Cheshire Police Force

Offender Health Needs Assessment – Police Custody

2012

Contents

Page Executive Summary 3

Background 3

Current Position 4

The Health Needs Assessment 5

Custodial Environments in 5

Juvenile Establishments in the North West 7

Female Establishments in the North West 8

Probation / Youth Offending Services in Cheshire 9

Overview 9

Local Demography 10

Current Healthcare Provision in: Police Custody 12

Crime in Cheshire 18

Current Health Provision in Cheshire: Prison 19 Probation Youth Offending Services

Current Health Provision in the Cheshire Area 22

Overview of Cheshire Custody HMIC Report 23

ROHT Recommendations 24

Scope and Limitations for the Report 24

References 25

Who was involved in the process 25

Gap Analysis 25

Appendices 26

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Executive Summary

This Health Needs Assessment presents an overview of the health needs of offenders primarily within the custody suites of . It also explores the needs of offenders who are in contact with community criminal justice agencies, namely the National Probation Service, Youth Offending Teams and Integrated Offender Management (IOM) across Cheshire.

Data has been gathered to inform this document via Cheshire Police, Reliance Medical Services, 5 Boroughs Partnership NHS Trust, Cheshire & Wirral Partnership NHS Trust, Cheshire, Halton and DAT Teams, local Primary Care Trusts and Local Authorities. A range of issues have been identified in this document and five recommendations have been made for service improvement and development.

The benefits of completing a robust health needs assessment will; enable improved partnership working between the police and NHS, more informed and improved identification of the clinical need of individuals coming into contact with criminal justice services including detention in police custody suites, improved and integrated pathways between the Criminal Justice System and the wider health and social care agencies and the opportunity for more appropriate staff training and understanding of the needs of offenders, particularly those with mental health problems and those with a learning disability.

Background

In 2009 Lord Bradley published a review into how the Criminal Justice System (CJS) interacted with those suffering with mental ill health problems and those with a Learning Disability, the Healthy Children, Safer Communities report also published in December of 2009 identified the needs of children and young people in contact with CJS. The needs of women had been identified in the 2007 Baroness Corston review of women with particular vulnerabilities in the CJS and were again referenced in the Bradley Report. The recommendations made in these reports were accepted by the previous government under the “Improving Health, Supporting Justice” delivery plan and have now been adopted by the coalition government.

Nationally governance of the deliverables is now via the National Health and Criminal Justice Board which has cross government representation from the Department of Health (DH), Ministry of Justice (MoJ), Home Office (HO), National Offender Management Service (NOMS) and Association of Chief Police Officers (ACPO).

On the basis of Lord Bradley’s recommendations, the Board currently manages two deliverables that affect the way that the NHS interacts with policing, namely: The transfer of commissioning, budgetary responsibility and accountability for police detainee healthcare, forensic provision and Sexual Assault Referral Centres (SARC) to the NHS by April 2013. The development of mental health criminal justice liaison and diversion schemes.

Both the Minister for Social Care, (DH) and the Policing Minister, (HO) have now signed off a joint submission detailing the benefits and trajectory of the transfer, which is inclusive of an Early Adopter programme, for which Cheshire Police has been accepted.

It is important to point out that this is a transfer of commissioning, as opposed to a transfer of provision. The Police Partnership Board with representation from the NHS Commissioner will make an assessment in the transfer process as to who the best provider may be, based upon cost, quality and scope of provision. Such a decision would need sign off by both the NHS and the police.

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Rationale for Change

All chief constables received a letter from Acting Commissioner; Tim Godwin, ACPO Criminal Justice Business Area inviting expressions of interest to become early adopters to a commissioning transfer during 2011/12. This letter outlines some of the organisational benefits to the services for change including: The transfer of the organisational risk of health provision in police custody and SARCS to the NHS. The development of improved care pathways for detainees in need of immediate access to Accident and Emergency. The eventual transfer of any clinical and financial liabilities to the NHS commissioner. Improved engagement with health colleagues to signpost and manage the healthcare of offenders upon their return to the community to reduce their re-offending. A reduction in re-offending based upon better engagement with health services particularly around drug, alcohol and mental health provision.

