Annex C
THE TRANSITION BETWEEN ACUTE AND SECURE MENTAL
HEALTH SECTOR
SECURE SERVICES
C1. In some areas, there are insufficient
secure places to meet demand. Conversely, some demand for secure
places is fuelled by a lack of appropriate acute hospital and
community mental health services. Timely access to appropriate
medium and high security hospital services has been hampered by
separation of both commissioning and provision of high security
services from the arrangements that apply to other secure mental
health services.
C2. The strategic objective is to achieve
continuity of care for people moving from secure to general mental
health services. This will be achieved by:
— increased funding through the Mental
Health Modernisation Fund. An additional £14 million was
made available in 1999-2000 for the development of new additional
secure places; and
— changes to both the commissioning
and providing of high and medium security services.
C3. To increase access to services extra
beds and assertive outreach teams have been funded. This will
ensure development of a greater range of mental health services
and greater availability of treatment in the least restrictive
environment appropriate to the patient's needs, which has been
a long standing principle of mental health care. These developments
may help reduce the demand for secure mental health places by
preventing crisis and ensuring more intensive aftercare in the
community following discharge from a secure unit.
C4. There are a number of prisoners who
are inappropriately placed in prison for too long while waiting
for transfer to hospital for mental health reasons, and where
it is readily acknowledged that they need secure mental health
care. Existing problems will be alleviated by the new commissioning
arrangements described below as well as the work of the new Prison
Service/NHS Executive partnership at local, regional and national
level.
NEW COMMISSIONING
ARRANGEMENTS
C5. In line with the principles set out
in the White Paper The new NHS, high and medium security
psychiatric services will, from 1 April 2000, be commissioned
by regionally based specialist commissioning groups. Funding for
high security services previously commissioned by the High Security
Psychiatric Services Commissioning Team, based in the NHS Executive,
will be devolved to health authorities. This removes the perverse
financial incentive where high security services were a "free
good" to health authorities. Health authorities, in the context
of regionally based specialist commissioning groups, will be able
to commission the full range of secure services which meet the
needs of their local population. Health Service Circular HSC 1999/141
(Commissioning in the New NHS: Specialised Commissioning—High
and Medium Security Psychiatric Services) was issued to health
authorities and NHS trusts in June 1999. This circular set out
the specific new arrangements for the commissioning of high and
medium security psychiatric services, including arrangements for
future national oversight and co-ordination of high security psychiatric
services.
INTEGRATED PROVISION—HEALTH
ACT AND
HIGH SECURITY
HOSPITAL CHANGES
C6. Section 4 of the NHS Act 1977 has been
amended to allow high security psychiatric services to be provided
by NHS trusts (section 41 of the Health Act 1999). It is proposed
that the three high security hospitals (Broadmoor, Ashworth and
Rampton) form new organisations with existing mental health trusts,
so that they become providers of high security psychiatric services
with an integrated secure and general mental health services trust.
C7. London NHS Executive Regional Office
published a consultation document on 13 January 2000 proposing
the dissolution of Broadmoor Hospital Authority and Ealing, Hammersmith
and Fulham NHS trust, and the establishment of a single new organisation
providing a full range of local, specialist and forensic mental
health services. Ashworth and Rampton Hospital Authorities are
involved in ongoing discussions with a range of local mental health
trusts with a view to establishing similar integrated secure and
general mental health services trusts in due course.
C8. Partnerships and integrated service
development within the wider NHS and other statutory and voluntary
agencies are priorities for a modern high security service, and
will end the isolation of the high security service.
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