Adult Mental Health Rehabilitation Redesign and Acute Inpatient Improvement

The Final Three Options:

The below diagram shows the Rehabilitation Pathway for all three options. It helps everyone work in the same way and cuts out unnecessary differences between services:

Where it is identified with the patient and care team that there is a rehabilitation need, a referral is sent to the rehabilitation pathway. It is then considered what is needed:

• Level 1 Rehabilitation 
• Level 2 Rehabilitation 
• Enhanced Community Rehabilitation Team or an ‘out of county’ placement

If an ‘out of county’ placement is needed, it’s because highly specialised support is required which can’t be managed within county. A Multidisciplinary Team (MDT) approach - from all areas of the rehabilitation teams - is needed to make the decision with this referrer.

A pathway which meets the need of the patient best is chosen and discussed with the patient. Each pathway will have differing evidence based (care that is proven to work) care offers. These follow NICE (National Institute for Health and Care Excellence) guidance, commissioning guidance and patient need.

Level 2 Rehabilitation: This will be provided as an inpatient facility. It will provide a higher level of support to patients needing this care. The care previously would be “out of county.” Now it would be closer to home to help supportive relationships in the local community and access to local services.

There is a key difference between Level 1 and Level 2 mental health rehabilitation inpatient services. A Level 2 service can offer more intensive support to people to meet their needs. This may be 'relational and/or adapted environments and procedures.'  (Commissioner Guidance for Adult Mental Health Rehabilitation Inpatient Services, 2024). This means care will be adjusted to people’s needs.

When the patient is ready for discharge, agencies will be brought together to support this process. The patient is also involved. If being discharged from a Level 1 rehabilitation unit, the Enhanced Rehabilitation Community Team will provide ‘step down’ support for a transition period.

Following this, the care will be transferred to a Neighbourhood Mental Health Team (or a Specialist Team). This depends on the needs of the patient.

A patient may be discharged to supported accommodation or a care facility. Here, the Enhanced Rehabilitation Community Team will provide support and training to the provider. This is to fully ensure the provider is able to manage the needs of the patient whilst caring for them. 

This will:

• promote mental health stability
• reduce future admissions
• prevent placement failure

Care will be individual to the patient and trauma informed. This means care and healthcare environments will be safe and supportive to help patients heal.  

 

Option 1:

There will be two centralised hubs where acute mental health wards will be based. They will be on transformed and developed sites in Herefordshire and Worcestershire.

The Psychiatric Intensive Care Unit (PICU) on Hadley Ward will remain the same. It will serve both counties as it currently does.

Rehabilitation will be provided as a complete pathway (all the steps in a patients care plan). It will consist of:

• Level 1 inpatient
• a community offer
• a Level 2 offer

Level 1 rehabilitation beds will be provided in one unit in Worcestershire.

The Level 1 rehabilitation unit in Herefordshire will close. This would mean Herefordshire having no dedicated mental health inpatient rehabilitation beds. Herefordshire patients who needed an outpatient rehabilitation stay would be admitted to a Worcestershire unit.

As a result, it is proposed that the Trust should explore alternative solutions working with external providers.

The cost of purchasing or constructing a new facility would be very high. The Trust should aim to work with a partner to secure access to suitable beds or a building. This would then meet the county’s rehabilitation needs.

This approach would ensure consistent/reliable care while avoiding significant funding. It also encourages partnership working.

There will also be the development of an Enhanced Community Rehabilitation Team to serve both counties. This will provide stepped rehabilitation care for patients leaving a rehabilitation inpatient unit (‘step–down’). It will also provide a ‘step-up’ approach from a community team. This is for patients who may require a more “bespoke” package/enhanced care to see if inpatient rehabilitation is required.

Community hubs can be used across Herefordshire and Worcestershire to reduce travelling long distances.

A Level 2 inpatient unit will be developed to serve both counties.

The resource from the closed units will be utilised for a Level 1 Enhanced Community Rehabilitation Team. This is in addition to the Level 2 inpatient offer.

The workforce implications (what it means for staff) and training required will need to be considered as part of the full review.

Option 2:

There will be two centralised hubs where acute mental health wards will be based. They will be on transformed and developed sites in Herefordshire and Worcestershire.

The Psychiatric Intensive Care Unit (PICU) on Hadley Ward will remain the same. It will cover serve both counties as it currently does.