In turn, the NHS anticipate that they will improve the quality of service delivery to disengaged groups who fail to register with healthcare services in the community, thus reducing the likelihood of such groups presenting to NHS services at a point of crisis, by better and earlier identification and management of their clinical needs and improve public health outcomes.

The transfer of commissioning responsibility from the police to the NHS will provide an opportunity to develop and deliver services that are aligned and integrated with the wider health and social care services. Contribute to the reducing re-offending objectives of all CJS, by providing increased support to vulnerable individuals, easier access to services and better understanding of the needs of offenders with improved training and joint working.

In the meantime, the current NHS reorganisation will lead to the development of an NHS National Commissioning Board that will eventually have responsibility for commissioning all healthcare services in secure settings. It is likely that regulations will be introduced in the next spending review of March 2015 that would include police custody suites in these provisions.

Current Position

Early Adopter sites have been selected against set national criteria including size, NHS commissioning experience and the flexibility of current commercial contract within the early adopter project timeframe. Twenty forces applied to be Early Adopters, of which ten have been accepted. (See Appendix A for the list of successful forces)

Cheshire Police have been awarded £70k annually for two years, with the option to opt out after one year, to engage with an NHS Commissioner to establish a partnership board to undertake this process.

Cheshire Police currently have a commercial contract with Reliance Medical Services for the provision of forensic medical services for police detainees.

An integral element of the Early Adopter work is to complete a Health Needs Assessment (HNA) within the custody suites within each Constabulary. This information will better inform the DH and NHS Commissioners with regard to the health needs and services required both within custody and community services, to ensure the safe detention and handling of detainees, reduce reoffending and improve public health outcomes. The two year pilot allows the NHS and HO time to develop arrangements to work in partnership, share learning and establish robust working relationships prior to the expected legislation change in 2015,

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which will transfer accountability for commissioning all Police health provision to the NHS from the HO.

The Health Needs Assessment (HNA)

Aim of the Health Needs Assessment

This Health Needs Assessment will examine the health needs of those detained within the custody suites across Cheshire. This data will be compared to national, regional and local trends wherever possible. This comparison will allow us to ascertain if offenders have a disproportionate need, examine current provision and identify unmet needs. Thus, informing the commissioning process nationally and locally. Where improved access to services is developed, it is hoped there will be a reduction in reoffending, increased community safety and improved public health outcomes.

Area to be Needs Assessed

This Health Needs Assessment will look at police custody primarily, with additional data from Prisons, Probation and Youth Offending Teams, where available, to support a better understanding of the health requirements of the overall population, specifically offenders involved with police custody and the impact on current health service provision across Cheshire.

Data Required to complete the HNA

Collating the data shown as Appendix C will provide information to identify what the current health needs of the specified population are in comparison with regional and national trends. This will allow a better understanding of the health and associated services required to meet these needs in the Cheshire area. Improved and regularly updated information will also allow the partnership to assess changes in current service needs, manage potential future need and plan accordingly.

The final HNA report will be signed off by the Cheshire Police Healthcare Partnership Board and will be shared with local partners and the Department of Health as part of the Early Adopter Pilot as detailed above.

Custodial Environments in Cheshire

Police Custody; There are three police areas with three regularly used custody suites, the three custody suites (highlighted in bold) located within the three areas are detailed below;

Eastern Western Northern Blacon () Risley Chester Town Hall Sankey Stockton Heath Warrington

The three custody suites have a throughput of 24,940 offenders annually (see below);

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Total No. through Cheshire Police Custody Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Total 2230 2035 2263 2055 2113 2136 2077 2063 2054 1972 1895 2047 24,940 (Data received from Cheshire Police Jan 2012)

Some of these offenders require medical treatment when in custody, a breakdown of the volume of calls to Reliance Medical Services for the period May 2011 - October 2011 is below.

Total No. of Calls to Reliance Medical Services for health input % of No of detainees Volume of detainees in requiring calls custody clinical input May-11 847 2077 41% Jun-11 871 2063 42% Jul-11 734 2054 36% Aug-11 890 1972 45% Sep-11 745 1895 39% Oct 11 803 2047 39% Total 4,890 12,108 40.38 (Data received from Cheshire Police Jan 2012)

See Appendix B for an overview of the Cheshire area and custody suites.

