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Annual Report 2010/2011


National High Secure Commissioning Group – England and Wales

Foreword 2010/11 has been another challenging but productive year in the commissioning of high secure services in ensuring they are integral to the whole pathway of services for mentally disordered offenders and others with similar needs. The National High Secure Commissioning Group has been in operation for over two years. The governance systems underpinning high secure commissioning are embedded in the wider functions performed by specialised commissioning groups, on behalf of all primary care trusts in England, and local health boards in Wales. Links between all partner agencies continue to ensure that all aspects of the pathway into, through, and out of high secure care fit with the overall aims that secure services deliver treatment in the most appropriate and least restrictive environment required to address need and risk. 2010/11 has seen major changes in the health service. Services have been asked to find increased levels of efficiencies, to optimise the available resources and continue to ensure that resources are prioritised to address the greatest need and risk. Individual specialised commissioning groups have set up QIPP (Quality, Innovation, Productivity and Prevention) plans with a focus on ensuring only those who need care and treatment in a secure environment because of the risk they present are in secure services and that the stay in those services is time limited with a focus on timely move on to the next step.

High secure services are an integral part of this work, ensuring the resources within high secure are only used for those who present that level of risk. The year has also seen further changes planned in commissioning. Subject to Parliamentary process, a national NHS Commissioning Board will be established to ensure clarity and consistency in commissioning health care. Part of this role will include commissioning specialised and secure services. This means changes to the commissioning of high secure services and for 2011/12, the plan is to move commissioning of high secure services back to those specialised commissioning groups which host each of the high secure hospitals. The specialised commissioning groups will work collaboratively to continue to deliver the key priorities in the high secure agenda.

Jon Develing Chief Officer High Secure Services Commissioning


Annual Report 2010/11

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Governance arrangements for High Secure Commissioning

Secretary of State for Health

NHS London

National Specialised Commissioning Group Chair persons from all the Specialised Commissioning Groups Chair: Chief Executive – NHS London

National High Secure Commissioning Group Chair: Chief Officer – North West Specialised Commissioning Team Representatives of the 10 Specialised Commissioning Teams and the Health Commission of Wales

National High Secure Commissioning Team Core National Team plus 3 Lead Commissioners of High Secure Services

Regional Commissioning Acting of behalf of PCTs and LHBs in accordance with governance arrangements North West scg West Midlands SCG Wales

East Midlands SCG Eastern SCG North East SCG Yorkshire & Humber SCG

London SCG South West SCG South East SCG South Central SCG

Secure Commissioning Lead North West Specialised Commissioning Team

Secure Commissioning Lead East Midlands Specialised Commissioning Team

Secure Commissioning Lead London Specialised Commissioning Team

Mersey Care NHS Trust Ashworth Hospital

Nottinghamshire Mental Health NHS Trust Rampton Hospital

West London Mental Health Trust Broadmoor Hospital

Service Commissioning and Contract Monitoring Core National High Secure Commissioning Team National Director of High Secure Commissioning

Background The National High Secure Commissioning Group was established in 2008 to commission high secure services on behalf of the 152 English primary care trusts and 7 local health boards in Wales. During 2010/11, the commissioning of these services was undertaken by the National High Secure Commissioning Team on behalf of the 10 regional specialised commissioning groups in

England and the Welsh Health Specialised Services Team. The National High Secure Commissioning Group provides informed direction and advice to the Team which in 2010/11 was hosted by the North West Specialised Commissioning Group and based in the North West. Governance arrangements for 2010/11 were unchanged. However, from April 2011, commissioning arrangements have

changed with a revised governance structure to underpin the new arrangements. The co-ordinating commissioners for high secure services based in the three Specialised Commissioning Groups with high secure hospitals continue to work collaboratively to deliver the high secure commissioning agenda.


