Commissioning health care in prisons 2008/09 Key findings from our analysis of primary care trusts as commissioners of prison health care May 2010 About the Care Quality Commission The Care Quality Commission is the independent regulator of health care and adult social care services in England. We also protect the interests of people whose rights have been restricted under the Mental Health Act. Whether services are provided by the NHS, local authorities or by private or voluntary organisations, we make sure that people get better care. We do this by: • Driving improvement across health and adult social care. • Putting people first and championing their rights. • Acting swiftly to remedy bad practice. • Gathering and using knowledge and expertise, and working with others About Her Majesty's Inspectorate of Prisons Her Majesty's Inspectorate of Prisons for England and Wales (HMI Prisons) is an independent inspectorate which reports on conditions for and treatment of those in prison, young offender institutions and immigration detention facilities. HM Chief Inspector of Prisons is appointed from outside the Prison Service, for a term of five years. The Chief Inspector reports to Ministers on the treatment of prisoners and conditions in prisons in England and Wales. The Prisons Inspectorate also has statutory responsibility to inspect all immigration removal centres and holding facilities. In addition, HM Chief Inspector of Prisons is invited to inspect the Military Corrective Training Centre in Colchester, prisons in Northern Ireland, the Channel Islands and Isle of Man. © 2010 Care Quality Commission and Her Majesty’s Inspectorate of Prisons Published May 2010 This document may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the document title and © 2010 Care Quality Commission and Her Majesty’s Inspectorate of Prisons. Care Quality Commission and HM Inspectorate of Prisons: Commissioning health care in prisons 2 Contents Summary 4 Recommendations from this report 5 1. Background 6 2. What's going well? 7 Management systems 7 Clinical governance 8 Service plans and framework 9 3. What needs to improve? 11 Monitoring performance 11 Personalised care 12 Continuity of care 12 4. The future: new systems of assessment 14 Appendix A: Primary care trusts included in our sample 15 Care Quality Commission and HM Inspectorate of Prisons: Commissioning health care in prisons 3 Summary This report reviews the key findings from our These inspectorates published a joint report on analysis of primary care trusts’ (PCTs) work as their findings for a sample of PCTs in 2006/07, commissioners of prison health care in 2008/09. leading to a follow-up report in 2007/08, which It relates to a sample of 21 PCTs that commission made recommendations in 10 areas. health care for prisons that received an announced or full (not targeted) unannounced This report shows where things have improved, or inspection by Her Majesty’s Inspectorate of not, since 2007/08. It also indicates some of the Prisons (HMIP) in that year. areas that CQC’s new systems of assessment will need to take into account from April 2010. PCTs became fully responsible for commissioning prison health care in 2006. This has been In general, our findings suggest that PCTs have reflected in how the Healthcare Commission, until made progress and are getting on top of 31 March 2009, and now the Care Quality embedding systems for management and clinical Commission (CQC) have coordinated their governance, although they need to continue to assessments of prison health care commissioners improve. We saw improvement in a number of with HMIP’s inspections of prisons. areas – such as electronic information management – where we highlighted concerns in Progress on the 10 areas for improvement 2006/07 and were generally told that these had from our 2007/08 findings already been identified as priorities for 2007/08. Putting all the necessary management systems in Regular needs assessment place still needs to develop further, but it is Better moving in the right direction. Clarity about resources We have not yet seen such clear progress in PCTs Better making sure that people experience good quality Measurement of care that is responsive to their needs. Nor did we performance No improvement see progress in specific areas, such as services provided for drug misusers, since PCTs' Information management arrangements for monitoring quality still do not Better go consistently to this level of detail. This is the Staff training third year in a row that we have found that PCTs Better need to do more to be able to ensure good quality care in these areas. Monitoring of staff training Better We recommend that PCTs should now raise their focus beyond getting management systems in Strategies for equal access place and ensure that they are giving top priority Better to monitoring the quality of care that they Complaints commission. They should particularly address the No improvement continuity of prisoners' health care during transfer and release, which is inadequate and seems to be Involvement of prisoners getting worse rather than better. Although this No improvement may not be a problem that PCTs can solve on Drug treatment systems their own, they must take the lead role in ensuring improvement. No improvement Arrangements for transfer and release Worse Care Quality Commission and HM Inspectorate of Prisons: Commissioning health care in prisons 4 From April 2010, providers of health care in prisons will be subject to a new system of statutory registration, with enforcement powers if standards of care fall below required levels. CQC and HMIP will work closely to check that providers meet these required standards, including those for coordinating care along the offender pathway. PCT commissioners will have an essential role in this new system and in working with us to make sure that the various roles for promoting good quality care work well together. Recommendations from this report In 2010/11, we expect PCTs to: 1. Be able to demonstrate that information systems are being used for regular review of clinical standards and that these reviews are followed up with action where needed. 2. Further develop the sophistication of the information that they collect on the quality of service provision and on health promotion. This will improve their ability to detect and correct unsatisfactory practice and ensure that individual services that they commission are achieving their objectives for quality of care. 3. Be able to demonstrate that they act on complaints (and the absence of complaints) in the ways that they commission and monitor services. We encourage PCTs to share their knowledge and experience about what works in making prison health care personalised and how they involve prisoners in delivery and planning. 4. Give priority to continuity of care at transfer and release and to be able to demonstrate that health care services for each prison in their area join up effectively with other services. We encourage PCTs to share knowledge and experience of what works in managing the common problems in this area. Care Quality Commission and HM Inspectorate of Prisons: Commissioning health care in prisons 5 1. Background This report summarises the findings from CQC's contact with PCTs in 2008/09. It will be of particular interest to PCT commissioners, so that they can compare local performance with national findings. As with our previous reports, these findings are from a sample rather than all PCTs. There are 21 PCTs in our sample this year (see appendix A). HMIP inspects all prisons regularly, and assessing health care services forms a key part of the inspections. CQC contributes information to HMIP about NHS trusts' performance, and uses HMIP's findings in its assessments. CQC also collects information from PCTs about how prison health services are commissioned and monitored specifically for HMIP's inspections that are announced in advance, or for their full unannounced inspections. In April 2010, NHS trusts that provide prison health care must register with CQC. Independent providers must also register from October 2010. Once registered, these providers will be subject to statutory requirements for the quality and safety of care. CQC and HMIP are developing a new memorandum of understanding to set out how we will continue to work closely together in monitoring and checking standards of care in prisons. Although registration applies to providers, PCT commissioners also have a major role. • Where CQC and HMIP detect a problem in prison health care, we will seek to involve PCTs as one of the key ways to address it and promote improvement, rather than rushing to use our enforcement powers. • CQC intends to develop ways of taking providers' performance into account in the way it reports on commissioners. Care Quality Commission and HM Inspectorate of Prisons: Commissioning health care in prisons 6 2. What's going well? PCTs have made progress in three broad areas: Governance systems similarly appear to have • Management systems. become well established, with every PCT in our sample holding regular partnership boards and • Clinical governance. other meetings to review the service. We explored • Service plan and frameworks. this further by asking about the membership of partnership boards, types of other meetings, if the Management systems prison governor is involved, and whether the PCT lead and professional executive committee or In 2006/07, when PCTs first became wholly board members visited the prison. Our findings responsible for commissioning prison health care, were that this was variable: for example, some not all of them could even describe to us how PCTs’ leads visited the prison weekly, others they developed and monitored a budget for it.