This report and its appendices provide information to support the Health, Care, and Wellbeing Scrutiny Committee’s scrutiny of the Herefordshire and Worcestershire Health and Care NHS Trust Strategy.

The committee received an overview of the Herefordshire and Worcestershire Health and Care NHS Trust Strategy from Sue Harris, Director of Strategy, People and Culture, and David Thomas, Associate Director, Primary Care and Community Mental Health Services.

The principal points of the discussion are summarized below:

1. The trust has made progress embedding cultural improvements including strengthened leadership, clearer governance, and revised approaches to staff support.

2. The reporting of the strategy will start in April 2026 which will embed it as part of the trust’s decision making so people will be able to track progress.

3. Talking therapy services are undergoing expansion, with local increases in capacity and workforce underway, though some lag exists due to training.

4. Individual placement services (IPS) are subcontracted with Landau. The trust’s key consideration is that there is a set of expectations and deliverables that Landau has agreed to meet. Overall, Landau consistently delivers against these requirements and maintains a strong overall performance record.

5. In response to a question around workforce, it was noted that staff turnover has declined over time. It was added that staff turnover in relation to IPS in Herefordshire is not so much a direct operational workforce question but rather a contracting question. It was noted that Landau has a good record in this area.

6. There has been a considerable focus on inappropriate out-of-area placements over the last year or so and has been very successful with a baseline of zero inappropriate out-of-area placements.

7. It was confirmed that inappropriate out-of-area placement patients may be sent either to another NHS trust offering commercial capacity or to a private provider, depending on available capacity at the time.

8. In response to a question about whether Herefordshire and Worcestershire provide services to other counties, it was confirmed that they do not.

9. Length of stay reduction for working-age adults and older adults is also a key objective, supported by a seven-day mental health bed-management function.

10. The older adult targets slightly trail the working age adult targets because there are some additional complexities related to caring for older adults in mental health settings.

11. Challenges around discharge were noted, particularly where social care or housing issues delay patient movement from inpatient settings.

12. In response to a question about partnerships, the trust noted ongoing collaboration with Talk Community, public health, education settings, and wider NHS partners to support proactive, community?based mental?health approaches.

13. In response to a question about where Talk Community sits within the trust’s strategy, it was noted that Talk Community forms part of the neighbourhood health agenda. It was also acknowledged that there are potential tensions in partnership working due to challenges around IT systems, data sharing, and governance, which need to be addressed to realise this ambition.

14. In relation to mental health support teams in schools, the target is to have two new teams stood up by the end of 2026/27 and then further expansion over the two successive years. New funding is confirmed for 2026/27 in support of this with commitments to continue that funding trajectory toward 2030/31.

15. In response to a question about schools without a mental health support team or those not currently covered, it was confirmed that child and adolescent mental health services (CAMHS) remains available and will continue to provide support. It was added that mental health support for children needs to be a broader conversation and needs to be kept as up-stream as possible with timely access to CAMHS, as necessary.

16. It was added that mental health support team workers are embedded within schools, where they work closely with partners to provide wraparound support for individual children and support schools to build confidence in managing lower-level mental health issues.

17. In response to a question about interaction with reablement pathways, it was noted that there is less interaction with reablement but greater interaction with the trust’s own home treatment services. For example, the bed management team works closely with the home treatment team to support timely discharge, with crisis teams also involved to ensure safe step-down arrangements.

18. In relation to the neighbourhood health agenda, ongoing work has been taking place with council colleagues, Wye Valley NHS Trust, and other partners involved in health and social care delivery across Herefordshire. this vanguard neighbourhood health programme focuses on collaborative working to take a holistic view of individual patient needs, with the aim of supporting people to remain at home and avoid hospital admission wherever possible.

19. In response to a question about the county’s rurality and how neighbourhood-at-home services will be delivered to the most rural residents, it was noted that effective collaboration and optimal use of resources are key. It was also acknowledged that very small teams are required to cover large geographical areas.

20. In response to a question about how the strategy has allowed the trust to build a more open culture where staff feel safe to raise concerns, it was noted that there have been a significant amount of work done to build a compassionate and inclusive culture. The trust’s internal performance metrics are showing that staff believe there is a more open culture and are now more comfortable with the way in which they can raise concerns at work.

At the conclusion of the debate, the committee discussed and agreed the following recommendations.

Resolved:

1. That the trust provides the committee with an annual update of its strategic priorities, including:

With any actions taken where performance was identified as requiring improvement.

2. Provide the committee with the findings of the national workforce survey when available, with detail pertaining to Herefordshire where possible.