The Health Overview and Scrutiny Committee met on Tuesday 21 July 2026 to discuss the redesign of adult mental health rehabilitation services and an update on end-of-life care. The committee received detailed presentations on both topics, engaging in discussion with officers and councillors regarding the proposed changes and their potential impacts.

Adult Mental Health Rehabilitation Redesign Update

The committee received an update on the proposed redesign of adult mental health rehabilitation services, a programme aiming to create a more integrated and community-focused pathway. Sue Harris, Director of Strategy, Partnerships and Culture at Herefordshire and Worcestershire Health and Care NHS Trust, along with Sian Westaway, Deputy Programme Director, presented the current proposals.

The core of the redesign involves shifting from a model with three inpatient units (Oak House in Hereford, Keith Winter House in Bromsgrove, and Cromwell House in Worcester) to a single inpatient unit at Keith Winter House, with a reduced bed capacity. This is intended to be complemented by an enhanced community rehabilitation team serving both Herefordshire and Worcestershire, aiming to support up to 135 patients. A Level 2 rehabilitation offer will be sourced through external providers.

The rationale behind this change is to reduce unwarranted variation across existing sites, align with national NHS England guidance for adult mental health rehabilitation, and move towards more community-based care, in line with the NHS Fit for the Future 10-Year Plan. The current buildings at Cromwell House and Oak House are considered unsuitable for modern rehabilitation needs.

The process has involved extensive stakeholder engagement, including patient and carer feedback, and expert review panels. The next steps include a review by the Clinical Senate in August 2026, followed by an NHS England Stage 2 Gateway meeting in November 2026. Public consultation is planned for early 2027, with implementation of the preferred option anticipated in mid-2027.

Councillors raised several points during the discussion. Councillor Borski inquired about the transition of young people from CAMHS to adult services, and Councillor Ward questioned the reduction in bed numbers and the capacity to meet demand, particularly for those outside Bromsgrove. Councillor Oudle sought clarification on the unsuitability of Cromwell House and Oak House, and the potential impact of without variation care on individual needs, also asking about the expansion of talking therapies. Councillor Cross raised concerns about the impact of local government reorganisation and travel implications for families. Councillor Victory questioned the number of patients the community provision would serve and the location of practitioners. Councillor McSweeney asked about the implications for people with disabilities and maternity services. Councillor Wilde focused on the support for carers, referencing lessons learned from Nottingham. Councillor Rudall inquired about specialist care for minority groups, including the Gypsy, Roma, and Traveller community, and the LGBT+ community. Councillor Borski also raised concerns about the Robinson Unit and a specific case requiring ongoing support.

The presenters emphasised that the changes are not about cost savings but about delivering better value and extending the offer of care. They assured the committee that no staff redundancies are planned, with a focus on redeploying staff into the new community team. They also highlighted that the current buildings are not fit for purpose and that the move to community-based care is evidence-based and modelled on successful approaches elsewhere, such as in Leicestershire.

End of Life Care

Mary Gay, Executive Director of Integration and Delivery and Deputy CEO of NHS Coventry and Warwickshire ICB and NHS Herefordshire and Worcestershire ICB, presented an update on end-of-life care. She highlighted that while Worcestershire was previously in a strong position with low rates of patients entering acute hospitals in their final phase of life, this has changed significantly. An increasing number of patients are receiving care in acute hospitals in their last 90 days of life, a trend attributed to the rising elderly population and urgent care pressures.

The strategy for Worcestershire aims to reintroduce the Gold Standards Framework (GSF) across acute and community wards, implement a 24/7 specialist palliative care single point of access, and re-establish a community outreach model (COMPASS) for palliative assessment and support, including specialist palliative care professionals in emergency departments. There is also a recommissioning of services to integrate care back into district nursing teams to coordinate 24-hour care with GPs.

The Neighbourhood Health Framework is also being utilised to focus on priority cohorts, including end of life and frailty, with a focus on comprehensive geriatric assessments and early identification using the Respect tool. Early data from October 2025 to May 2026 shows positive progress, including an increase in frailty assessments, Comprehensive Geriatric Assessments, and advance care planning discussions.

Councillor Borski raised concerns about do not resuscitate (DNR) orders, particularly when patients regain capacity. Councillor Victory asked how the cohort requiring support is identified in advance to prevent hospital admissions. Councillor McSweeney questioned the phrasing around patients spending time in hospital in their last 90 days of life. Councillor Oudle expressed concern that the shift to home-based care could place undue pressure on relatives and carers, and that emotional and physical capacity to care at home might not always be present. Councillor Kumar, with a background in pain management and palliative care, asked about the training of palliative care nurses in advising relatives on pain management and the implications of digitising the Respect form. Councillor Cross inquired about the formatting of charts and the public understanding of Respect forms, advanced directives, and living wills, and whether overrides of Respect decisions are recorded. Councillor Wilde praised neighbourhood teams and hospice services but asked about extending night care provision. Simon Adams from Healthwatch raised points about patient involvement in auditing medical records, the effectiveness of the shared care record system, and the interpretation of Respect forms.

Mary Gay acknowledged the challenges and stressed the importance of personalised care, advance care planning, and integrated community support. She confirmed that the GSF is being rolled out across secondary care, and that a 24/7 helpline and COMPASS model are planned for Autumn 2026. She also addressed concerns about the digitisation of Respect forms, stating that communication and education for staff are crucial. The committee noted the importance of ensuring carers' needs are met and that decisions about end-of-life care are made with full understanding and capacity.

Work Programme

The committee reviewed its work programme for the upcoming year. Councillor Oudle suggested adding social isolation to the programme, particularly its impact on mothers of newborns. Councillor Victory proposed including neighbourhood health and its impact on long-term conditions, and waiting times for diagnostic and elective surgery. Councillor McSweeney highlighted a perceived lack of mental health topics on the programme and suggested including care for neurodivergence. Councillor Ward and Councillor Kumar raised the issue of robotic surgery provision and its effectiveness compared to conventional methods, suggesting this be brought forward. The committee noted these suggestions for the work programme, with some being considered for earlier meeting dates.

The meeting concluded with thanks to the presenters and committee members for their attendance and contributions.