To provide an update on Herefordshire and Worcestershire Health and Care NHS Trust’s adult mental health rehabilitation services redesign.

The committee considered a report on the Adult Mental Health Rehabilitation Redesign – Update item.

The principal points of the subsequent discussion are summarised below:

1. The Herefordshire and Worcestershire Health and Care NHS Trust provided an update on its adult mental health rehabilitation service redesign programme. It was noted that the programme had been developed over a two-year period and sought to ensure that people received the right care, in the right place and at the right time.

2. The committee heard that the trust currently operated three inpatient mental health rehabilitation units across Herefordshire and Worcestershire, providing 33 beds in total. Rehabilitation services are intended to support people to develop the skills required to live as independently as possible, with level one rehabilitation focused on daily living and functional skills and level two rehabilitation providing more intensive clinical stabilisation.

3. It was reported that the preferred option is to establish a community rehabilitation team for level one rehabilitation, reduce the number of rehabilitation beds from 33 to 18, and procure level two rehabilitation beds from external providers. The trust considered that this would enable it to support a greater number of people in their own homes and communities, with the proposed community service expected to support up to 135 people.

4. The committee was advised that the option appraisal had involved clinical modelling, expert panels and engagement with staff, local authority and integrated care system colleagues, the voluntary and community sector, public health, and people with lived experience. It was noted that the process had been paused during 2025 to consider new potential providers of bedded facilities, although this had not changed the preferred option.

5. In response to questions about the planned closure of Oak House, the trust clarified that Oak House is a rehabilitation unit rather than a secure unit. It was confirmed that the proposals would not affect the secure mental health bed provision at Stonebow. The trust stated that the resources currently used for Oak House would instead support a community rehabilitation offer, although bedded rehabilitation capacity would remain available in Bromsgrove where required.

6. The committee noted the trust’s view that public-health modelling indicated that the proposed model should reduce the need for out-of-area rehabilitation placements. However, concerns were raised regarding access for Herefordshire residents required to attend a Worcestershire-based unit, particularly for people without access to a car and for their families and support networks. The trust acknowledged that detailed transport arrangements had not yet been developed and would require further work.

7. Members also raised concerns about the practical delivery and affordability of community provision in a rural county, including the availability of housing to support discharge and recovery. The trust advised that the proposal is intended to be cost-neutral, with staff from units proposed for closure offered opportunities within the community rehabilitation team. It was added that the trust had experience of a similar model through its hospital-at-home service.

8. The trust explained that a detailed implementation and transition plan would be developed only if the proposal passes the next assurance stage. This would include staff training and redeployment, a phased transition period during which both services could operate, and work with partners to address housing and wider support needs. The committee heard that joint work between Herefordshire Council and the Integrated Care Board under section 117 funding is important in providing appropriate housing and community support for eligible people.

9. In response to questions about level two rehabilitation, the committee heard that there are currently no dedicated level two rehabilitation beds in Herefordshire or Worcestershire. The trust advised that people requiring intensive clinical stabilisation are presently placed out of county or supported through alternative arrangements within acute mental health services. The proposed approach would seek to secure appropriate provision from external providers as close as possible to Herefordshire and Worcestershire.

10. The committee noted that engagement with people with lived experience had influenced the programme. It was reported that feedback had led to a pause in the programme to explore an alternative opportunity and to a revision of the approach used to assess options. Staff feedback had been mixed, reflecting concerns about the proposed changes, but the trust stated that it was maintaining regular communication and engagement with affected staff.

11. The committee emphasised the importance of ensuring that the proposed model was integrated with partners including from within adult social care, as well as voluntary and community sector organisations. The trust confirmed its intention to develop the operating model through partnership working across localities.

12. The Director of Public Health welcomed the involvement of public health teams and people with lived experience in the programme. It was stressed that the next stages of development must avoid widening inequalities in access to services or outcomes, including the wider effect on families and carers.

13. A committee member expressed concern that the proposals could reduce the quality of rehabilitation provision available to Herefordshire residents and be driven primarily by financial considerations. In response, the trust stated that the preferred option was based on national best practice and was intended to improve outcomes and quality, rather than generate savings. It was added that the proposal would be subject to independent clinical scrutiny and, if implemented, monitored through appropriate performance measures and service-user feedback.

14. The committee noted that the next stage would be a visit from the Clinical Senate in August 2026, followed by consideration of its findings by the trust and the Integrated Care Board and an NHS England assurance gateway. Subject to the outcome of these processes, a 12-week public consultation is expected to take place in early 2027.

15. It was agreed that the committee would receive a further update following the public consultation, provisionally in July or August 2027, and that further information arising from the discussion would be provided in advance of the committee’s next meeting on this topic.