Prisons; There are three prisons in the Cheshire Area, which contribute towards the population residing in the Cheshire as detailed below;

Prison Name Prison Operational % of Area in NHS Lead Category Capacity Offender Cheshire Provider for (ie maximum Population Prison Health in 2009 number of from occupies detainees held Cheshire in the area establishment) HMP Risley C 1095 22% Warrington NHS Warrington HMP / YOI Female 460 7% Styal Styal Community Health HMYOI Thorn Male YOI 322 6% Appleton NHS Warrington Cross Thorn Total 1877 (max) prisoners residing in Cheshire Prisons (Prison data sourced from www.hmprisonservice.gov.uk and Cheshire area data information is from the Cube database as of November 2011. This is the most recent data they hold and it is sourced from Offlock).

HMCIP follow up Inspection Reports of 2008 and 2011 have described the prisons as follows;

HMP Risley –On this inspection we found a prison transformed in many areas and reasonably good outcomes for prisoners in all areas. Nevertheless, there were still gaps and important areas where outcomes need to improve further. (Follow up inspection February 2011)

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HMP / YOI Styal – Overall this was a positive inspection of a prison which has had a chequered history, and it was apparent that the upward curve of improvement in recent years had been maintained. (Follow up inspection July 2011)

HMYOI Thorn Cross – Overall, Thorn Cross remains a high-performing young offender institution. However, it is now dealing with a more varied population, without the dedicated resources previously provided for juveniles. It will need to ensure that it strengthens its resettlement work, to provide the best possible support for an age group that has a very high risk of reoffending. (Follow up Inspection July 2008)

(The full reports can be found at www.justice.gov.uk/inspectorates/hmi-prisons)

A snapshot of people in prison by the Prison Reform Trust Bromley Briefings Factfile of December 2010 (www.prisonreformtrust.org.uk/portals/0/Documents/FactfileDec10small.pdf) found that; The average age of those sentenced to custody in 2006 was 27, a quarter was aged 21 or under. The number of sentenced prisoners aged 60 and over rose by 119% between 1999 – 2009. At the end of September 2010 there were 11,062 foreign national prisoners (defined as non-UK passport holders), 13% of the overall prison population. 23% of young offenders have learning difficulties (IQ below 70) and 36% borderline learning difficulties (IQ 70-80). In HM Inspectorate of Prison Surveys, 15% of people in prison reported a disability.

HMCIP have reported that 19% of prisoners surveyed by HM Inspectorate of Prisons reported having an alcohol problem when they entered prison, it was even higher among young adults at 30% and women at 29%. (HM Chief Inspectorate of Prisons for and Wales (2010) Alcohol Services in Prisons: an unmet need, London: HMCIP).

The UK Drug Policy Commission (2008) Reducing Drug Use; Reducing Re-offending, London: UKDPC reported between a third and a half of new receptions into prison are estimated to be problem drug users (equivalent to 45,000 – 65,000 prisoners in England and Wales.

However, a recent study completed in a Scottish prison on the use of the AUDIT screening tool, showed a higher prevalence of alcohol problems with 73% of sentenced prisoner scores indicating an alcohol use disorder. (Assessment of alcohol problems using AUDIT in a prison setting: more than an 'aye or no' question, Susan MacAskill, Tessa Parkes, Oona Brooks, Lesley Graham, Andrew McAuley and Abraham Brown)

This is probably a more accurate reflection of the real prevalence as it is based on the systematic use of a validated screening tool rather than relying on recording of a problem in routine clinical practice.

Juvenile Establishments in the North West

Whilst there is not a Juvenile prison within the area of Cheshire, HMYOI Hindley is the only Juvenile establishment for the North West area and as such will house juvenile offenders from the Cheshire area.

HMYOI Hindley caters solely for male offenders aged between 15 and 18 years and has an operational capacity of 440. The average sentence length for the whole population is approximately 20 months however, 41% of Hindley’s population serve less than a 12 month Detention and Training Order sentence.

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There is a full range of healthcare services available to the young men at HMYOI Hindley however demand for the Dentist and the Vaccination Clinics is high. It is also noted that many young men coming into the establishment exceed the safe guidelines for alcohol consumption prior to detention with almost half of the juvenile population drinking either harmfully (22-50 units weekly) or hazardously (over 50 units weekly).

