APPENDIX 9
Memorandum by North West Regional Secure
Commissioning Team, Sefton Health Authority (MH 28)
INTRODUCTION
1. This submission is made by Sefton Health Authority,
Regional Secure Services Commissioning Team. The commissioning
of high secure psychiatric services for the NHS North West Region
is delegated to Sefton Health Authority.
2. The Secure Services Commissioning Team
undertakes its' responsibilities using a whole systems approach
and commissions the following services for the population of the
North West Region:
— Secure services for mentally ill,
learning difficulties and personality disorder of people (secure
service for children may be included in the future) involving:
— High Secure Care (Special
Hospitals).
In directly commissioning these
specialist services the team makes active links to the multi agency
commissioning of:
— Criminal Justice Liaison Team.
— Prison Mental Health Services.
— Any other services relating to mentally
disordered offenders.
In addition the commissioning team
acts as "host" commissioner for Ashworth Special Hospital
on behalf of the other eight Regions and Wales.
The composition of the team includes specialist
posts covering NHS Mental Health, Prison Care, Probation, Learning
Disabilities, Social Services, Forensic Medical, User, Family
and Advocacy as well as Financial and Information Analysts.
STRATEGY
3. The principles defining the strategy
which we would ask the Committee to endorse are:
— We will work in supportive partnership
with organisations and their workers to provide services, encouraging
and facilitating effective communication and co-operation between
them.
— We will ensure that services are
available so that each person in need is able to receive effective
care and treatment in no greater security than they require.
— We will ensure that public safety
and understanding is maintained.
— Those detained in secure care will
be treated with respect and be helped to make visible pathways
along which they may travel towards independent living in the
community. Each will have the opportunity to develop skills which
will assist them to make positive contributions in our society.
THE CONTEXT
4. When we considered how best to take forward
the commissioning of secure services for those with mental health
needs, we took the view that to be effective the commissioning
body had to be representative of the range of statutory agencies
which work in this field. By representing, within ourselves, the
interface tensions which currently exist across the spectrum of
service providers, we believe we can more effectively understand
them and from that understanding reduce them. Currently services
reflect vertical structures of provision which were developed
and strengthened throughout the last century. In working to modernise
service commissioning we aim to increase lateral co-operation
across agencies for all those involved in secure mental health
and learning disabilities provision.
5. Our consultations with providers of services
and other directly involved agencies (Police, Prisons, Probation
Voluntary Groups) have shown the importance of improving and strengthening
relationships between agencies at both formal and informal levels.
There is a clear need for more openness in communication between
those working in the service system and a need to ensure all agencies
are focused on supporting the individual and balancing the requirements
for safety in our society.
6. We are seeing positive attempts to develop
closer and more integrated inter-agency working. Whilst we will
further facilitate this process we believe that, in order to take
it further there needs to be additional statutory authority to
strengthen and encourage this. The 1999 Health Act allows Local
Authorities and the National Health Service to pool financial
resources in order to improve the quality of services provided.
We wonder whether the Health Committee could consider how this
positive initiative can be extended to other statutory bodies.
The new relationship between the Prison Service and the National
Health Service is going forward in partnership but it would be
given greater effectiveness if the two services were allowed to
pool monies for specific pilot projects. Currently the Prison
Service funds all primary healthcare within prisons. Secondary
healthcare is funded by the NHS and provided within their own
structures. We believe that for the achievement of a comprehensive
service providing public safety and individual rehabilitation,
we will require mental health services across the NHS, Local Authority
and Prison sectors to meet the spectrum of individual and societal
needs. A project that was jointly funded—for example, a
joint NHS/prison mental health needs assessment and treatment
unit would strengthen the partnership interface between the two
services, provide a stronger dynamic to the exchange of skills
between the services and maintain a stronger focus on cost. It
would reduce the isolation of staff working in prison healthcare
by maintaining their employment in the NHS and this would help
change current culture.
SECURE CARE
7. In the provision of mental health or
other care in secure settings there is a continual tension between
security and standards of treatment and care. The Fallon Report
of 1998, into events at Ashworth highlights the issue. It is an
issue services in these settings appear to struggle with, and
it appears extremely difficult to achieve and maintain the balance
between the different requirements on a daily basis. The tension
between the concepts of care and security can be polarised between
different disciplines of staff—for example between security
staff and medical staff. The Fallon Report shows how difficult
it can be to maintain the two concepts in practice. In the past
the results seem often to have been security or care. Our vision
is for patient and public safety to be maintained within sound
and progressive models of care. How staff in the NHS and prison
services are to manage the exacting demands and how they are to
be supported and trained in this work requires greater research
and practice modelling through pilot initiatives.
RECOMMENDATIONS
1. The Committee endorse the need for greater
openness in communication between all the agencies working in
mental health, including criminal justice agencies.
2. The Committee endorse the provision in
the Health Act 1999, which allows Local Authority and NHS to pool
financial resources and recommend an extension of the principle
to include the Prison Service, Probation Service, Police as well
as Local Authorities and the National Health Service.
3. The Committee should actively support
research into how the balance between care and security can best
be delivered in secure settings in both the NHS and Prison Services.
The research should consider how staff working in both these secure
care environments can best be supported in maintaining the necessary
balance between these different demands where managed risk is
an essential aspect of treatment and rehabilitation.
February 2000
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