1. Positive about mental health and learning disability 1 Do Managed Clinical Networks (MCNs) have a place in the Management of Personality Disordered Offenders in the NHS? Conor Duggan Professor of Forensic Mental Health University of Nottingham & Honorary Consultant Psychiatrist, Nottinghamshire Healthcare NHS Trust

2. Integration of the PDU with other Services PDU PRISONS LOW SECURE UNITS COURT HIGH & MEDIUM SECURE UNITS COMMUNITY ?

4. Lord Darzi’s vision for the NHS is that it should be Fair – equally available to all Personalised - Tailored to the needs and wants of each individual Effective - Focussed on delivering outcomes for patients that are the best in the world. Safe

5. How do services for MDOs with PD measure up to these criteria? Are they Fair? Are they Personalised? Are they Effective? Are they Safe?

6. Major Shortfalls in our current provision for MDOs with PD Inequitable service provision and access -piecemeal development Services are separate and disconnected -Mental health, social services, probation, primary care are ‘talking different languages’ -Lack of skills and knowledge -Lack of cohesion and standardisation - - No universal system of ‘good practice’.

7. A Managed Clinical Network – Definition ‘These are linked groups of health professionals and organisations from 1 o, 2 o and 3 o care and social services and other services working together in a coordinated manner to ensure an equitable provision of high quality, clinically effective care.’ …The emphasis shifts away from buildings and organisations towards services and patients.’ Baker & Lorimer 2000

8. 5 Functions of a MCN Monitoring and updating of the core standards of care Developing and maintaining skills and knowledge – Education and Training Auditing and research – maintaining standards Leadership and authority Co-ordinating and managing change.

9. Features of a MCN The appointment of one person with overall responsibility for the network, a clinician, manager or other professional. The purpose of the network is to improve patient care in terms of equality, access, convenience and co-ordination. The expected service improvements (and cost savings) are made explicit from the outset and the MCN measured against these. Adherence to evidence-based treatments. Networks ought to support research and professional development. Outcomes need to be measured so that audit is an integral part of the network. Each network produces an annual report that is available to the public Networks needs to be multidisciplinary and patients involved in shaping the network.

10. Relevance of a MCN for MDOs with PD. PD is a disorder across the life span with a range of severity so that its service provision needs to be integrated. A large number of agencies are involved in providing for this group in addition to MHS (incl. CJ, SS, Housing etc.). These are often operating with different agendas and languages. The provision of psychological therapies by often rivalrous professional groups (e.g. psychiatrists, psychologists, nurses etc.) needs to be managed. There are competing models of therapy at play with little evidence to support them. There are few skilled professionals to deliver the therapy – even if one could decide what this might be. The field is changing rapidly and this change needs to be managed in a sensible and effective manner.

11. But, you could say that we have heard all of this before … So, What is New? Managed Clinical Networks have to be Managed. It is likely that many within the organisation will not like that!.

12. Thank You