Substance misuse is a problem for young people with 65% of adolescents experimenting with illegal drugs. 69% of juveniles arriving at Hindley have used drugs in the week prior to custody, with Cannabis being the main drug of choice, followed by Cocaine, Methadone and Amphetamines.

HMYOI Hindley is a no-smoking establishment, however 96% of offenders entering Hindley are smokers and therefore a comprehensive smoking cessation package is available.

All young people entering the establishment undergo a comprehensive mental health assessment by an RMN, any young person identified as needing further input is then referred to the appropriate service. (Data sourced from HMYOI Hindley HNA 2010)

Female Establishments in the North West

On 12 June 2009 the number of women in prison in England and Wales stood at 4,269, 236 fewer than a year before(1). In the last decade the national women’s prison population has gone up by 60%. In 1997 the mid-year female prison population was 2,672. In 2000 it stood at 3,355 and in 2007 it was 4,283. A total of 11,847 women were received into prison in UK during 2007(2).

HMP YOI Styal is one of the largest women’s prisons in the UK prison estate and is the only female prison in the North West. Like all women’s prisons, following the shrinkage of the female estate, it needs to multi-task: holding second stage lifers as well as young adults and short-sentenced and remanded women coming directly from court. Prisoners entering HMP YOI Styal have complex healthcare needs as well as a range of learning disabilities that are not often recognised.

The healthcare contract at HMP YOI Styal is run by Cheshire East Community Health (CECH) and Greater Manchester West as a collaboration. The current contract became operational in April 2009. There is a doctor on site covering routine GP services Monday to Friday, limited access on Saturdays for receptions and no service on a Sunday. In addition clinical IDTS is part of the healthcare contract, with non-clinical IDTS delivered by Lifeline and Phoenix.

Clinic sessions cover genito-urinary health and family planning, Nurse Triage, stop smoking, bloods, independent drug treatment services, midwifery and sonography services. Once a month, there is a specialist podiatry service which is arranged by referral only. There is a fortnightly optometrist service. In addition, there is a family support worker who works with women with children who have drug and alcohol issues. The Healthcare Centre (which is in need of modernisation) does not provide in-patient care. Consultant psychiatrist clinics and visiting counsellors are facilitated by the Mental Health In-Reach Team and a day care centre deals specifically with prisoners with primary mental health problems.

The age distribution of prisoners at HMP YOI Styal can be broken down as follows;

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Age Number of Percentage Women (%) 18-20 years 42 9 21-29 years 127 31 30-39 years 157 37 40-49 years 87 20 50-59 years 13 3 60-69 years 3 1 70 years plus 0 0 Maximum age 0 0 Total 429 100 (Table – Age distribution of prisoners at HMP YOI Styal 01/05 Sept 2008)

It has been noted that prisoners are increasingly coming into HMP YOI Styal with multiple healthcare needs. Since the HNA took place in 2005 those entering prison with alcohol problems have risen to 40%. (Taken from the HM Inspection Report 2008)

The average age of the prison population within HMP YOI Styal has begun to shift from an average of 22 years old to 28 years old. This age shift means that more people are coming into HMP YOI Styal with chronic diseases.

There has also been an increase in the number of wheelchair users.

There is still a mixture of both long and short periods of remand and sentences for women at HMP YOI Styal, but the average length of stay is 6-7 weeks. This relatively short time period can have an impact on healthcare, for example smoking cessation programmes last for 12 weeks, appointments for specialist clinics and services may not be achieved and women requiring counselling services to support identified psychological needs are more difficult to access due to the high turnover of the female prison population. If a prisoners’ stay is shorter then data is either incomplete or lost. (Data sourced from HMP Styal Health Needs Assessment 2009)

Probation / Youth Offending Services;

There are 6 Probation Offices in Cheshire and 2 Youth Offending Service offices, detailed below;

Probation Offices in Cheshire; Chester Crewe Halton Macclesfield Warrington Winsford

