Simon Wilson and colleagues (July 9, p HO)1 make cogent arguments for improved community-based services for offenders with mental disorders in the UK. However, although the principles of quality community-based services are laudable, Wilson and colleagues put the cart before the horse. What we need upstream of community services is a more effective use of medium-secure services and theirfull integration with community-based treatment programmes.Commissioners need to stop restricting prisoners' access to medium-secure hospital beds and include the National Health Service and independent sector in calculating the total number of available beds. Men and women in prison identified as needing treatment in medium security should be transferred out of prison to hospital within 14 days— this is what Bradley recommended2 and there is capacity to achieve this. In London there are 60 medium-secure beds in the independent sector immediately available, but the average time taken to effect a transfer from prison to hospital is measured in months, not days.
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