year timespan.

Wolsey Wing became operational in April 2013 and patients from JCW moved in.​​​​​​

Given our equivalent services have been running well since the suspension of these wards, we are confident the change does not amount to a ‘significant service change’ – which is the threshold for running a formal public consultation.

As a result, we believe that our enhanced engagement process is a proportionate response to the level of change that is being discussed. The enhanced engagement process we have followed is also very close to the same parameters that would be expected of a formal consultation process, but we hope it will allow us to reach a conclusion on the future of these services as quickly as possible to allow us to continue to improve our overall mental health offer to our service users and patients in Ealing, Hammersmith & Fulham and Hounslow.