Youth Offending Service Offices in Cheshire; Cheshire Halton & Warrington

Overview

The link between crime and ill health is long established, the client groups include children, young people and women who are often amongst the most vulnerable in our society. (McManus, J (2000a) Health & crime: some issues from the literature, London: Nacro, Robinson, F, Keithley, J, Robinson, S and Childs, S (1998) Exploring the Impacts of Crime on Health and Health Services: A Feasibility Study, Durham: University of Durham)

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Offenders lifestyles are often chaotic and lack stability, many who go through custody have been in care or involved with Social Services. Mental health needs, issues with substance misuse and alcohol abuse are prevalent. In the majority of cases offenders have been excluded from formal educational settings from an early age and therefore lack the skills required to access many support systems available to them. It is also known that many people in the criminal justice system face multiple disadvantages, have complex needs and often face numerous barriers to engaging in education, training and employment.

The criminal justice system can act as a gateway to health services for vulnerable people who find it hard to access mainstream health and social care services and indeed significant health gain can be made in this way while a person is in custody. The challenge is to not only affect this move towards health improvement whilst in custody but to maintain this on discharge with community services. It is also imperative to ensure the safe detention and handling of detainees whilst in custody.

Local Demography

The population breakdown for the four Unitary Authorities in the Cheshire police area is shown as Appendix D. (Data collected from the Office of National Statistics 2010)

The population of Cheshire is estimated at 1,009,200 with 93.2% of the population from a white ethnic background which is higher than the national average of 87.5%, however the area of Halton shows an even more notable percentage of residents in the white group of 95.6%. (Data collected from the Office of National Statistics 2009)

A breakdown of the age of the Cheshire population is shown below (Figures supplied via Office of National Statistics 2010);

Age Ranges Percentage Females Males for all people 0-14 17.4 16.6 18.3 15-24 12.0 11.4 12.6 25-44 24.7 24.5 24.8 45-64 27.7 27.6 27.8 65+ 18.2 19.9 16.4

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Overall the health of people in Cheshire is mixed in comparison to the England average, The people of Cheshire East generally have better health, Warrington and Cheshire West and Chester have mixed health, but the people of Halton generally have worse health than the England average. Deprivation is lower than the England average, although there are pockets of high deprivation in each of the four unitary authorities. Across Cheshire there are approximately 33,170 children who live in poverty.

All areas have a lower life expectancy than the England average, but higher than the North West average.

Children in Cheshire achieved 58.6% of 5 grades A-C which is higher than the national average of 55.3% but Halton‘s results of 50.1% are worse than the national average.

Generally, the level of violent crime in the county (13.4 per 1,000 population) is lower than the North West (14.8) and national averages (15.8), but Halton has rate of 17.5 which is significantly worse than the England average.

Long-term unemployment is also at its highest in Halton (7.5 per 1,000 population aged 16- 64) but across Cheshire (4.5) is significantly lower than the England average (6.2).

The level of teenage pregnancy under 18 in the county is lower than the England average (40.2 per 1,000 females aged 15-17), with a hotspot in Halton (60.6), which is nearly double the rate in Cheshire East (33).

Life expectancy varies across the county, with Cheshire East having higher life expectancy for both males and females than the England average, Warrington having higher for males, but Halton and Cheshire West having lower life expectancies than England for both males and females. Early death rates for both cancer and heart disease and stroke are lower than the England average across Cheshire as a whole, but are higher in Halton and Cheshire West. Although these rates have fallen right across the county in the last 10 years.

Each borough has lower breastfeeding initiation rates than the England average. The smoking rates in pregnancy in Halton (24.2%) and Cheshire East (17.2%) are higher than the England average (14%). The percentage of adult smokers overall varies across the county, with Halton (26%) and Cheshire West and Chester (22.5%) having significantly higher rates than the England average (21.2%) but Cheshire East (19%) having a significantly lower rate. This correlates closely with the mortality rates from smoking related diseases.

Alcohol related admissions to hospital are increasing across the county and are significantly worse than the England average, but around the North West average. Halton and Cheshire West both have rates higher than the North West but Cheshire East has a rate significantly lower than the England average. Although Halton and Cheshire East have lower rates of Increasing and higher risk drinking than the England average, Cheshire West and Warrington have higher rates.

Drug misuse in the county (10 per 1,000 resident population aged 15-64) is higher than the national average (9.4) but still lower than the North West average.

