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Abstract
Special Hospitals in the United Kingdom developed from an ambitious Victorian vision for the care of mentally disordered offenders in need of security. Historically, however, they have provided only a part of that care. It is now accepted that the needs of current patients are exceptionally diverse and that a wider, more local range of services is needed. The proposals for a new commissioning board for maximum security care, the creation of three separate Special Health Authorities SHAs to manage the hospitals, and the mechanisms for transferring resources and choice to local district health authorities could provide a framework for revitalising high security services.