Dear Care Quality Commission,
Can you confirm if the Care Quality Commission is required to adhere to the Reed Report - Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services.
Can you confirm that to be deemed Mentally Disordered an individual has to meet what standards or circumstances?
Can you confirm that to be deemed under the Offender strategy and subject to Risk Assessments one has to be an Offender?
Can you confirm that to be subject to a Hare Psychopathy Screening Version (Hare PCL:SV) one must be an offender?
Can you confirm if the NHS is authorised to apply a Hare PCL:SV in clinical NHS settings
Good afternoon Mr Clark,
Thank you for contacting Care Quality Commission (CQC), the reference for
your enquiry is ENQ1-15970091291.
Mr Clark, I have forwarded your email to our Mental Health Policy team for
their attention, you can expect to hear further from them shortly.
If you have any further queries please call us on 03000 616161 or
email [email address]
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Dear Mr Clark
Thank you for your various emails. You have raised a large number of
questions, none of which trigger CQC’s Freedom of Information duties, as
they are not requests for information that we hold. However, I have
grouped your questions and will try to answer them as best I can, although
in some cases this will be limited as I will explain.
CQC came into being in April 2009, as a result of the Health and Social
Act 2008, as a regulatory body independent of government. An outline of
CQC’s role is available on our website here, which also outlines our
role in monitoring the application of the Mental Health Act. The
fundamental standards we use as a basis of regulatory judgments is
here. We are now moving towards a Single Assessment Framework that is
outlined here. Our regulation also considers known national clinical
guidelines such as those originated by the National Institute for Clinical
In general terms, and at risk of sending you in circles, I am afraid that
questions about government guidance can really only be answered by
government officials. CQC is independent of government and has no
authority to answer questions on government policy.
Can you confirm if the Care Quality Commission regulates the Health
Service Guidelines HSG(94)5 which requires all Health Authorities to
ensure through their contracts for mental health services that providers
draw up, maintain, and use supervision registers?
Can you confirm what happens to the Health Service Guidelines HSG(94)5
which requires all Health Authorities to ensure through their contracts
for mental health services that providers draw up, maintain, and use
supervision registers if it has been superseded?
Can you confirm what happens to the Health Service Guidelines if they have
Can you confirm if the Care Quality Commission acknowledges that for the
purpose of the Health Service Guidelines HSG(94)5, 'mental illness'
includes people diagnosed with a personality disorder (psychopathic
Can you confirm if the Care Quality Commission understands that NHS
England has a legal duty to ensure that the NHS Trust's treat psychopathic
disorder/psychopathy in the community as per the Health Service Guidelines
Can you confirm if the Care Quality Commission monitors supervision
In 2006, the Mental Health Act Commission noted that:
Supervision registers were introduced in 1994, requiring Trusts to
identify patients at risk in various ways, and ensure that they received
care under the Care Programme Approach (CPA). The implementation of
Modernising the Care Programme Approach (1999), which created the current
system of standard and enhanced CPA, foreshadows their eventual
discontinuance. The effectiveness of supervision registers probably was
curtailed as no new resources were provided to establish them or meet the
inevitable increase in sessional commitment from health and social service
professionals. See Coid J ‘Failure in Community Care: Psychiatry’s
Dilemma’ BMJ 1994; 308; 805-6 (26 March).
(In Place of Fear? The Mental Health Act Commission Eleventh Biennial
Report 2003-2005, footnote on page 190)
I am not certain of the exact date, but it follows that supervision
registers as a formal policy requirement were discontinued sometime around
the turn of this new century. They have never been the subject of CQC’s
interests, as CQC was established in 2009. Supervision registers were
effectively replaced by a much more broad expectation for care planning
for all people receiving support for serious mental disorder.
Supervision registers would have been applicable to people with
psychopathic disorder who met the other criteria for their use.
Other Health Service Guidelines from the 1990s
If the Health Service Guidelines (HSG) that were published in 1994 and
have since been superseded by guidance from the Care Quality Commission
(CQC) what has superseded HSG(94)27 and where is what has superseded
HSG(94)27 has been made available to the public to view?
