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Commissioning Healthcare in Prisons: the Results of Joint Work Between Commissioning healthcare in prisons The results of joint work between the Healthcare Commission and Her Majesty’s Inspectorate of Prisons in 2007/08 February 2009 Commissioning healthcare in prisons 1 © February 2009 Commission for Healthcare Audit and Inspection and Her Majesty’s Inspectorate of Prisons 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 © Commission for Healthcare Audit and Inspection and HM Inspectorate of Prisons 2009. ISBN: 978-1-84562-213-8 Concordat gateway number: 152 Commissioning healthcare in prisons 2 Contents The Healthcare Commission and Her Majesty’s Inspectorate of Prisons 4 Summary 5 Background 8 Methodology 10 Findings, priorities and areas for action 11 Conclusion 17 Appendix 1: Primary care trusts included in inspections of healthcare in prisons 18 Commissioning healthcare in prisons 3 The Healthcare Commission The Healthcare Commission works to promote The Healthcare Commission aims to: improvements in the quality of healthcare and public health in England and Wales. • Safeguard patients and promote continuous improvement in healthcare services for In England, we assess and report on the patients, carers and the public. performance of healthcare organisations in the NHS and independent sector, to ensure that they • Promote the rights of everyone to have are providing a high standard of care. We also access to healthcare services and the encourage them to continually improve their opportunity to improve their health. services and the way they work. • Be independent, fair and open in our decision making, and consultative about our In Wales, the Healthcare Commission’s role is processes. more limited. It relates mainly to national reviews that include Wales and to our yearly report on the On 1 April 2009, the Care Quality Commission, state of healthcare. the new independent regulator of health, mental health and adult social care, will take over the Healthcare Commission’s work in England. Healthcare Inspectorate Wales will become responsible for carrying out our activities relating to Wales. Her Majesty’s Inspectorate of Prisons Her Majesty's Inspectorate of Prisons for England The Prisons Inspectorate also has statutory and Wales (HMI Prisons) is an independent responsibility to inspect all immigration inspectorate which reports on conditions for and removal centres and holding facilities and has treatment of those in prison, young offender been invited to regularly inspect the Military institutions and immigration removal centres. Corrective Training Centre in Colchester. In addition, HM Chief Inspector of Prisons is HM Chief Inspector of Prisons is appointed from invited to inspect prisons in Northern Ireland, outside the Prison Service, for a term of five the Channel Islands, Isle of Man and some years. The Chief Inspector reports to the Commonwealth dependent territories. government on the treatment and conditions for prisoners in England and Wales and other matters. Commissioning healthcare in prisons 4 Summary For the second year, the quality of the budgets for healthcare in prisons sit within provision of healthcare in prisons was PCTs, so that it is seen to be a priority. variable. The assessment of needs for healthcare is paramount and Use of service level agreements (SLAs) in comprehensive assessments for this group monitoring healthcare in prisons appeared of patients have not always driven to have increased since 2006/07, when just development and provision of healthcare one PCT mentioned that data was required services. The result of this is that the in their SLAs for health services for prisons. service delivered has not always best met All PCTs confirmed they had SLAs in place. the health needs of individual prisoners. There are other types of data that PCTs used Although primary care trusts (PCTs) have to monitor prisons’ performance including: emphasised the importance of an • Comparison with the Department of assessment of health needs to inform their Health’s Standards for better health. priorities and strategies for commissioning • Indicators of national performance for services, the majority of PCTs did not have prisons or other wider targets for PCTs, such an assessment, or had not completed such as access to GPs and dental it. Overall, there has been some services. improvement in the commissioning of • Monitoring contracts. healthcare in prisons, but further work is needed to ensure that specific areas, such All PCTs appeared to have processes in as access to health services and the place for managing serious untoward assessment of health needs, are addressed. incidents (as was the case in 2006/07 for PCTs must ensure that prisoners’ needs for most PCTs), which informed their overall healthcare are regularly assessed, agreed system for reporting incidents. and signed off by PCTs’ boards. They should also have processes to monitor these However, for the second year we found very 1 agreements. limited evidence of clinical audit of health services