Agenda item

Attached to this report is a paper from the Integrated Care Board (ICB) which provides information on a proposed pathway redesign within mental health services, which would include the decommissioning of Bedgebury Ward in Maidstone. It explains that the core aim is to improve patient experience by supporting people to move from secure inpatient care directly into appropriate community-based support wherever clinically safe to do so.

Estimated time: 35 minutes

Discussion:

Representatives from both NHS Kent and Medway Integrated Care Board (ICB) and the Kent and Medway Mental Health NHS Trust (KMMH) introduced the report which proposed a mental health pathway redesign that had been developed between both the commissioner (ICB) and the provider (KMMH) and aimed to redirect resource to a more proactive, assertive outreach model. It was explained that the in-patient service at Bedgebury was an outdated model developed prior to forensic outreach and community based support, which was now sufficiently established to support patients, complemented by assertive outreach treatment. As a result, admissions to Bedgebury Ward had been paused and the remaining five in-patients were expected to leave between September 2026 and January 2027, when the ward would close.

Members then raised a number of questions and comments, which included:

·         Timeframes – in response to a question about when decisions were taken to pause admissions, it was confirmed that discussions between the ICB and KMMH had taken place in early 2026 when it was decided to pause admissions while the proposals were considered. Members were reassured that no patient care plans had been accelerated as a result of the timeframes for closure of Bedgebury Ward.

·         Public safety – in response to concerns around public safety when people with complex mental ill health were treated in the community, it was explained that patients were not discharged into community based provision without support and many were subject to Ministry of Justice Restriction Orders, providing legal requirements of how patients were monitored and supported. If a patient relapsed, they were admitted to the acute setting and where patients improved, they were moved to the Community Mental Health Team. It was added that some patients were known to be difficult to engage and discharge between the forensic outreach service and community mental health services and therefore the assertive outreach treatment would bridge the gap between the two teams and improve patient care and public protection outcomes.

·         Reduction in mental health beds – concern was raised that there would be an overall reduction of beds across the mental health service within Kent and Medway. In response it was explained that Bedgebury Ward was contained within a medium secure forensic site so had very specific limitations. In addition, the increased utilisation of community based support had reduced reliance on mental health beds.

·         Case study – the point was made that a case study to demonstrate the care between the two pathway models would have been beneficial in understanding of the rationale provided. In response, an offer to provide more detail on the step down from the in-patient forensic unit was made and would be shared with Members outside of the meeting.

·         Funding resource – clarification was sought on the resourcing for the service and whether all funding from the closure of Bedgebury Ward would be repurposed into the Assertive Outreach pathway. The ICB confirmed that the funding would be redirected into the new model, with additional investment, anticipated to be at least double the current allocation, being provided.

·         Skills resource – clarification was sought as to whether staff with the correct skill set were already in place to provide the care for the new pathway or whether training or new personnel was needed. It was confirmed that current staff within the wider Forensic Psychiatry Service, and those in Bedgebury Ward, would have the relevant skills and once a formal decision was made, KMMH would work with the ICB to allocate current staff or recruit additional staffing as required.

·         Insufficient information - Members expressed their frustration at the lack of information in the report, particularly around financial implications. It was reiterated that when information was commercially sensitive, it was possible to share with the Committee under confidential papers which would not be published but would provide the Committee with the information they needed to effectively scrutinise the issue.

·         Engagement – it was confirmed that Healthwatch had not been notified or engaged with in relation to the proposals. Criticism was also made of the late engagement with the Committee, given the decision to pause admissions was already taken and being implemented.

·         New pathway – clarification was sought about how Bedgebury Ward had been used and it was explained that it was a step down unit for those within the forensic psychiatry service that were discharged from acute secure wards, which meant patients received unnecessary extended hospital stays. It was confirmed that discharging those patients to the Forensic Outreach Service instead, did not mean they were moved to independent living. Many were moved to specialist residential care providers with forensic expertise so continue to receive treatment but within the community.

·         Accommodation funding – referring to the specialist residential care and accommodation, clarification was sought on how this was funded. In response it was confirmed that there were a variety of sources, included local authorities that would be expected to fund some accommodation provision.

• Capacity – concern about the capacity of community provision was raised. It was confirmed that any patient in the acute forensic unit would meet the criteria for the new pathway and would begin transition while in the acute setting. In terms of capacity, robust monitoring would be undertaken and such issues would need to be managed on an individual basis. The ICB were unable to provide detail around capacity and provision mapping for this pathway redesign at the meeting.

Decision:

1)            The Committee noted the submission from the ICB, as set out at Appendix 1 to the report and the SV questionnaire, as set out at Appendix 2 of the Supplementary Agenda and determined that the proposal did constitute a substantial variation or development in the provision of health services in Medway because of the lack of engagement through the development stages and decision making process and lack of clarity of cost benefits.

2)            The Committee also requested an urgent briefing on the following:

·      The funding envelope and financial implications of the proposal;

·      Clarification of when the decision to pause admissions to Bedgebury was officially made;

·      More information on the additional accommodation placements required and how these would be funded.