I am puzzled as to why you have been informed that CQC would have issued
guidance to replace HSG(94)27. The Health Service Guideline HSG(94)27was
government guidance over the implementation of Aftercare Under
Supervision, a Mental Health Act power introduced in 1995 and repealed in
2007. As this power is no longer in force, the guidance over its use is
Arguably, the replacement for Aftercare under Supervision was the 2007
introduction of Community Treatment Orders. This power, still extant, is
discussed in the current Mental Health Act Code of Practice.
Can you confirm if the Health of the Nation and NHS Management Letter
(93)54 has been somehow superseded, and confirm what may have superseded
the Health of the Nation and NHS Management Letter (93)54 and confirm
where what has superseded the Health of the Nation and NHS Management
Letter (93)54 has been made available to the public to view?
I am afraid that, 30 years on, I am unable to identify the subject of NHS
management letter (93)54. If it was about care planning, it may be
helpful to follow this link for the current government position Care
Programme Approach: NHS England position statement.
The Reed report
Can you confirm if the Care Quality Commission regulates the Reed Report
and all that has been introduced because of the Reed Report?
Can you confirm if the Care Quality Commission is required to adhere to
the Reed Report - Review of Health and Social Services for Mentally
Disordered Offenders and Others Requiring Similar Services.
The Department of Health and Home Office joint review of services for
mentally disordered offenders (the "Reed report") was published on 27
November 1992. In It made a number of recommendations on the future
development of services to government and has been extremely influential
in that development in the subsequent three decades. A key objective
identified and endorsed by the report was the diversion of mentally
disordered offenders from the criminal justice system wherever possible.
Commentators since the report’s publication will have varying views on how
fully or successfully subsequent governments have implemented the report’s
As such there is no specific regulation over the report. It is part of
the general background against which all of us concerned with psychiatric
Mental disorder definitions
Can you confirm that to be deemed Mentally Disordered an individual has to
meet what standards or circumstances?
Mental disorder is defined at Section 1 of the Mental Health act 1983.
The definition is very broad: “mental disorder” means any disorder or
disability of the mind; and “mentally disordered” shall be construed
The question of what, in general terms, meets that definition is a
clinical judgment usually guided by the diagnostic manuals such as the
World Health Organisation’s International Classification of Diseases.
It is not a matter for CQC to judge.
Can you confirm if psychopathic disorder/psychopathy is a clinical
Can you confirm if psychopathic disorder/psychopathy is a medical/legal
Can you confirm that to be deemed under the Offender strategy and subject
to Risk Assessments one has to be an Offender?
Can you confirm that to be subject to a Hare Psychopathy Screening Version
(Hare PCL:SV) one must be an offender?
Can you confirm if the NHS is authorised to apply a Hare PCL:SV in
clinical NHS settings
Can you confirm that any individual diagnosed with psychopathic
disorder/psychopathy would be subject to the Care Programme Approach,
whether this is defined as a historic interpretation of the CPA or whether
it would be a current one?
‘Psychopathic disorder’ was a legal term used in the Mental Health Act
1983 until it was removed by amendment in 2007. It was defined as a
persistent personality disorder or disability of mind resulting in
abnormally aggressive or seriously irresponsible conduct. The 2007
amendments removed this (as well as the contrasted definition of ‘mental
illness’) to fall back on the broader concept of ‘mental disorder’
encompassing both. Psychopathic disorder was always a legal rather than
clinical term, although as I’ve mentioned above it was defined as usually
a form of personality disorder, and the latter is a term still in clinical
The Hare tests are used by clinicians as diagnostic tools, across mental
health services. Risk assessment and diagnostic screening tools are
applicable in a broad range of clinical situations. However, the guidance
over clinical practice is a role for the National Institute for
Clinical Excellence, and not CQC.
I hope that this is of some help.
National MHA Policy Advisor
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