Special Hospitals (Hansard, 21 June 1995)

§ Mr. Bowis

We have decided on a number of important changes in the organisation and funding of high security psychiatric services provided by the three special hospitals, Ashworth, Broadmoor and Rampton. Their purpose is to integrate special hospital services more closely with mainstream mental health services while fully maintaining the protection of the public, staff and patients themselves. They build on the substantial improvements in quality and effectiveness of services that have been achieved by the Special Hospitals Service Authority since it was set up in 1989.

The changes take account of the recommendations of the expert group, chaired by Dr. John Reed CB, on high security and related psychiatric provision whose report was published in July 1994. I announced then that we were asking officials to examine further the group's recommendations and advise on what changes, if any, should be made in the funding, management and deployment of the services. In doing this, they were to pay particular regard to Ministers' obligations to maintain the security and quality of the services and to achieve value for money. The decisions I am announcing today have been taken in the light of this further advice.

The key features of the new arrangements that we are introducing are: a national high security psychiatric services commissioning board within the NHS executive, which will be responsible for commissioning services provided by the special hospitals. It will advise and be accountable to Ministers through the chief executive of the national health service executive and include representation from NHS purchasers, the Welsh Office, Home Office, Prison Service and the present Special Hospitals Service Authority; the establishment of three new special health authorities which will be responsible for managing services provided by the special hospitals; the establishment of a co-ordinated structure of commissioning arrangements for secure psychiatric services from the special hospitals to those provided at local level.

Further details are contained in a paper entitled "High Security Psychiatric Services—Changes in Funding and 257W Organisation" which is being published today, copies of which are available in the Library.

This will bring high-security services much more closely into line with the arrangements for other NHS services through:

separation of responsibility for commissioning and provision of high security services: This will extend to the special hospitals the benefits which have been achieved in the NHS generally through the separation of the purchasing and providing functions. The hospitals will concentrate on improving the quality and effectiveness of service delivery. The new commissioning board will be responsible for assessing national needs for psychiatric care in conditions of high security and contracting for services to meet those needs;

local management for the three special hospitals: will give greater responsibility to the people who work in each hospital so that they are able to develop the organisation in ways that best meet the needs of their patients and respond quickly on day-to-day matters affecting patients and staff;

better integration of high security services with other parts of the mental health services: will help to reduce, both for patients and staff, the isolation of the special hospitals and the impediment this presents to improving the quality and effectiveness of their services. This includes the removal of financial and organisational barriers which have tended to impede the movement of patients through services in accordance with their clinical and security needs. It will also allow freer movement of staff between the hospitals and other NHS employment. It will support the reshaping of existing patterns of services in accordance with assessed patients needs;

direct involvement of local NHS health purchasers in commissioning high security services: will ensure that the needs of patients requiring high security are better understood and strategies to meet their continuing care needs are built into local mental health service development plans. This will help secure the most effective use of available resources to provide high- quality services at the level of security required.

The new arrangements will take effect on 1 April 1996. At that point, the Special Hospitals Service Authority will cease to be responsible for the management of special hospital services and we intend to take the necessary steps to abolish it. I should like to take this opportunity of paying tribute to the chairman, Mrs. Anne-Marie Nelson, her predecessor Dr. David Edmond, the members of the authority, and all its staff for the invaluable work that they have done in the past six years in improving and modernising the services of the special hospitals.

The new arrangements will incorporate special provisions for funding, commissioning and regulation to maintain the degree of central oversight which is essential for high security services. The chief executive of the NHS executive is putting in hand the necessary preparatory work to enable the change to be implemented from April 1996.

I recognise that the period of change will be a challenging one for the staff of the authority and the hospitals. The authority is arranging for there to be full discussion with staff and patients about the implications of the changes for them. I have complete confidence in their commitment and dedication to ensure that the quality of the service they provide is fully maintained as the changes proceed.

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Our task now is to consolidate the authority's past successes and develop a service for the future which can respond to the full range of patients' needs, meet the aspirations and potential of staff and work effectively with other secure psychiatric services, while continuing to ensure the protection the wider public rightly expects. I believe that the changes I have announced today create the framework we need for achieving this.