Rehabilitation will be provided as a complete pathway. It will consist of:

1. Level 1 inpatient across the two counties
2. a community offer in addition to a Level 2 offer

Level 1 rehabilitation beds will be provided across both counties. The Level 1 rehabilitation unit in Herefordshire will provide a reduced number of Level 1 beds.

In addition, there will be the development of an Enhanced Community Rehabilitation Team to serve both counties. This will provide stepped rehabilitation care for patients leaving a rehabilitation inpatient unit (‘step–down’ approach). It will also provide a ‘step-up’ approach from a community team. This is for patients who may require a more ‘bespoke’ package/enhanced care to see if inpatient rehabilitation is required.

Community hubs can be utilised across Herefordshire and Worcestershire to reduce travelling long distances.

A Level 2 inpatient unit will be developed to serve both counties.

The resource from the closed unit will be utilised for a Level 1 Enhanced Community Rehabilitation Team. This is in addition to the Level 2 inpatient offer.

The workforce implications (what it means for staff) and training required will need to be considered as part of this full review.

 

There will be two centralised hubs where acute mental health wards will be based. They will be on transformed and developed sites in Herefordshire and Worcestershire.

The Psychiatric Intensive Care Unit (PICU) on Hadley Ward will remain the same. This will serve both counties as it currently does.

Level 1 rehabilitation beds will be provided for the two counties.

The Level 1 rehabilitation unit in Herefordshire will close. This would mean Herefordshire having no dedicated mental health inpatient rehabilitation beds. Herefordshire patients who needed an outpatient rehabilitation stay would be admitted to a Worcestershire unit.

As a result, it is proposed that the Trust should explore alternative solutions in partnership with external providers.

Rather than incurring the costs of purchasing or constructing a new facility, the Trust should aim to collaborate with a partner. This is to secure access to suitable beds or a building that can fulfil the county’s rehabilitation needs. This approach would ensure continuity of care. It would also avoid large capital investment and encourages partnership working.

A Level 1 Enhanced Community Rehabilitation Team.

This will include a community outreach model. A small team of staff would work closely with housing and supported living providers. They would make sure the right accommodation is sourced for each patient. Providers will be supported with resources and skills in addition to providing short term intervention to the patient for a transition period.

The outreach model will work with, and support, the VCSE sector (Voluntary, Community and Social Enterprise). The VCSE sector will help provide services within the community for patients with rehabilitation needs.

The Trust has a similar resource in the form of the PARTNER Service. The PARTNER service refers to various ways third-party organisations, developers, and individuals work with the NHS. However, their remit would need to be expanded to enable this offer.

In addition, there will be the development of an Enhanced Community Rehabilitation Team to serve both counties. This will provide stepped rehabilitation care for patients leaving a rehabilitation inpatient unit (‘step–down’ approach). It will also provide a ‘step-up’ approach from a community team. This is for patients who may require a more ‘bespoke’ package/enhanced care to see if inpatient rehabilitation is required.

Community hubs can be used across Herefordshire and Worcestershire to reduce travelling long distances.

Level 2 rehabilitation would serve the two counties within the area the ICS (Integrated Care System) covers. There would also be four step down beds. These will be provided locally to help a community placement transition.

The resource from the closed units will be utilised for a Level 1 Enhanced Community Rehabilitation Team. This is in addition to the Level 2 inpatient offer.

The workforce implications (what it means for staff) and training required will need to be considered as part of the full review.

 

Please get in touch:  whcnhs.adultmhinpatientredesign@nhs.net

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September 2025 update:

Over the last few years, we have worked with many different groups to hear their ideas. This list doesn’t include everyone involved but some of the groups included were:

• VCSE (Voluntary, Community or Social Enterprise) organisations
• Housing organisations
• Primary Care

We also held events where anyone interested in Adult Mental Health Inpatient and Rehabilitation Services in Herefordshire and Worcestershire. People could come along, learn more, and share their thoughts. This helped us create three possible designs for how the service could look in the future.

We planned to hold a meeting in October 2025 to talk about these three options and choose the best one. This type of meeting is called an “options appraisal.”

However recently some new opportunities have come up that might change the three options. We want to look at these carefully before making a final choice. Because of this, the October meeting has been delayed. We will update this page once we have reviewed the new opportunities and set a new timeline.

Thank you for your continued support and commitment as we take the time to get this right for our service users, staff and the wider Herefordshire and Worcestershire community.

