The Scrutiny Committee - Adults and Health of Somerset Council scheduled a meeting to discuss a trauma-informed service for adults facing homelessness, and the future of community hospitals in Somerset. The committee also planned to discuss its work programme.

Community Hospitals

The committee was scheduled to consider a report on community hospitals in Somerset, and how they might fit into the NHS's 10 Year Health Plan.

The 10 Year Health Plan, published in July 2025, sets out ambitions for the NHS, including shifting care closer to communities. According to the report, 270,000 people nationally took part in the 10 Year Health Plan engagement, and people in Somerset backed the shift to care at home.

The report stated that to realise the benefits of the 10 Year Health Plan, services need to be transformed to guarantee sustainability, and that new ways of thinking and working are needed. The plan outlines the establishment of Neighbourhood Health Centres offering integrated local services, with the aim of ending traditional hospital outpatient services by 2035.

Our aim is to establish a Neighbourhood Health Centre (NHC) in every community… NHCs will be a 'one stop shop' for patient care and the place from which multi-disciplinary teams operate. NHCs will be open at least 12 hours a day and 6 days a week providing access to coordinated services locally, removing the need to go to hospital for urgent care. NHCs will co-locate NHS, local authority and voluntary sector services, to help create an offer that meets population need holistically. That will mean NHCs will not only bring historically hospital-based services such as diagnostics, post-operative care and rehabilitation into the community, but they will also offer services like debt advice, employment support and smoking cessation or weight management services.

NHS Somerset Integrated Care Board (ICB) is focusing on delivering the 10 Year Health Plan, including bringing services to people as close to home as possible, and working across health and social care with voluntary services.

The ICB has launched a public engagement programme to help shape how Somerset NHS shifts care to neighbourhoods for better health outcomes and to reduce pressure on main hospitals. This includes community services such as outpatient clinics, inpatient care, therapy services, dementia services and children's services.

The report noted that there have already been some positive changes in community hospitals, with more healthcare being delivered, and the hospitals being seen as vibrant hubs for the community. This has been made possible by temporary bed closures to test different models of care. Somerset NHS Foundation Trust (SFT) is implementing 'test and learns' to assess how communities are affected by temporary closures.

The report outlined several drivers influencing changes to how services are delivered in the county:

• Shifting patient needs: Most people using inpatient community beds are older, and many are living with dementia or other cognitive impairment. The unfamiliar inpatient environment can make delivery of reablement difficult compared to a person's own home.
• A better understanding of the risks associated with bed-based care for older people: Previous models of care associated with bed rest and recuperation have given way to new models of care for older people as we have come to better understand the risks associated with immobilising older people.
• Resource allocation: There has been a shift in resource with more resource currently being needed to deliver services in people's own homes.
• Technological advances: Medical innovation and advances mean that there are more same-day procedures, and this has reduced the need for overnight stays and onward inpatient recovery needs.
• Estate: Some of the Community Hospital buildings are in poor repair.
• Focus on delivery of services closer to home: There is a move towards providing more care closer to home, or in a person's own home.

The report stated that there are currently three strands of work which aim to underpin this strategic transformation:

1. The test and learn of the next phase of Intermediate Care development, designed to support more people to live independently for longer. This phase will test reducing reliance on bed-based care in community hospitals as additional investment is put into community alternatives. The design of this programme includes temporary bed reductions at Frome Community Hospital, West Mendip Community Hospital and Bridgwater Community Hospitals.
2. Engagement with local people and partners in the Burnham-on-Sea and Crewkerne areas regarding how best to use these community hospitals for the benefit of local people in the future as part of a test and learn. Discussions will include the current healthcare needs of local people and consideration of what is the best future mix of bed-based care and new additional services that could be offered at the hospital sites in the future, such as chemotherapy, cardiology, urology, community midwifery etc.
3. Looking at future service provision in Shepton Mallet, Chard and Wellington Community Hospitals and reviewing the temporary arrangements in place.

