National Preventive Mechanism Eighth Annual Report 2016–17 particular problem for women, with 75% of all low secure units in England and Wales and the two units providing a large share of dedicated beds for women in Scotland being in the independent sector.81 There is under-provision of beds in many areas (this has been recognised as a problem that needs solving particularly in England and Wales),82 with many people placed in services outside their home area, creating difficulties with discharge planning back to their home. There is a lack of provision of secure care services, particularly low secure beds, for women across the UK. A 2015 study in Northern Ireland identified that 105 patients required low secure care that was currently unavailable.83 During its recent visits to medium and low secure services, the Mental Welfare Commission for Scotland (MWCS) was told of people in medium security facilities on waiting lists for low security placements, and patients in low security facilities waiting to move to rehabilitation services or a community setting. In total, 89 out of 400 patients had been identified as ready for discharge. It is anticipated that a comparable situation would be found in England and Wales. Similarly, there is lack of provision for children with specific conditions who need secure care (including for girls with a learning disability or emerging borderline personality disorder). In addition, pathways for children out of medium secure care are often hindered by the lack of provision in units with lower security and/or appropriate community services. As a result, some children find themselves remaining in secure mental health care until they are 18 so that they can be discharged to adult inpatient services when it was agreed in principle that they could have been discharged earlier. Cross-jurisdiction transfers Rampton Hospital is the only high secure provision for women in the UK. There is a service level agreement (SLA) for Rampton Hospital to provide high secure care for patients from Scotland, but because of the considerable bed pressure the Rampton service faces, it is likely that female patients in Scotland requiring high secure care may face difficulties accessing services. In medium/low secure care in Scotland there are 54 beds designated for female patients and a further 34 that can be used for men or women (out of 439 beds in total). There is no dedicated medium secure provision for women in Wales and a limited number of beds for women in a mixed medium secure unit. Evidence from all jurisdictions indicates that female patients in particular experience difficulties moving on through a secure care pathway, especially moving down to low secure care, because of the lack of low secure beds in many areas. As a result, 40% of women in low secure care are held in units away from, and often at a considerable distance from, their home area.84 81. Harty, Somers and Bartlett, 2012, ‘Women’s secure hospital services: national bed numbers and distribution’ in Journal of Forensic Psychiatry and Psychology. 82. Harty, Somers and Bartlett, 2012, ibid. Welsh Assembly Government, 2009. A Review of Secure Mental Health Services. 83. Harty, Somers and Bartlett, 2012, ibid; Bartlett A et al., 2014. ‘Pathways of care of women in secure hospitals’ in British Journal of Psychiatry. See also Welsh Assembly Government, 2009. A Review of Secure Mental Health Services. 84. Harty, Somers and Bartlett, 2012, ibid. 32