Needless complexity in commissioning

Prasanna N De Silva

doi:10.1192/pb.37.1.37a

Abstract

Having attended a local third-sector and service user conference and having read the editorial by Holloway,[1][1] I wonder whether the following needs more consideration. It strikes me that dividing mental health commissioning responsibilities locally between the clinical commissioning groups (

Highlights

We receive some prison transfers; these include general adult community patients with no prior forensic history who were missed in the community owing to service lapses
At a recent presentation by some Californian psychiatrists, I was very impressed by the vigour with which they grapple with often very difficult legal circumstances of psychiatric care in their jurisdiction
They noted that most of their state hospital beds were occupied by their forensic patients

Summary

COLUMNS Correspondence

As a National Health Service forensic psychiatrist working on a newly commissioned low secure ward, the statement: ‘it is all too predictable that yet more patients will be pushed down forensic care pathways from which return to mainstream care will be difficult (p. 402)’ in Holloway’s excellent November editorial[1] struck a firm chord with me. At a recent presentation by some Californian psychiatrists, I was very impressed by the vigour with which they grapple with often very difficult legal circumstances of psychiatric care in their jurisdiction They noted that most of their state hospital beds were occupied by their forensic patients. I wonder whether here in England we are heading in that direction It appears that in this evolving, risk-focused, forensic-heavy psychiatric care environment, the ‘forensic’ patient today is not the same forensic patient from 20 years ago. The expanding low secure estate ought to provide an easier interface within the psychiatric services than was the case in the past This way we will have done our best for our patients while contending with the difficult care environment being planned for us by this government.

Needless complexity in commissioning

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