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National High Secure Commissioning Group – England and Wales

High Secure Services High secure services are a highly specialised and complex part of the NHS portfolio of secure health care. They form part of the forensic mental disorder pathway, linking them not only to NHS services but also to criminal justice services, specifically prisons and offender management services. High secure services are provided in three high secure hospitals across England – Ashworth Hospital (part of Mersey Care NHS Trust – www.merseycare.nhs.uk); Broadmoor Hospital (part of West London Mental Health Services NHS Trust – www. wlmht.nhs.uk); and Rampton Hospital (part of Nottinghamshire Mental Health NHS Trust – www.nottinghamshirehealthcare. nhs.uk). Rampton Hospital also provides national services for women, learning disabilities and for those who are deaf.

High secure hospitals are for those detained over the age of 18 and admissions are usually either direct from prisons, courts or from medium secure services. However, catchment medium secure services are always involved in this process, as part of the overall care pathway oversight. The high secure services are for those who present the highest levels of risk, who are assessed as mentally disordered and require a period of assessment or treatment as part of their overall pathway through criminal justice, health or a combination of the two. The high secure services have two main objectives: • Treatment and therapies to reduce risk – the therapeutic objective of the high secure hospital is to provide services that address a patient’s illness or

disorder and make their behaviour less dangerous to others and sometimes themselves. • Security – to ensure the delivery of a safe and secure environment, which prevents escape or abscond, provides security through physical, procedural and relational security and protects the public, staff and other patients. It is the grave and immediate risk presented by patients of high secure hospitals which distinguishes them from patients in other parts of the secure health service pathway.


Annual Report 2010/11

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Strategic objectives 2010/11 The key strategic objectives are set out in the High Secure Services Strategic Commissioning Plan and are reproduced below: • The populations of England and Wales will have fair and equitable access to the full range of high secure services. • All treatment and care will be patient centred, pathway based and address offending and risk behaviour. • Each patient will receive the right treatment at the right time. • High secure services will be delivered using the principles of QIPP (Quality, Innovation, Productivity and Prevention). • The hospitals will deliver high quality services, meeting the security standards equivalent to Category B in prisons, to deliver a safe and secure environment for patients.

Front cover Ashworth Hospital Reception in Broadmoor Hospital This spread David Wilson Learning Disability Unit at Rampton Hospital Woodwork in Broadmoor Hospital Artwork produced by patients at Ashworth Hospital (partially cropped) Launch of the Healthy Eating Recipe Book at Rampton Hospital


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National High Secure Commissioning Group – England and Wales

Work plan objectives 2010/11 One of the key objectives in 2010/11 was the development of an overarching High Secure Services Strategic Commissioning Plan in order to set out the context for future change to meet needs within a complex and challenging environment. The 2010/11 – 2015/16 plan was published in February 2011. Continuing to build relationships with all key partners is a vital part of delivering the right service at the right time and optimising resources: through national links to the Royal College of Psychiatrists, Nursing and also to National Offender Management services, as well as collaborative working with the Welsh Assembly Government. These have all been vital in ensuring a coordinated and collaborative system. Partnership working between the three hospitals has continued to produce a better understanding of each other’s ways of working, learning from experiences and the sharing of expertise, all of which have been a key part of continuous improvement in service quality and safety. CQUIN has again promoted the development of consistency across the country, ensuring a holistic approach to healthcare: work on preventing cardiovascular problems,

improving health and wellbeing as part of overall progress along the pathway, and steps to rehabilitation and recovery were key achievements in 2010/11. Through collaborative work across the wider system, between medium secure services and local commissioners, and specifically through the work led by case managers, we have seen improvements in access to and discharge from services. Recognising the forthcoming major changes to systems, the team has developed and continues to evolve while a business continuity and transformation plan for commissioning reflects the emerging NHS infrastructure. The requirement to ensure services continue to be delivered within the financial envelope available in 2010/11 has required the three hospitals to examine how to deliver QIPP i.e. ensuring that services explore innovative ways of working to deliver the service. The aim has been to ensure that consistency across all three sites is maintained whilst comparing and discussing options available. The delivery of these will be monitored closely during the lifetime of the plan.

