Agenda item

Report of the Vice Chairman of the Joint City and County Health Scrutiny Committee

The Committee received a presentation by Dr John Wallace, Clinical Director at Rampton Hospital on the High Secure Men’s Personality Disorder Service and the decommissioning of the Dangerous and Severe Personality Disorder Programme (DSPD).

Dr Wallace explained that, following consideration of the decommissioning of the DSPD Programme by the Committee in November 2015 and subsequent visit by Committee members to Rampton Hospital in January 2016, it became apparent that the Committee should receive a further explanatory presentation of the proposals, pitched at a less clinical level.

Dr Wallace covered the following points in his presentation:

(a)  the Mental Health Act allows people with a mental disorder to be admitted to hospital, detained and treated without their consent, and has safeguards in place to ensure these powers are not abused.

(b)  To be detained, the individual must have a mental disorder, be of a nature or degree warranting detention and treatment because of the risk to self and to others, and there must be available treatment in hospital. This final requirement replaced the ‘treatability test’, a change triggered by the murders of Lin and Megan Russell by Michael Stone, who had a severe personality disorder but who was not deemed ‘treatable’;

(c)  depending on the degree of risk and security, patients can access low-, medium- and high-secure hospitals. Rampton is one of 3 high-security hospitals in England – the others being Ashworth and Broadmoor – with almost 800 beds commissioned nationally;

(d)  the DSPD programme was established in 2007 to deal with those with a severe personality disorder or disorders who had a high risk of harming themselves or others and where there was a link between the personality disorder(s) and the risk of harm. Patients often present with self-harm and violent behaviour, have complex co-existing symptoms of a range of mental disorders, have physical health concerns, are past victims as well as offenders and have committed offences such as murder, sex assaults, hostage taking, arson and sadistic acts;

(e)  a consultant psychiatrist had to make a referral for admission and further ‘gatekeeper’ approval was required to ensure that the referral was appropriate. Assessment reports were then considered by an Admissions Panel, comprising clinicians not involved with the assessment process, and a further independent panel oversaw appeals against rejections by the Admissions Panel;

(f)  a ministerial decision was taken in 2011 to decommission DSPD services, to be replaced by a new Offender Personality Disorder (OPD) pathway, delivering a majority of treatment in prisons. In July 2014, the decision was taken to decommission the DSPD service at Rampton Hospital, and a Task Group led by NHS England was established to oversee the process;

(g)  a mitigation plan is in place to manage the impact of decommissioning the DSPD service at Rampton. This includes provision to increase the ‘standard’ Personality Disorder service while phasing in a decrease in DSPD provision. Overall, around 35 beds will be lost through this process. The expectation is that a new suite of prison-based OPD services will reduce the number of prison referrals, while a High Secure Hospital capacity review will be carried out to inform future Personality Disorder bed capacity requirements at Ashworth, Broadmoor and Rampton hospitals.

The following issues were raised during discussion:

(h)  while the provision of specialist services in prison was welcomed, the Prison Service was facing enormous financial and capacity pressures, and there was concern that the quality and care currently provided at Rampton would not be replicated in a prison environment;

(i)  the decommissioning plan does not generate public protection issues and is centred on patient need;

(j)  Sufficient capacity will be retained at Rampton to admit appropriate personality disorder patients.  Dr Wallace assured councillors that if there was insufficient capacity then the Healthcare Trust would request a review with commissioners of capacity/ the pace of decommissioning;

(k)  Dr Wallace expressed the view that in the past there was a tendency not to press charges if offences took place in hospital, but this had changed because of the importance of compiling accurate offender profiles;

(l)  movement into, through and out of the system was both needs-dependent  and needs-appropriate. Dr Wallace also confirmed that the Mental Health Act cannot be used to detain individuals on the basis of perceived risk;

(m)  Dr Wallace acknowledged that there was a risk that the highly skilled workforce would be dispersed following full decommissioning of the DSPD unit in October 2017. There is a national shortage of such skills;

(n)  Dr Wallace expressed the view that feeling secure, having a job and having sufficient support funding in place were the critical factors needed to ensure that former inpatient offenders establish a life outside hospital/prison. However, investment resources were at crisis point.

RESOLVED to:

1)  thank Dr Wallace for his informative presentation and discussion, and to note Dr Wallace’s offer to help arrange a further Committee visit to Rampton Hospital;

2)  invite NHS England to a future Committee meeting to discuss how the quality of care provided under the Offender Personality Disorder Pathway will be assured;and

3)  explore Psychologically Informed Placement Environments (PIPEs) and services for those with personality disorders in prison.