The ICB and SFT are committed to ensuring that community hospitals continue to play an increasingly significant role in serving the Somerset population, and are committed to continuing to invest in these hospitals and to further develop new local models of care in each area, with the involvement of local people.

The committee was asked to consider how they can be involved in co-producing the strategic transformation and future service provision in our communities, and to support the direction of travel regarding the work taking place looking at future service provision in Shepton Mallet and other Community Hospital sites.

The committee was also scheduled to receive regular updates on the strategic transformation of community hospitals going forwards and the evaluation from the Intermediate Care test and learn.

The report provided an example of work that has taken place in Shepton Mallet, where a collaboration of system partners and community representatives have worked together to develop a Vision Proposal for the future use and model of health services in the town.

Further work is now taking place to support the estates options of moving services from Shepton Community Hospital to another location within Shepton Mallet of which the Shape building is being explored. The vision for local services does not include a requirement for inpatient beds in Shepton Mallet and therefore the beds that have been temporarily closed for an extended period of time, would not need to be reopened. There will however be a range of services going into the new location with teams being co-located (primary and community) and this includes retention of the Urgent Treatment Centre.

Work is commencing to look at future services in Chard and Wellington Community Hospitals. A Case for Change is being developed to reimagine the Community Hospitals as modern, integrated Neighbourhood Health Centres for health and wellbeing.

An example of where Somerset is embracing the ethos of more care being delivered at home is through the test and learn for Intermediate Care where we are changing the way that services are delivered. By moving staff from inpatient settings, more people can be looked after for the same investment.

Intermediate Care services in Somerset were created in 2016 to help people recover after a hospital stay for up to six weeks.

Recent data shows that less than one in three Community Hospital beds are occupied by someone from the local area. Insights from Somerset Council's 'My Life, My Future' programme found that practitioners believe more people currently receiving treatment in beds can be supported in their homes by changing the way we offer care in Somerset.

Due to these findings, rising demand, and because outcomes show that independence is best achieved in a person's own home, Somerset has invested £1.6m over the next 12 months to provide more reablement at home, as an alternative to bed based support.

The test and learn involves changing the way clinical teams operate. Delivery of reablement in a person's own home gives greater control to the person receiving the support whilst in the familiarity of their own home as their bed is the best bed to help them recover.

While there will be fewer inpatient beds, the actual number of beds in use by our patients will go up, as it will be the patient's own bed, or depending on their needs, located in a local Care Home (paid for by the NHS).

Somerset NHS Foundation Trust have commenced engagement and detailed operational planning on the test of change at Frome, West Mendip and Bridgwater. It is the ICB view that their plans do not constitute major service change provided there is evidence that:

• The entirety of the bed stock is not removed from a single site
• There is local engagement in the change
• That robust capacity planning has been undertaken and the reprovision of the bedded care is explicit
• That a Quality Equality Impact Assessment has been undertaken
• Any proposed changes are temporary and must be fully reversible and subject to clear success criteria and transparency around review

Somerset NHS Foundation Trust have also commenced exploratory engagement with Burnham-on-Sea and Crewkerne Hospital League of Friends over potentially reducing bedded capacity at those hospitals in order to create more physical space for additional services such as outpatients, chemotherapy, cardiology, urology, community midwifery etc as part of a test and learn.

Trauma-Informed Service: Support for adults facing homelessness or multiple exclusions

The committee was scheduled to consider and give feedback on proposals for a trauma-informed service for adults facing homelessness or multiple exclusions, before the commissioning process reaches a formal procurement phase.

The aim of the service is to target a specific cohort of adults who are homeless, or at high risk of becoming homeless, and facing multiple disadvantages and exclusions. The agreed budget is £570,000 for a new contract starting on 1 April 2026. The proposed length of the contract is for an initial period of 5 years with the option to extend by another 2 years. The budget brings together funding from Adult Social Care (ASC) and Housing.

The proposal is scheduled to go to tender on 19 September, with a key decision to take place on 10 December 2025.