Following on from Phase 1 of the pathways work, Phase 2 picked up on specific issues to explore the reasons for any differences across the three. The output from this is still under debate as at the end of the year and will be picked up in 2011/12. In addition, through the joint hospital work, the aim is to better understand what differences there are between patients and referrals from different areas and what factors underpin these issues. An option appraisal exercise was undertaken about the future site configuration. This confirmed that the current plans were appropriate. Planning work towards the redevelopment of Broadmoor Hospital has continued and changes to capacity as set out in the capacity review have been implemented in year. It was identified that a consistent approach to access to the hospitals from countries outside current arrangements was needed and therefore work has been undertaken to develop a protocol to set out both the circumstances in which such a referral may be accepted and how it will be managed.


Annual Report 2010/11

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This spread Broadmoor Hospital – Main reception Broadmoor Hospital – Staff in conversation Ashworth Hospital – Koestler Awards: prize winning images Ashworth Hospital – National Training Awards 2010 Ashworth Hospital volunteer Brian McCormack won the Greater Merseyside Befriender of the Year 2010 award Art on the wards at Rampton Hospital

Priorities for 2011/12 The key priorities highlighted for 2011/12 are: • Monitoring and reviewing the contract for high secure services to ensure key targets are met, service quality delivered and risks managed. • Maintenance of effective communications networks. • CQUINs delivered to continue to make progress on improving the physical health and well being of patients; supporting patients to make progress with their pathway; ensuring consistency of access. • Delivering QIPP as part of the delivery of the plan. • Delivering changes in capacity. • Continuing to support the redevelopment of Broadmoor Hospital. • Development of an outcomes framework with performance managers and the hospitals to replace the existing key performance indicators.

• Developing an implementation plan for personality disorder. • Supporting the primary care research programme. • Reviewing the implications of the Women’s Enhanced Medium Secure Services programme. • Reviewing the strategic plan and financial assumptions. The high secure commissioning team work plan for 2011/12 has been approved by the Group.


Contact If you have any queries about high secure commissioning, contact the appropriate high secure co-ordinating commissioner: Kath Murphy, lead for Rampton Hospital and initial contact for queries from North East; Yorkshire and Humber; East Midlands and East of England Kath.Murphy@emscg.nhs.uk Paul Meechan, lead for Broadmoor Hospital and initial contact for queries from South Central, South East Coast, South West and London Paul.Meechan@londonscg.nhs.uk Carole Hardwick, lead for Ashworth Hospital and initial contact for queries from Wales, West Midlands and North West Carole.Hardwick@nwsct.nhs.uk Jon Develing, Chief Officer, North West SCG, continues to chair the NHSCG. Jon.Develing@nwsct.nhs.uk

National High Secure Commissioning Group membership Patrick Neville

South West Specialised Commissioning Group

Annie Norman

Royal College of Nursing

Caris Vardy

North East Specialised Commissioning Group

Carl Shortland

National High Secure Commissioning Team

Carole Theobald

East of England Specialised Commissioning Group

Ged McCann

Yorkshire and the Humber Specialised Commissioning Group

Dr Ceralin Rogers

Welsh Health Specialised Services Committee

Jon Develing (Chair) North West Specialised Commissioning Group Karen Howell

National High Secure Commissioning Team

Janet Parrott

Royal College of Psychiatrists

Jo Seward

Department of Health

Mary Ann Doyle

West Midlands Specialised Commissioning Group

Kate Caston

East Midlands Specialised Commissioning Group

Simon Jupp

South Central Specialised Commissioning Group

Maria Crowley

South East Coast Specialised Commissioning Group

Sue McLellen

London Specialised Commissioning Group

Carole Hardwick

Commissioner – Ashworth Hospital

Paul Meechan

Commissioner – Broadmoor Hospital

Kath Murphy

Commissioner – Rampton Hospital

National High Secure Commissioning Group Quayside Wilderspool Park Greenalls Avenue Stockton Heath Warrington WA4 6HL Tel: 01925 406013 Published by National High Secure Commissioning Group © Crown Copyright


Annual Report 2011 – NHS National High Secure Commissioning Group