5 Nations Meeting

PHE, Waterloo House,

Waterloo Road,

London

17th July 2018

Minutes and Matters Arising

Minutes of the meeting on 16th March in Belfast were agreed.

Matters Arising:

 Project ECHO was noted as a useful tool for driving QI. The 5 Nations is supporting it.  Impact of the built environment. Architects were to be invited to the next (this) meeting, this will be carried forward.

The theme of the meeting was Research.

Eamonn O Moore introduced the topic and explained that the outcome of the meeting was to be a 5 Nations statement on priorities for prison health research. Advice from PHE researchers was to focus on specific research needs/questions.

Emma Plugge opened the discussion. She began by giving an update on the recent conference in Prague that had had a WEPHREN panel on ‘What Makes Good Research?’ One aspect was that user involvement is important, not least because of the power relationship.

Emma described the disparities in prison research outputs across the globe in both quantity and quality with least output from LIMCs. Researchers get judged on amount of funding brought in, robustness of methods and number of outputs. Not really judged on impact.

National Overviews on Prison Research

Each nation then gave a brief overview on prison research in their jurisdiction.

Wales (Stephanie Perrett)

Research priorities have been agreed: medicine management; substance use; mental health; environmental impact.

Stephanie suggested research outputs should identify economic outputs and effective service design.

Scotland (Lesley Graham)

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See attached briefing paper.

Ireland (Deidre O’Reilly)

Research is very undeveloped with not even a basic needs assessment having been undertaken. Possibility of a natural experiment with delivery of healthcare by health vs. Justice as justice still deliver healthcare in Ireland.

Northern Ireland (Bria Mongan)

Emphasis on QI. A a series of meetings with Belfast University have been had. Raised idea of common outcome tools across countries. Important to make links with the Royal Colleges.

England (Eamonn O Moore)

Exploring ‘What is a Healthy Prison’ through new partnership arrangements with PHE, NHS England and others.

RCGP report on medicines management due out in September.

Fall in head and neck cancers ?due to smoke free prisons.

‘Capture/re-capture’ study to investigate harm reduction post prison (not really capture/re-capture but asks returning prisoners about whether harm reduction was maintained post prison).

Priorities for research would include drugs, alcohol, suicide, violence, self harm. (Important to remove ligature points in prisons). What is the long term impact of NPS?

Data, evidence and intelligence group chaired by EOM is developing meta- metrics for a prison health dashboard including for a prison enabling environment.

Development of a 5 Nations Research Statement

Audience for a research statement

 Funders  Policy makers  Academics  Practitioners and planners  Prisons  Royal Colleges  NOMS (research evidence committee)  others

Suggested structure for statement

High level:

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Set out rationale as to why prison health matters and what is good prison health e.g. part of public health; vulnerable, underserved population with high levels of ill health; opportunity to tackle health inequalities as well as reduce re- offending; wider gains beyond the individual; becoming a good neighbour etc.

Ipse facto, why prison health research matters and what good prison health research would look like. ‘Good prison health research helps improve the lives of those living and working in prisons’.

Medium level:

Themes to be general and well as topic specific.

General themes such as user views; health gain; sustainability; staff experience; costs; community dividend; policy orientated; emotionally intelligent (trauma informed); service led; shifting culture; longitudinal (links to community).

Research/evidence can be small scale, tests of change, innovation

Low level:

Suggest 5 focused research questions e.g.

 Staff needs and views  What do those imprisoned think is most important for their health and wellbeing (e.g. relationship with their children)  Post release  Impact of population dynamics in the prison estate on health service delivery  Delivery of life skills

What is the Ask?

Need to be clear on what we are asking stakeholders for. Will vary. Need a simple message, good comms. Language is important. Encourage stakeholders to become advocates too.

Building capacity

Build prison health into GP training

Programme for public health training.

FPH starting up a SIG in prison health.

UKCC update

WHO HIPP meeting in Copenhagen took place in May. Introduction of new lead (Carina) who is based in Moscow. Daniel Lopez, Consultant in WHO has been giving advice on future direction. Work with Pan American health organisation to

3 happen. E&W to be a WHO case study as to how to do good governance (example of partnership set up).

WHO HIPP conference will be in Copenhagen in the 2nd week of December.

WHO database: concerns had been fed back. Not all agreed with. Working group has been set up to refine indicators.

Country profiles to be published on July 18th on the WHO Global Health Observatory (though I cannot find them).

WHO looking for interns.

NCD slide set presented (I had provided material for an alcohol slide). Carina to decide on further development.

HPV programme in prison for MWHSWM. Sunita may approach for intelligence.

Women in prison strategy just been published (mirrors approach in Scotland). Gender specific standards to be developed. https://www.gov.uk/government/publications/female-offender-strategy

DONM

Date of next meeting is 18th October 2018 in Dublin. Theme to be confirmed but might be women.

Lesley Graham, ISD

24th July 2018

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WEPHREN

WEPHREN steering committee Monday 16th July 1-2pm, PHE, Waterloo House, Waterloo Road, London

Further discussion on TOR, not totally resolved, as to whether youth detention centres should be included with Stuart Kinner, Australia very strong on this. He had to leave the meeting early. We went on to discuss there will be different terms and configurations for different countries which will have to be understood.

WEPHREN action plan discussed. Delphi study on research priorities to be conducted.

WEPHREN 1st anniversary event 4-8pm in the Wesley Hotel, Euston Street, London.

This included the inaugural Alex Gatherer Lecture given by Professor Brie Williams and introduced by Professor Sir Muir Gray. This was an inspiring talk with 4 case studies. The main message for me was that it was not enough to produce evidence but that change/impact could be brought about by advocacy and action. Hopefully we can get the presentation. Funding was raised in Q&As. Brie said that she had many small grants from a range of organisations rather than fewer large grants.

Other points of note: WHO HIPP is hosting a collaborating centre meeting late this year and research will be prioritised at that.

There is to be a UN Declaration on NCD later this year (?Sept). There is an opportunity to try to include prison health. Member states will need to pursue (Ireland and UK to investigate).

Prisons can also affect the health of staff. In the US, prison officers have a life expectancy of 58 years (!).

Large NIHR funding just secured for an English based study on cancer led by Elizabeth Davies, KCL:

//kclpure.kcl.ac.uk/portal/en/projects/how-is-cancer-care-best-provided-to- patients-in-english-prisons-assessing-the-disease-burden-in-the-prison- population-experiences-of-diagnosistreatment-and-support-and-of-receiving- and-providing-cancer-care(f8a78c2a-c940-4d8a-a179-52ce875b2bf7).html

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