There are a lot of abbreviations and technical terms included on these pages. Please find a glossary and vocabulary guide (listed in alphabetical order) below to help:

• Acute setting: a health setting, usually a hospital, that can give immediate help for an illness or condition that suddenly starts/worsens.
  
  
• Acute MH (Mental Health) inpatient: a person who is admitted to a hospital for short-term, intensive treatment during a severe mental health crisis
  
  
• Crisis teams: mental health services that provide support during a mental health crisis to help prevent hospital admission
  
  
• Enhanced Community Rehabilitation Team: provide specialised, patient centered support (treatment/care designed around the specific patient). This helps individual people regain independence and achieve personal goals after a hospital stay or illness (from Level 1 and/or Level 2 rehabilitation step-down, see more information below)
  
  
• EI (Early Intervention) in Psychosis teams: a community mental health service for young people and adults experiencing a first episode of psychosis
  
  
• HTT: Home Treatment Teams: mental health services that provide intensive, short-term support to individuals with severe and acute mental health problems in their own homes
  
  
• Level 1 inpatient (Rehabilitation): a specialised rehabilitation service for patients with highly specialist needs. They may also be known as 'community rehabilitation units.' This is explained in more detail on slide 3 of the above presentation. For further information click here.

• Level 2 inpatient (Rehabilitation): these units are a 'step down' from Level 1 inpatient. This means that specialised inpatient rehabilitation is still needed but not at the same level as level 1. They may also be known as 'high dependency rehabilitation units.' This is explained in more detail on slide 3 of the above presentation. For further information please click here. 

• Major change process: an NHS England process used when a 'big' change is being put in place i.e. large health service redesigns. This is the case here. 

• MDT: Multidisciplinary Teams: a group of different  healthcare professionals who specialise in different areas. They work together to support a patient's care.
• MHL: Mental Health Liaison Teams: provide mental health assessment in acute (generally in A&E) and community hospitals. 

• NICE: (National Institute for Health and Care Excellence): is a UK public body that provides evidence-based guidance and advice to improve health and social care in the NHS.

• NMHT: Neighbourhood Mental Health Team: provide local, community-based mental health support, offering assessments and care plans for individuals with mental health needs.

• Participation Partners: volunteers, patients and the public who give their time, energy, skills, expertise, and experience to support our work are known as participation partners. . All Trust volunteers, patient and lay representatives and experts by experience are known as participation partners. They support various strategic activities and roles. 

• Pathway: the structured steps/process a patient takes for a specific healthcare need/treatment.

• PICU: Psychiatric Intensive Care Unit: a specialised, secure ward in a mental health hospital that provides a higher level of care for individuals experiencing severe mental health problems.

• Rehabilitation: help for someone to recover and regain their independence after an injury or illness. It can involve physical, mental and social support.

• Rehabilitation beds: the number of patients that can be treated in a particular unit/ward - in this case a rehabilitation unit/ward.

• Step down beds: used for patients who are ready to transition to a lower level of care i.e for patients who are getting better and need less support.

• Trauma informed: refers to a psychological treatment approach and healthcare environments that are safe and supportive to support patients to heal.

Below are the wards/buildings that are talked about on these webpages. We've included where they are and the care they offer:

Bromsgrove:

• Keith Winter House for Level 1 inpatient rehabilitation

Redditch:

• Hill Crest for Level 2 inpatient rehabilitation
• Hollywell for Level 2 inpatient rehabilitation - four step down beds

Worcester:

• Cromwell House: for Level 1 inpatient rehabilitation beds 
• Elgar Unit: Holt Ward and Athelon Ward for adult acute mental health inpatient service
• Elgar Unit: Hadley Ward for PICU (Psychiatric Intensive Care Unit)

Hereford:

• Stonebow Unit: Mortimer Ward for adult acute mental health inpatient service
• Oak House for Level 1 inpatient rehabilitation 

Health Overview and Scrutiny Committee (HOSC)

• The function of HOSC is: to oversee local health services and ensure they are effective and accountable to the community.
• What 'power' do they have? They have the statutory power to scrutinize the work of NHS trusts and other health bodies, and can refer concerns to the Secretary of State for Health.

Please find below the latest reports:

Agenda item - Adult Mental Health Acute Inpatient and Rehabilitation Redesign - Modern Council

Report Template Cabinet