for prisons. This was mainly There were links with the PCTs’ overall because PCTs found it difficult to gain structures of governance, with information access to clinical information due to the lack about prisons being communicated to PCTs’ boards and other governing committees. Collecting information about healthcare in 1 Clinical audit is the process formally introduced in prisons was restricted by a lack of IT: the 1993 into the United Kingdom's National Health implementation of electronic records was at Service (NHS), and is defined as "a quality an early stage and some prisons used a improvement process that seeks to improve patient system that was paper-based. care and outcomes through systematic review of care PCTs need to adopt a more structured against explicit criteria and the implementation of change". approach to resources, to clarify where Commissioning healthcare in prisons 5 of computerised records and data in ethnic (BME) prisoners and monitoring the prisons, with some prisons still using a ethnicity of the people in prison. A small system that is paper-based. Clinical audit is number of PCTs have employed, or were extremely important, as it is the best way for due to employ, community development PCTs to find out where improvement in workers to help with these assessments services is taking place and identify areas locally. where improvement needs to be made. Some PCTs said that they used the National Similarly, although some PCTs told us they Institute for Mental Health in England’s collected national data, such as national (NIMHE) BME strategy, although more said service frameworks and information on that they did not use the current strategy, quality relating to GPs, this was restricted in despite being aware of it. As such, although many cases by a lack of IT systems. We PCTs’ awareness of NIMHE’s BME strategy recorded that only two PCTs could has improved since 2006/07, the use of it is demonstrate clinical audit activity being still limited. used to improve health services in prisons. Five PCTs said that complaints were We found that PCTs that employ the staff in reported to their prison partnership board, the prisons in their areas provided training and five PCTs were unclear about how that was said to be in line with that provided complaints were dealt with in their to all their other staff. This was less clear, management systems. however, for staff that are employed by the prison. Involving users of service has been challenging for PCTs. There appeared to Similarly, PCTs gave us a mixed response have been some progress since 2006/07 about how they monitored training. For when there was little evidence of the some PCTs, it was through reviews of involvement of users by most PCTs performance and appraisals, while others interviewed. kept databases or had no current system for monitoring in place. Over half of the PCTs told us that they have some processes for transferring or Planning relating to the workforce did not releasing prisoners, or that these were appear to be well advanced. Some PCTs currently being addressed. However, PCTs’ were taking this forward, while others said arrangements seemed to vary widely, that it needed to be reviewed. Two PCTs told depending on the type of prison and the us that such planning would be done prisoners’ circumstances. PCTs must through the assessment of health needs. continue to ensure that they have arrangements in place for the continuing PCTs identified assessments of health care, transfer and release of prisoners and needs as being the main means of that compliance with these arrangements is addressing the needs of black and minority routinely monitored. Commissioning healthcare in prisons 6 PCTs rarely commissioned court diversion schemes2, although in some cases such schemes were commissioned by other groups. Summary of recommendations PCTs should: • Ensure that prisoners’ needs for healthcare • Regularly seek and record prisoners’ are regularly assessed, agreed and signed feedback and complaints about healthcare off by PCTs’ boards. services to improve their management systems. • Clarify where the resources for healthcare in prisons sit within their overall budgets. • Ensure that their prisons are implementing drug treatment systems. • Continue to measure performance within wider PCT targets, by using offender health • Continue to ensure that they have indicators of performance, for example. arrangements for the transfer and release of prisoners and that compliance with these • Promote the development and arrangements is routinely monitored. implementation of electronic records to improve clinical audit. • Provide their staff with specific training that The Healthcare Commission and its successor addresses prisoners’ needs for healthcare. organisation, the Care Quality Commission, will monitor whether these recommendations are • Improve their strategies that ensure that actioned by PCTs. prisoners receive equal access to healthcare, identifying the needs of black and minority ethnic groups more effectively.
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