Agenda item

Report CS17071

The Sub-Committee received a presentation from Adrian Dorney, Associate Director, Inpatient and Crisis Services and Iain Dimond, Service Director, Adult Mental Health and Learning Disability, Oxleas NHS Foundation Trust outlining the redesign of the Mental Health Rehabilitation Pathway which aimed to modernise the Pathway and re-balance provision of rehabilitation across inpatient and community settings.

The redesign would invest in the development of multi-disciplinary community rehabilitation services to provide care for patients in their own homes and avoid the need for admission to inpatient rehabilitation settings, and to assist those who were in an inpatient rehabilitation setting to move back to more independent settings.  It also aimed to reduce the number of inpatient rehabilitation beds that were required, with the reduction in inpatient beds enabling the re-investment in community rehabilitation services including medication, tenancy and crisis support which was expected to reduce demand for inpatient care, and to meet the needs of patients in a more cost effective way.  Patients who required inpatient rehabilitation would continue to receive care within this setting, and any patient moves would be conducted appropriately in line with patients’ individual clinical needs.

In order to achieve the required service development, it was proposed that Barefoot Lodge be maintained as an in-patient rehabilitation unit, but that services no longer be provided at Somerset Villa and Ivy Willis Open and Closed units with funding for these units to be reinvested in a range of community rehabilitation services and third sector provision.

In considering the service redesign, the Chairman was concerned that the beds available for inpatient rehabilitation would be reduced from 46 to 15, and emphasised Members concerns around the number of patients that would be displaced into the community and of these, how many would not have existing accommodation to return to, as well as how many additional Oxleas NHS Foundation Trust staff would support them.  The Local Authority had statutory responsibilities to provide housing for vulnerable people, but there was a lack of suitable housing available within the Borough which might cause difficulties in enabling these patients to receive rehabilitation services in a community setting. 

The Associate Director, Inpatient and Crisis Services, Oxleas NHS Foundation Trust explained that the service redesign would initially be focused on patients with existing accommodation, but that consideration would also be given to the threshold of patients in supported accommodation that providers could care for.  The Service Director, Adult Mental Health and Learning Disability reported that Oxleas NHS Foundation Trust would continue working alongside Community Options to support patients into suitable accommodation, and that work would also be undertaken to reassure prospective landlords of the high level of support that was in place, which under the proposed scheme could include daily contact.  Oxleas NHS Foundation Trust was not currently planning to establish new supported accommodation but this might be revisited in future. 

A Member noted the geographical size of the Borough and queried if this would be challenging to a community-based service.  The Associate Director: Inpatient and Crisis Services, Oxleas NHS Foundation Trust confirmed that staff would be required to travel to patient’s homes to provide support, and that this level of support would be maintained for as long as the patient’s needs were assessed as requiring it.  There would be a community team based in each of the three Boroughs that were covered by Oxleas NHS Foundation Trust, and the size of each team would be dependent on the current level of need and could be flexible across the three Boroughs.

The Service Director, Adult Mental Health and Learning Disability reported that an effective community rehabilitation service had been delivered in the London Borough of Bexley for a number of years which allowed Oxleas NHS Foundation Trust to anticipate the number of patients that were likely to ‘step down’ from an inpatient rehabilitation setting each year.  Modelling had also been undertaken of those patients currently resident in an inpatient rehabilitation setting and it had been identified that over 50% did not require this level of care and were potentially suitable for community rehabilitation services.

In summarising the discussion, the Chairman noted that Members were generally in favour of intensive community rehabilitation being provided as a Step Up/Step Down service between the existing levels of inpatient rehabilitation and community care, but that more information was required on how this would work in practice, particularly around the provision of suitable accommodation and community care for those patients that would no longer qualify for inpatient rehabilitation services.  A Co-opted Member highlighted the need to engage with service users in developing the proposed redesign, and the Associate Director: Inpatient and Crisis Services, Oxleas NHS Foundation Trust confirmed that inpatients and their carers had been consulted, and that patients had generally voiced a preference to move toward more independent living.

The Local Authority and Bromley Clinical Commissioning Group’s responses to the consultation on the proposed service redesign would be circulated to Members of the Health Scrutiny Sub-Committee when available and Members and Co-opted Members were requested to provide their comments.

The Chairman led Members in thanking Adrian Dorney and Iain Dimond for their presentation which is attached at Appendix B.

RESOLVED that the redesign of the Mental Health Rehabilitation Pathway be noted.