Freedom of Information Request – Ref: GHC-20052026-920077
Thank you for your recent Freedom of Information request. Please find our response below.
1. Current Demand and Placement Need
You asked:
Does your organisation currently commission or utilise open rehabilitation or step-down rehabilitation services from independent providers?
Our response:
Yes.
You asked:
Approximately how many individuals are currently placed within open rehabilitation or community rehabilitation settings?
Our response:
5 individuals placed in out of area open rehabilitation and 2x Trust Recovery Units providing open rehabilitation (approximately 23 beds).
You asked:
What are the most common presenting needs requiring this type of placement?
Our response:
Psychotic illness, dual diagnosis and complex emotional needs.
2. Hospital Discharge and Delayed Transfer Pressures
You asked:
Approximately how many individuals are currently experiencing delayed discharge from:
Our response:
Acute mental health wards -17
Rehabilitation wards – 5
PICU or low secure settings – <5
Specialist autism or learning disability services – NHS Gloucestershire ICB is responsible for commissioning
You asked:
What are the most common barriers to discharge?
Our response:
Availability of placement in care home with or without nursing, awaiting ministry of justice agreement, lack of housing, no social care support including social care funded placement.
3. Out-of-Area Placements
You asked:
Does your organisation currently place individuals outside of its local area for rehabilitation or step-down support?
Our response:
Yes.
You asked:
If yes:
Approximately what proportion of placements are out-of-area?
Our response:
Approximately 18%.
You asked:
What are the primary reasons for out-of-area placements?
Our response:
Risk profile being unsuitable for level of staffing and environment at Recovery Units.
You asked:
Is reducing out-of-area placements a current strategic objective?
Our response:
Yes.
4. Service User Cohorts
You asked:
What service user groups are currently most difficult to place within community rehabilitation settings?
Our response:
Dual diagnosis and complex emotional needs.
You asked:
Are there identified gaps in provision for individuals with:
Our response:
Autism • Learning disabilities – NHS Gloucestershire ICB responsible for commissioning
Dual diagnosis – Yes
Personality disorder – Yes
Complex trauma – Yes
Forensic histories – Yes
Behaviour that challenges – Yes
5. Current Provider Market and Sufficiency
You asked:
Does your organisation currently identify a shortage of rehabilitation or step-down placements?
Our response:
Tier 2 is limited locally.
You asked:
Are there specific rehabilitation models or service types currently required but limited in availability?
Our response:
Local short-term transitional support that can manage risk and dual diagnosis.
You asked:
Does your organisation have a current rehabilitation, mental health, or accommodation sufficiency strategy?
Our response:
Strategy around local Recovery Units in progress.
6. Placement Models and Support Levels
You asked:
What support levels are most commonly commissioned?
Our response:
24 hour staffed rehabilitation.
You asked:
What are the most common referral pathways into these services?
Our response:
Via hospital discharge of step-down from secure/forensic settings.
7. Spend and Commissioning
You asked:
What was the approximate total spend on independent rehabilitation or step-down placements in the last financial year?
Our response:
£773,000
You asked:
How are such services typically commissioned?
Our response:
Spot purchasing.
8. Quality and Outcomes
You asked:
What are the most important factors considered when sourcing rehabilitation placements?
Our response:
Ability to meet identified rehabilitation goals, close to home, least restrictive, flow through the pathway, clear and collaborative discharge planning.
You asked:
What outcomes are considered most important when evaluating placement success?
Our response:
Achievement of goals, increased independence, reduced likelihood of readmission.
You asked:
What are the most common reasons for placement breakdown?
Our response:
Lack of clear recovery goals, individual unable/unwilling to engage with rehabilitation, unsuitable placement.
9. Commissioning Contacts
Please provide the structure or generic contact details for the teams responsible for:
Our response:
Rehabilitation commissioning STAR (Specialist Treatment and Rehabilitation) Team in GHC – STAR@ghc.nhs.uk
Complex mental health commissioning STAR (Specialist Treatment and Rehabilitation) Team in GHC – STAR@ghc.nhs.uk
Learning disability/autism commissioning – NHS Gloucestershire ICB
Hospital discharge pathways GHC Bed Managers – bedmanagers@ghc.nhs.uk
Next steps:
Should you have any queries in relation to our response, please do not hesitate to contact us. If you are unhappy with the response you have received in relation to your request and wish to ask us to review our response, you should write to:
Louise Moss
Head of Legal Services / Associate Director of Corporate Governance
c/o Gloucestershire Health and Care NHS Foundation Trust
Edward Jenner Court
1010 Pioneer Avenue
Gloucester Business Park
Brockworth, GL3 4AW
E-mail: louise.moss@ghc.nhs.uk
If you are not content with the outcome of any review, you may apply directly to the Information Commissioner’s Office (ICO) for further advice/guidance. Generally, the ICO will not consider your case unless you have exhausted your enquiries with the Trust which should include considering the use of the Trust’s formal complaints procedure. The ICO can be contacted at: The Information Commissioner’s Office, Wycliffe House, Water Lane, Wilmslow, Cheshire SK9 5AF.