Abstract High secure services treat patients who may have very complex clinical needs under conditions of security. Until very recently such services were run and managed on the periphery of the structures and accountability arrangements put in place for the rest of the NHS, becoming isolated from modern thinking and evidence‐based therapeutic practice. A high percentage of patients in the high secure system were assessed as no longer requiring that level of security.Following an inquiry at Ashworth hospital which reported in 1999, steps were taken to bring these services into the mainstream of the NHS, to decentralise further the commissioning and performance management and to develop the capacity and capability to enable discharge of patients to lower levels of security. New partnerships and new relationships have resulted in an NHS Plan target of 400 patients discharged from high security.The inclusion of high security services within Health & Offender Partnerships creates a framework for managing proposed and ongoing changes. High security services are a necessary part of our mental health system and should be valued and developed. This paper outlines how quality improvements will be enabled and embedded.
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