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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:
- Level 1 inpatient across the two counties
- 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.
Option 3
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.
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