In December 2023, we had to temporarily close one of our four inpatient mental health facilities, Simmons House Adolescent Unit in Highgate, which is provided by Whittington Health NHS Trust, following safety concerns. 

We made some immediate and temporary changes to the services we provide so that children and young people could continue accessing the care and treatment they need. 

These changes included using more beds in the other three general adolescent units in our area. At the same time, a newly established intensive home treatment team, provided by Barnet, Enfield and Haringey Mental Health NHS Trust, was extended to cover the whole of the North Central London footprint including Camden and Islington. The development of home treatment teams means young people are only admitted as inpatients when absolutely necessary. 

We are pleased that since December 2023, no child or young person has had to be transferred out of the area to get the care and treatment they need, unless appropriate for the individual patient (for example, to be cared for closer to where they live, or for admission to a specialist eating disorder unit).

While it is good news that we have not had to transfer any young patients out of our geographical area for care during the period since we temporarily closed Simmons House, we do need to adapt and improve upon the temporary arrangements that we have had in place from December 2023 until now. 

This is because, as you would expect, our other three inpatient units are seeing and treating more children and young people than they did when Simmons House was open and some of them are having to travel further to receive the care they need. 

We need to make sure that our services are resilient and can cope with additional demand without having an adverse impact on patient care. And we need to make sure that we can keep providing as much care as possible close to where children and young people live. Simmons House needs a significant building upgrade to function safely as a children and young people’s inpatient mental health unit. As a result, reopening the unit is not currently viable. 

Together, these reasons mean we now need to put further interim arrangements in place to make sure we are continuing to provide children and young people with the best possible care until more permanent arrangements can be made. 

These proposed arrangements would be for the short to medium term – for approximately the next 18 months – while we develop a long-term solution for how we organise these important services.

The Medical Director for the NHS’s North Central and East London Provider Collaborative led a team of senior clinical leaders to develop an approach for how best to provide care for children and young people during this interim period. The clinical leaders were nominated from across all our Provider Collaborative partners in North Central London. These include Barnet, Enfield and Haringey Mental Health NHS Trust, Whittington Health NHS Trust, and The Tavistock and Portman NHS Foundation Trust. 

In designing a series of clinical options, the team considered: 

• the health needs of children and young people across North Central London
•  demographic changes among children and young people in the area · patterns of demand for children and adolescents’ mental health services, including analysing data since the temporary closure of Simmons House 
• how the services we design would be experienced by local children and young people, their parents and carers · how we maintain a focus on treating and caring for young people close to home in their local communities 

The team’s modelling shows that we require an average of 4.3 additional beds, compared to the temporary service we have now, at any one time to meet the current demand for our services. ‘0.3’ of a bed refers to a bed – or the equivalent resource to a bed – used a third of the time.

Our other general adolescent unit in North Central London, The Beacon Centre in Edgware, has additional space that we can make use of. Like Simmons House, it also has an onsite school, meaning children and young people can get educational support during their stay. 

We are proposing to commission three additional inpatient beds for children and young people at The Beacon Centre, to help us meet their needs.

Importantly, we will also make sure that, wherever possible and clinically appropriate, children and young people will receive the care they need at home. 

We are proposing to increase the capacity of the North Central London home treatment teams by enhancing the care they are able to provide for young people with learning disabilities or autism. 

We also want to extend and invest in the existing North Central London adolescent assessment and outreach teams. These teams work intensively with young people in the community who require mental health support and help them to avoid needing inpatient care where possible. As part of our proposals, this service would be available in the evenings (until 8pm) and at weekends for the first time, and would also have specialist support available for parents and carers.

Our interim proposals place a strong emphasis on enhancing alternative ways to provide care, which aims to prevent children and young people from being admitted to an inpatient unit unless absolutely clinically necessary. 

Our proposals aim to ensure that there are more specialist roles to support those with learning disability and autism in our home treatment teams, and enhanced adolescent and assessment outreach teams. This would mean that the needs of these young people can be met with specialist, tailored approaches, outside of inpatient settings.

The enhancements we want to make to these out-of-hospital services are equivalent to the 1.3 beds, on average, that we need, in addition to the three inpatient beds described above, to meet the demand for our services (4.3 beds in total).

We can also commission an extra inpatient bed – in addition to these three – if we need to, for example in times of very high demand. This would be purchased on an ‘as needed’ basis from an independent service provider and, if this is needed, we will make every effort to ensure this is as close to the child or young person’s home as possible.

As part of a wider piece of work outside of these proposals, we are also working to improve the way we care for young people with eating disorders at The Beacon Centre, linking with Royal Free London NHS Foundation Trust’s eating disorder ‘Hospital at Home’ team.

We are keen to hear what children, young people, their parents and carers think of these proposals, and the impact that they would have on you or your child. 

More information about the proposals is available in our presentation and we have also developed some frequently asked questions. Please let us have your feedback by 29 November 2024. You can email us at elft.ncelengagement@nhs.net, or write to us at: 

The Communications Team
NCEL Provider Collaborative
Robert Dolan House
Trust Headquarters
9 Alie Street
London E1 8DE