Agenda item

Mr Dominic Cox (Deputy Chief Commissioning Officer) and Mrs Rose Waters (Service Director for Forensic and Specialist Directorate) presented the item:

1)    Mr Cox introduced the item, which was about a proposed pathway redesign which would see Bedgebury Ward in Maidstone decommissioned.  The officer explained that a recent review had identified that the existing model was not aligned with national expectations for rehabilitation and was not delivering the most appropriate outcomes for service users and their families.

2)    Mrs Waters provided further detail, noting that Bedgebury Ward was a 10-bed unit located within a medium secure setting, which limited its effectiveness as a rehabilitation environment. 

3)    Members were advised that:

a)    The proposal was to redirect resources towards a more proactive, community-based model of care, including assertive outreach and more intensive multidisciplinary support, in line with recognised best practice.

b)    The unit had opened in 2016 but had not been fully utilised as part of a typical rehabilitation pathway and was not regarded as a high-quality setting. Admissions and transfers to the unit had already been paused, reflecting concerns about its suitability.

c)    Additionally, the unit’s location had limited opportunities for patients to reintegrate into the community, including maintaining contact with family and social networks, which were key components of a successful and effective rehabilitation.

d)    The established Forensic Outreach and Liaison Services (FOLS) would be supporting patients on discharge pathways from secure settings. Discharge planning had involved partnership working with local authorities, including care needs assessments and panel considerations, with a range of outcomes identified based on individual need, such as supported or independent living, rehabilitation units, or residential care options.

e)    There were currently five patients within the Bedgebury unit. All five patients were on established discharge pathways and would not require the new assertive outreach provision.Discharge planning was progressing appropriately.  It was anticipated that all patients would be discharged by early 2027.

f)     The Committee was informed that the proposal was to reinvest resources into community-based support, including the development of an assertive outreach service to support patients transitioning from secure settings to the community. 

g)    The new model aimed to:

i)     provide care closer to home

ii)    improve rehabilitation outcomes

iii)   reduce reliance on inpatient step-down beds

iv)   better align with national clinical models and best practice. 

4)    In response to questions and comments from Members, the following points were noted:

a)    Members queried how patients would be supported during the interim period between the cessation of admissions to the Bedgebury unit and the implementation of the new community-based arrangements in the Autumn, seeking assurance that appropriate care would be maintained during this transition. Mrs waters confirmed the individuals would continue to be supported by the FOLS team.

b)    In response, Members were advised that that resources would be reinvested into a community-based model, including multidisciplinary and assertive outreach support, as the current service was not aligned with best practice.

c)    Officers emphasised that this represented a redesign rather than a reduction in service, aimed at improving integration and patient outcomes. The number of patients affected was small and issues with the current model, including its suitability and location, had informed the proposed changes.

d)    Additional queries were raised on the assessment of impacts arising from the proposed change.Further clarification was sought on the potential impact on local authorities, referencing earlier comments in the meeting.

e)    Members expressed concerns that insufficient information was available to fully assess the implications and that the proposal should be treated as a substantial variation due to the current uncertainty regarding its impacts. They asked for clearer and more definitive information on resources and finances.

f)     Officers responded to concerns that the specific areas may become disenfranchised by the removal of specific provisions and explained that multiple sites of rehabilitation were present throughout the County.

g)    Members considered that there was a lack of patient experience and engagement  in the presented paper. Officers acknowledged the concern and suggested this aspect be presented in a returning paper.

h)    The Committee discussed  patient outcomes and transition arrangements,  a number of patients had already been discharged over recent months and years with positive outcomes.

i)     Remaining patients had been progressing well, and many were already on extended trial leave and benefiting from community placements. Currently there was no indication that remaining patients would need to return to inpatient care.

j)     Officers responded to questions from Members regarding how a redistribution of resources and investment into community resources could be an overall better model. Officers referred to national evidence which indicated that such approaches could lead to improved outcomes for individuals’ rehabilitation and recovery and that the intention was to utilise existing investment more effectively by reallocating resources to areas where they could have a greater impact.

k)    The importance of strengthening community-based services was highlighted. The officer acknowledged that, as services shifted further into the community, there would be a need to ensure sufficient capacity and capability to manage increased demand. It was noted that this consideration would form a key part of the ongoing work to implement the model.

l)      A Memberquestioned the proportion of bed discharges that had required rapid readmission within 12 to 24 months, including through crisis team interventions or Accident and Emergency attendance, and sought clarification on how these outcomes would be monitored in the context of any decommissioning. Officers acknowledged that the data was not available at this time.

5)     Mr Rayner proposed, and Mr Jeffery seconded, the motion that: 

a)    the Committee deem the Bedgebury Ward pathway redesign as a substantial variation of service, and

b)    that the NHS, Kent and Medway representatives be invited to attend the Committee and present an update at an appropriate time, including the information requested regarding the proportion of bed discharges that had required rapid readmission within 12 to 24 months, including through crisis team interventions or Accident and Emergency attendance, and sought clarification on how these outcomes would be monitored in the context of any decommissioning

The motion was carried by majority vote.?    

RESOLVED that:

a)    the Committee deem the Bedgebury Ward pathway redesign as a substantial variation of service, and

b)    that the NHS, Kent and Medway representatives be invited to attend the Committee and present an update at an appropriate time, including the information requested regarding the proportion of bed discharges that had required rapid readmission within 12 to 24 months, including through crisis team interventions or Accident and Emergency attendance, and sought clarification on how these outcomes would be monitored in the context of any decommissioning.