Funding treatment of offender patients with severe personality disorder. Do financial considerations trump clinical need?

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Abstract
Information is presented on 40 funded and 52 unfunded extra-contractual referrals (ECRs) to Henderson Hospital. There were no significant differences between the groups on measures of motivation, self-esteem, personality disorder and dysthymia made blind to funding status. The only discriminating variable was being on probation at referral which was more common in those refused funding. These results complement earlier work suggesting that the internal market funding of referrals to specialist services is made on financial not clinical grounds and reinforce the view that offender patients are less likely to get treatment despite the recent recommendations of the Reed Committee (Department of Health and Home Office, 1992). Although the recent revision of ECR arrangements to give automatic funding for tertiary referrals may ameliorate such problems, we argue that the simultaneous devolution of budgets to individual clinical teams will prevent proper assessment of costs and benefits of tertiary treatment and reduce ECRs further.