Camden Clinical Commissioning Group (CCG) sought views on a potential change to the Mental Health Acute Day Units (ADUs) we fund in Camden. We ran a consultation from 6 November 2017 to 10 January 2018. Camden and Islington NHS Foundation Trust (C&I) supported the consultation process.
Camden CCG currently commissions C&I to run two Mental Health ADUs; one at the Jules Thorn unit on the St Pancras Hospital site and one at the Daleham Gardens unit in Belsize Park.
The units provide intensive structured day support over a period of around six weeks to patients experiencing an acute mental health crisis. Both units can support 30 patients at any one time. The support helps patients with acute mental health needs avoid being admitted to hospital (around two third of patients referred to the unit) and to leave hospital sooner (around one third of patient referrals).
Throughout England, the rising cost of healthcare coupled with an increase in demand for services has put immense pressure on NHS budgets. In 2017-18 Camden CCG must make savings of circa £18m to balance our budget, and the 2018-19 financial savings requirement will be higher. This is a substantial challenge and means that we are scrutinising all of our costs to ensure the most effective delivery of services within the money that is available.
It requires making difficult decisions about reducing our spending in some areas to ensure our health service is sustainable for the future. Although the CCG is having to look for significant savings, the majority of these will be to physical health care services.
Camden has very significant mental health needs and the CCG has identified mental health as a priority area for investment for many years. Comparison shows that Camden spends more than other areas, including boroughs with a similar level of need, yet outcomes are similar but not generally better.
Camden CCG has a statutory duty to ensure that commissioned services offer high quality, yet cost effective care in order to ensure we commission care within the financial envelope available to the CCG. Where possible we will always look for opportunities to change services in ways that improve or maintain patient outcomes at less cost; for example, by investing in prevention or early intervention; using data more intelligently to target services; supporting people to reduce use of expensive and crisis services or ending services that are underused or ineffective. Through transforming the care pathway for Mental Health ADUs we believe there are opportunities to make it easier for patients to be referred sooner to the most appropriate setting, while achieving efficiencies to ensure the financial sustainability of these services in the future.
Our consultation explored local people’s views on whether Camden CCG should reduce the number of Mental Health ADUs to deliver financial efficiencies. As part of our consultation, we proposed to increase support available in the remaining settings so that patients receive a better, more responsive service from there, and strengthening links between ADUs and support in the community, such as the Wellbeing Hub; Healthy Minds and the Recovery College. In doing so, savings of around £248,000 per year would be delivered, without a detrimental effect on patient care.
To gather views we ran a formal consultation on two options:
Option One - Strengthen acute care at the Jules Thorn unit, support more people to access Highgate Day Centre and close the Daleham Gardens Unit. (This was identified as Camden CCG and C&I’s preferred option).
Option Two – Strengthen acute care at the Daleham Gardens unit, support more people to access Highgate Day Centre and close the Jules Thorn unit.
Camden CCG undertook a full programme of consultation to gather feedback on these options, to inform our decision, which is summarised in this report.