Nottinghamshire Healthcare, UK
Title: A review of the factors that influence high, medium and low secure care pathways in the UK
Julie Hall is the Executive Director with responsibility for high secure provision at Rampton Hospital; medium secure units at Arnold Lodge in Leicester and Wathwood Hospital in Rotherham, the Low Secure and Community Forensic Directorate and Offender Health in the East Midlands and Yorkshire. Julie began her career as a Registered Mental Nurse, and has since worked as a clinician, senior manager and director within mental health services in the East Midlands. Between these appointments Julie spent time as a full time lecturer in Nursing at the University of Nottingham, before returning to the NHS. Julie’s role prior to taking up this position is of Director of Nursing and Operations at Lincolnshire Partnership NHS Foundation Trust. Julie has made a number of professional contributions and gained accolades including holding the title of Queen’s Nurse, being a Senior Fellow of the Institute of Mental Health and Visiting Fellow at the University of Lincoln, and appointment to the East Midlands’ Clinical Senate. Julie is professionally known particularly for her research into the use of care pathways in mental health, service redesign, quality improvement and governance.
The purpose of this review was to consider the influence of statutory mental health provision upon the use of high, medium and low secure psychiatric services. The brief for this review posed the ultimate question: ‘which, if any available statutory mental health services correlate with a lower use of secure services in region?’ The overall profile of the secure services used in the region shows a decline in high secure services and a growth in low secure. However, it has only been in high secure services where the rate of discharge exceeds the rate of admission. Therefore assuming that there is little or no intention to increase capacity in low and medium secure services an increased rate of discharge would be required. A particular area to consider is the numbers accessing low secure services from local services and the functioning of intensive care and step down services enabling discharge from low secure services. In financial terms one PCT is a low outlier for its spend on secure and high dependency services and this same PCT is a high outlier in its spend on PD services. On considering relationships between wider mental health provision and secure service use it was found that PCTs in the region that spend more on Assertive Outreach used less low secure occupied bed days and spent less overall on secure and high dependency services.
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