The Kent and Medway NHS Joint Overview and Scrutiny Committee met to discuss the proposed decommissioning of the Bedgebury Unit and to elect a Chair and Vice-Chair. The committee voted to elect Councillor Dan MacDonald as Chair and Councillor Diane Morton as Vice-Chair. The main item of discussion was the proposed decommissioning of the Bedgebury Unit, a 10-bedded forensic pre-discharge rehabilitation service.

Bedgebury Unit Proposed Decommissioning

The committee discussed the proposal to decommission the Bedgebury Unit, a 10-bedded forensic pre-discharge rehabilitation service. The review of the unit concluded that it no longer aligns with its original service specification, current best practice guidance, or the desire to move patients into the least restrictive care setting as quickly as possible. The proposal is not financially motivated, but rather a clinical service redesign to place the pathway into the best possible clinical position.

Professor Rafi Faruqi, a consultant neuropsychiatrist and clinical director for forensic and specialist services at Kenton Medway Mental Health Ministries Trust, explained that patients in forensic services undergo rigorous risk assessments, including the HCR20 tool. He assured the committee that the system for supporting discharged patients into the community is more robust than in previous years, with increased investment in specialised forensic outreach liaison services. However, he acknowledged that very regrettably, we still hear about very difficult and side cases where system doesn't work.

Councillor Councillor Satinder Shokar raised concerns about public perception of risk, asking about assurances that individuals discharged from secure services would not pose an increased risk to the public. Professor Faruqi detailed the use of Ministry of Justice restriction orders (Sections 37/41) and Community Treatment Orders (CTOs) for patients, which include conditions and a system of clinical and social supervision, with provisions for recall if necessary.

Donna Hayward-Sussex, chief operating officer of Kenton Medway Mental Health Trust, stated that the Bedgebury Unit, a 10-bedded facility, currently has five patients. She indicated that discharge plans were in place for all but one patient, with the final patient expected to be ready for discharge in January 2027. The annual cost of the unit is £1.73 million, with approximately £680,000 identified as potentially releasable.

Councillor Smitha Campbell questioned the communication plan for patients and families, drawing a parallel to a previous issue with the ADHD and Autism Pathway redesign. It was clarified that the Bedgebury Unit is a very different type of service, with no patients on a waiting list for admission.

Councillor Alex Ricketts inquired about similar facilities and the last admission date to Bedgebury. It was noted that the decision to decommission was operationalised in May 2025, and that patients on Bedgebury ward had historically had very long lengths of stay, averaging around 50 months. The committee was informed that a comprehensive review of mental health, autism, and other council-wide services is planned, which will include looking at the fitness for purpose of all clinical models.

Concerns were raised about the potential impact on adult social care budgets, particularly regarding Section 117 arrangements¹. Leanne Farragh, Director of Adult Social Care for Medway, confirmed that Section 117 can have ongoing costs for local authorities, but that these are based on individual needs. She noted that the papers alluded to no additional costs for social care, which she concurred with, but had not seen a mathematical breakdown of costs associated with Bedgebury.

Councillor Diane Morton, Vice-Chair, expressed frustration at the lack of readily available financial data, particularly concerning Section 117 arrangements, stating, the money side of things should be key to what, that's why we're here today. We need that reassurance. We should have them answers.

The committee was assured that the proposed changes represent a net investment in mental health services, with significant reinvestment in community rehabilitation pathways, including a countywide Assertive Outreach Team (AOT) costing approximately £3.5 million per annum, and £1 million to improve step-down capacity and patient flow.

Councillor Campbell highlighted the importance of understanding the impact on residents and budgets, and suggested that case studies would be helpful. The committee was informed that the provider collaborative for Kent, Surrey, and Sussex works to ensure swift placement of patients and shares best practices. It was noted that this collaborative does not involve the voluntary sector, but a separate local collaboration in Kent does.

The committee ultimately supported the proposal to decommission the Bedgebury Unit, with a recommendation to write to the Royal College of Psychiatrists to gather data on comparable units nationally. They also requested to be updated on progress by the Joint Overview and Scrutiny Committee (HOSC) and the Health and Adult Social Care Overview and Scrutiny Committee (HASC) on a 12-monthly basis.