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In the last four years health services in public sector prisons in England have undergone a period of rapid reform and modernisation. Before this, prisoners' health care was characterised by over‐medicalisation, isolation from the NHS, and lack of education and training for health care staff. As part of this process of reform, responsibility for funding and commissioning these services has moved from the Prison Service to the National Health Service (NHS). The results so far seem encouraging. Services are better funded, standards have improved and there is significant progress in developing a strong partnership between the key partners ‐ the Prison Service and the NHS ‐ at national and local levels. These reforms address human rights and the aim of the Prison Health Unit, that prisoners should be able to expect their health needs to be met adequately by services that are broadly equivalent to services on offer in the community. Some learning points for other countries are considered. An equivalent strategy for the modernisation of public sector prisons in Wales is being developed by the Welsh Assembly Government.

Service systems for people with learning disabilities in Scotland have developed in the context of the Scottish legal system and devolved policy for health. Scottish organisations are responding to the spectrum of mental health needs by working in partnership to improve quality. This article describes this system and the key organisations, and presents some findings of the National Overview Report of services undertaken by NHS Quality Improvement Scotland.

An urban mental health service undertook a quality improvement programme to involve staff in the identification and resolution of cross‐cultural issues. The programme involved clinical file audits, staff survey and workshops, and a focus group for consumers and their carers. It was found that non‐English speaking patients received a different spectrum of services from English speaking patients. Non‐English speaking patients were found to receive more pharmacological treatments and less cognitive behavioural therapy. In seeking to address these issues and improve their service delivery to all patients, the mental health service is now in the process of developing cross‐cultural training; revising policies and procedures; and engaging bilingual mental health counsellors in a revision of their roles, particularly to increase their availability to staff as cultural consultants.

New public health policies present social services with new opportunities and challenges. A shared public health and social care agenda is emerging around health improvement, social exclusion and regeneration. Early signs of synergy indicate that social services have a key role to play in shaping the public health agenda and in acting as a bridge between the NHS and the wider local authority.

Summarizes the difficulties facing today’s adolescents and data on the prevalence of risk‐taking behaviour which threatens their health. Describes how the school nurse is in a unique position to influence the health of school age children, and is often perceived by them as a caring, listening person whom they can trust. Suggests that school health services are in a rut, straddling the boundary between health and education services and failing to fit neatly into the primary health care team. Outlines how this is having a weakening effect, as providers and purchasers are unwilling to support a service which appears expensive and of questionable value. Deplores the lack of documented evidence on the effectiveness of school health services. Applauds authorities which have replaced routine medical examinations with more appropriate services. Urges the school health service to design services which recognize adolescents as a group with specific health needs. Makes a list of recommendations for achieving this aim.

The poor health of prisoners was highlighted in the results of two comprehensive health surveys conducted with prisoners in New South Wales (NSW), Australia. The capacity of a dedicated service to address the health needs of prisoners was tested through analysis of the health of two prisoner cohorts: a continuously serving cohort, and a cohort of prisoners who had been incarcerated and released during the period of interest, 1996‐2001. It appears that mental health services best addressed the needs of a stable prisoner population. Short‐stay prisoners do not gain any degree of benefit. Primary health and drug and alcohol services address the needs of prisoners less effectively, irrespective of their duration of stay. Women’s health was very poor on all measures that were assessed. With the exception of mental illness, the health inequalities that prisoners experience are not addressed by existing prisoner health services. This may be due to the magnitude of the burden of ill health among prisoners, or due to inadequate resources ‐ or some combination of both. While these results should not be taken as supportive of coercive institutionalisation (i.e. imprisonment) as a therapeutic option, there may be benefit in more humane and compassionate institutions for some of society’s most vulnerable individuals. The results highlight the potential for prisoner health service providers in redressing years of health neglect and the low levels of service utilisation by this group while in the communi

In 2002, a Review of Mental Health and Learning Disability in Northern Ireland was launched, which reported during 2005‐6 and produced a framework for future learning disability and mental health services. This article will address three broad areas: first, it will provide an overview of the current structure of health and social services within Northern Ireland and summarise how these structures are expected to change within the next few years. Second, it will outline the key policy objectives in relation to the health of people with learning disabilities, giving particular attention to individuals among this population who develop mental health problems. Third, it will consider some key challenges that may lie ahead if the recently stated policy objectives are to be realised.

The U.S. mental health service delivery system consists of a broad array of inpatient and ambulatory services operated under governmental, corporate, nonprofit, and entrepreneurial auspices. Granted this complex mixture of control patterns, a primary question to be addressed by this paper is the degree to which this set of services can be conceptualized as a system at any level of social organization beyond a single control point for a subset of services. This paper will also explore the utility of systems formulations, including cybernetic processes, for addressing the question of whether mental health services can be controlled and directed to such a degree that they act in concert across different control points. Reference will be made to exogenous systems, such as public and private reimbursement programs, that may influence control processes. Some directions for future research will also be explored.

Needs led person centred services are the hallmark of high quality intellectual disability services. Commissioning mechanisms such as Payment by Results (PbR) have been established in acute health services. An outcome focussed version of PbR will be implemented nationally from 2012 in an incremental manner in mental health services for adults and older people. Though intellectual disability services are currently excluded, it is proposed that needs led approaches would improve the quality and efficiency of specialist intellectual disability services. This paper aims to suggest that this approach could be the key to commissioning and designing personalised pathways of care.

Health needs are scoped and care pathways are defined as primarily consisting of Needs, Interventions and Outcomes. The mandated cluster groups to be used for PbR in adult mental health and older people's services are extended to cover the non overlapping needs of people with intellectual disability to provide an integrated framework of health needs usually met by specialist services. A framework of interventions is suggested and components of “assessment” and “therapeutic” activities are outlined. An outcome framework is described. A case example illustrates the application of these components to design a care pathway to provide a personalised, needs led service.

It is possible to use the principles underlying PbR to commission personalised services of high quality, improved efficiency and thus greater value.

The principles underlying PbR can be used to commission personalised pathways of care in intellectual disability services at a time when this approach is being extended to mental health services nationally.