NHS cash crisis casts shadow over future of children’s in-patient units

Every children’s mental health in-patient unit in England could close within five years if NHS commissioning continues to be dictated by financial pressures, psychiatrists have warned.

The Royal College of Psychiatrists believes up to six of the 13 dedicated children’s units, which typically hold under-13s, have either closed or are under threat of closure, and that the total number of beds is likely to fall below 1999 levels.

Units no longer taking child in-patients include Stepping Stones in Sutton, south London, and Shirle Hill in Sheffield, while Birmingham Children’s Hospital NHS Trust is considering closing its dedicated children’s ward.

The trusts have argued that children under 13 are better served by outreach services or can be treated separately within adolescent mental health units.

But the Royal College fears commissioners are succumbing to local financial pressures and are not following national guidance on the provision of in-patient services for children.

In a letter to health secretary Patricia Hewitt, two leading children’s psychiatrists dismiss the “romantic notion” that treating the most vulnerable children at home will produce better outcomes.

Consultant child and adolescent psychiatrists Brian Jacobs and Gillian Rose say in the letter: “There is no evidenced work to show the effectiveness of assertive outreach services for such complex, vulnerable child patients.”

They also suggest there is a widespread misunderstanding that child psychiatry services are the same as adolescent in-patient services, saying it is not safe or appropriate to treat children in adolescent wards.

The number of children in each area needing inpatient services is small and Jacobs and Rose say they can become financially non-viable in the absence of more strategic commissioning.
They say current commissioning of such services is “unsatisfactory and unfocused”, and suggest there will be no in-patient services within five years if “financial pressures dictate commissioning priorities”.

A spokesperson for the Department of Health said: “We expect local specialist commissioning groups to commission in-patient  psychiatric units which allow for effective service planning for the local population.”