A full recommissioning exercise has taken place including a full review of current services and consultation with stakeholders and people with lived experience. Somerset continues to have a need for a service with the right specialism and skills to support people in this high-risk group. The cost to the system attached to supporting people in crises informs the commissioning of a specialist support service, but also the need for innovation and transformation to reinforce prevention and improve outcomes. The proposed service will align itself to Somerset Council Plans and Strategies, and supports the delivery of the Local Authority's legal obligations.

The aims and objectives of the service are to:

• Reduce crisis intervention and cost attached to such interventions that often do not achieve optimal outcomes for people due to them being in crisis.
• Support people to access suitable housing and timely support
• Prevent escalation of needs and people's admission to acute hospitals including specialist mental health wards
• Promote the safeguarding of people and positive risk management
• Work together to bring down barriers and access universal services
• Support people's recovery and wellbeing and meaningful participation in their communities.

The service will be county wide and work in partnership with the individuals themselves and with the Voluntary, Community, Faith and Social Enterprise (VCFSE), Health, Social Care and Housing teams. Key to the service and outcomes will be a trauma informed approach to the direct delivery of support to people and to the support provided to the staff team. The service provider will build on the work and achievements from predecessor services that have been commissioned by Adult Social Care and Housing over the last 5 years, and continue to support creativity and innovations and respond to system leader aspirations.

The service will take a trauma informed approach, which acknowledges:

'the need to see beyond an individual's presenting behaviours and to ask, 'What does this person need?' rather than 'What is wrong with this person?'' (Office for Health Improvement & Disparities- Gov.UK- Guidance 2022)

The provider will understand how trauma can negatively impact on individuals and communities, and their ability to feel safe or develop trusting relationships with health and care services and their staff. In practice, the staff team will be expected to manage positively people's reluctance to engage with support and demonstrate perseverance in their efforts and build people's confidence, and will receive robust support.

The service aims to continue to support creativity and innovations and respond to system leader aspirations, and to build capacity across service and holistic approach to people needs. There is a future ambition for teams supporting people with multiple disadvantages and exclusions to co-locate bringing efficiency, specialism and ultimately better outcomes for people.

The report identified budget pressures driven by an increasing number of people coming through services with higher needs, and the risk of service not achieving optimal flow due to length of time some people may require support. Mitigations include strong partnership work with existing services, placing an emphasis on prevention, move on pathways to alternative services ie Housing; Open Mental Health and VCFSE organisations, and continuing existing approaches to innovation and transformation to improve outcomes for people.

Work Programme

The committee was scheduled to discuss its work programme. The work programme included items scheduled for discussion at future meetings, including:

• Shared Lives (9 October 2025)
• Yeovil Maternity Closure/Paediatric Improvement Update (9 October 2025)
• Impacts of service changes on Ambulance Services (Yeovil to Taunton) (9 October 2025)
• Homelessness and Rough Sleeper Strategy – Action Plan (9 October 2025)
• GP Services and Primary Care - Gaps in service provision and risks (20 November 2025)
• Crime and Disorder Overview Report (20 November 2025)
• Social Care Training in Bridgwater (8 January 2026)
• Defibrillators in the community (8 January 2026)
• Impacts on Musgrove Park Hospital (Maternity unit) (26 February 2026)
• Armed Forces / Support for Veterans (9 April 2026)
• Executive Lead Member Annual Report (14 May 2026)

The committee was also scheduled to discuss items to be added to the agenda, including:

• Armed Forces Covenant
• Haematology Services -Yeovil
• Mental health
• Social Care Training (Bridgwater Academy)
• My Life, My Future Digital Platform
• Drug and Alcohol Services
• Healthy Weston Paula Clarke/Helen Edelstyn

Annual Reports to be taken through Scrutiny:

• Crime and Disorder Annual Report
• Safeguarding Adults Annual Report
• Director of Public Health Annual Report
• Somerset Strategic Drugs and Alcohol Partnership Annual Report