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Successive government policies over the past 15 years have encouraged the growth of the independent sector (not for profit and for profit) and its involvement in the delivery of mental health care. Not for profit and for profit sectors are currently working both alongside and in competition with NHS provider organisations. How all parts of the service system interconnect will in future be crucial for service users and carers. This paper describes the developmental approach in response to many of these issues by agencies in the West Midlands.

This paper traces the innovative development of the Nottingham Cochlear Implant Programmes. The paediatric programme was the first to be established in the UK in 1989 and remains the largest programme in the UK today, whilst the adult programme developed later, in 1994. The first section of the paper describes trends in service development whilst the second section makes detailed reference to the history of funding arrangements which enabled the programme to become established. The third part of the paper examines the (de)merits of locality purchasing versus centralised purchasing for specialist services, using cochlear implantation as way of illustration. The paper aims to provide an informative history of the development of the service in Nottingham and from this background create debate as to the most appropriate future funding mechanism for cochlear implantation in particular and specialist services in general.

No‐one doubts the progress that has been made, through implementation of the National Service Framework for Mental Health (NSF) (DoH, 1999), in improving services for people with mental health difficulties. More needs to be done to continue these improvements and, in the current context of system and focus change for the NHS, success will depend on identifying the most promising areas to make progress.

This paper aims to describe the experience of a secure learning disability service in participating in the national Shared Pathway pilot project in secure services.

Some background drivers to the project are explored as well as the experience of service users and staff who were involved in the pilot project. Recommendations on service‐wide implementation of the Shared Pathway are made.

The Shared Pathway will lead to considerable changes in practice. This will also have resource implications.

The paper shows that the Shared Pathway may be useful in ensuring evidence based outcomes are routinely used by clinicians in secure services in collaboration with patients. It may also clarify to patients what their role is in engaging in treatment that helps them in moving through secure services.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.

Suicide and self‐harm are major public health issues. This study aimed to assess how local and national data could be used more effectively in local suicide and self‐harm prevention strategies. Twelve semistructured interviews were carried out with a purposive sample of suicide prevention leads in one strategic health authority area and other key local and regional informants. Although suicide prevention work is supported by data, problems were identified with current processes and data and information availability. Local, regional and national health agencies all have a role in ensuring information is used in the best possible way to reduce self‐harm and suicide.