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The predicted impact of the NHS White Paper on the use and funding of a specialist service for personality disordered patients: a survey of clinicians' views

  • Bridget Dolan (a1) and Kingsley Norton (a1)
Extract

In an earlier report (Dolan & Norton, 1990) we commented upon the potential vulnerability of specialist psychiatric units following the implementation of Working for Patients and the NHS Bill. Specialist units provide a valuable resource, not only in terms of treatment, but as sources of practical training, education, development of new therapies and of research. Many such units previously enjoyed financial protection at the regional health authority level. Downloading financial responsibilities to DHAs or NHS trusts will complicate the issue of funding since contracts will now need to be entered with each relevant DHA or NHS trust. This more cumbersome system is inevitably more costly for a specialist unit to operate. Users of such units (customers and consumers) will find referral problematic since funding must be identified in advance. Difficulty in negotiating the new, more complicated contracting system, may lead to a decline in specialist referrals. This will in turn lead to questioning of how necessary such ‘regional’ or (as in the case of Henderson Hospital) ‘national’ specialities really are. Managers may tend to argue that referral patterns will reflect (eventually) the true needs for treatment of particular client groups.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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Dolan, B. M. & Norton, K. (1990) Is there a need to safeguard specialist psychiatric units in the NHS? Henderson Hospital: a case in point. Psychiatric Bulletin, 14, 7276.
Dolan, B. M., Wilson, J. & Evans, C. D. H. (1990) Therapeutic community treatment for personality disordered adults: a long term follow up study paper presented at British Psychology Society London Conference.
Kernberg, O. (1982) Advantages and liabilities of the therapeutic community. In The Individual and the Group (ed. M. Pines). New York: Plenum Press.
Lewis, G. & Appleby, L. (1988) Personality disorders: the patients psychiatrists dislike. British Journal of Psychiatry, 153, 4449.
Vaglum, P. et al (1990) Treatment response of severe and non-severe personality disorders in a therapeutic community day unit. Journal of Personality Disorders, 4, 161172.
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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The predicted impact of the NHS White Paper on the use and funding of a specialist service for personality disordered patients: a survey of clinicians' views

  • Bridget Dolan (a1) and Kingsley Norton (a1)
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