The tables and graphs detailing the above are shown in appendix E with the data sourced from the Public Health Observatory Health Profiles and the information centre. (www.healthprofiles.info, http://www.indicators.ic.nhs.uk)

In 2010/11 26.4% of young people aged 15 to 24 years have been tested for chlamydia, with a positive results rate of 6.5%. The test and positive results rate vary across PCT, with

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34.9% of young people tested in Warrington with 5.4% positive results but with only 20.7% tested in Western Cheshire with 6.8% positive results.

Rates of selected STI diagnoses per 100,000 population by patient PCT: 2010 (hpa) Chlamydia (by Gonorrhoea Syphilis Herpes Warts Acute age group) STIs 15-24 25+ Central and Eastern 2042.2 41.4 15.4 0.7 54.0 123.5 510.9 Cheshire Halton and St Helens 3109.9 99.0 23.7 3.4 50.7 168.0 868.7

Warrington 2918.2 83.8 17.7 3.5 38.4 162.3 726.6

Western Cheshire 2446.9 60.6 18.4 2.6 75.4 162.0 685.7 North West Average 2639.4 103.1 26.8 5.7 55.1 170.0 848.9

Mental Health Admissions

Hospital stays for self harm are higher in all five boroughs in Cheshire than the England average (198.3 DSR per 100,000 population), with only Warrington (252.1) having a rate lower than the North West average (263.2). This reflects the higher admission rates for mental health related problems.

Learning Disabilities

It is estimated that 26,225 people across Cheshire have a learning disability, but only 5,458 people are identified or known to services on the GP practice QoF Registers. This is consistent with research by Eric Emerson and Chris Hatton that showed that roughly twenty people in every thousand have a learning disability. 4.6 of these are likely to be known to local health and social services. But these numbers vary with age.

Current Healthcare Provision in Police Custody

Cheshire Police Constabulary currently employ Reliance Medical Services to comply with Safer Detention and Handling of Prisoners (SDHP) and Police and Criminal Evidence Act (PACE) guidance regarding detainees in police custody (documents attached as Appendix F). Across the three custody suites 11.5 nurses and 4.5 Forensic Medical Examiners (FME’s) work with the police dealing with approximately 24,940 health related call outs per year.

For the month of October 2,047 persons were detained within Cheshire’s custody suites, with approximately 14% female offenders. The breakdown of people in the Cheshire area detained by Cheshire Police for the month of October 2011 is below;

No. of persons detained in the period 1st – 31st October 2011 Custody Suite Total Number Number of Females Number of Males Blacon 469 83 386 Middlewich 700 100 600 Runcorn 671 96 575 Total 1,840 279 1,561 (Data received February 2012)

It should be noted that the breakdown above was only available for primary arrivals, this is why the total figure is lower than 2,047, which includes secondary arrivals.

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Out of the 2,047 detainees, 803 (39%) required medical intervention / advice by Reliance Medical Services, with 20% of those seen being female. The number of people detained in Cheshire Police custody and visited by Reliance Medical Services for treatment is detailed below;

No. of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 Total No. of No. visited % of Detainees No. of Custody Custody Suite Detainees by Reliance seen by Reliance records reviewed Medical Medical Services by ROHT Services Blacon 469 241 51% 24 Middlewich 700 262 37% 26 Runcorn 671 270 40% 26 Total 1,840* 773 42% 76 (*Primary arrival figure as stated above)

No. of persons detained and visited by Reliance Medical Services Custody Suite in the period 1st – 31st October 2011 Total Number Number of Females Number of Males Blacon 241 38 203 Middlewich 262 50 212 Runcorn 270 71 199 Total 773 159 614 (Data collected November 2011)

The ROHT reviewed approximately 10% of custody records of those detained persons who required medical treatment from Reliance Medical Services, the results of this data collection is outlined below.

Methodology

In order to complete this report comprehensively the following methods were used;

Review of current healthcare provision within Cheshire Custody Suites. Analysis of number of detainees through custody and those seen by healthcare providers for the period 1st – 31st October 2011. Audit of 10% of custody records for the period 1st – 31st October 2011 to establish reasons for detainee health assessment and if further treatment is required ie via A&E, Mental Health Services, community Drugs and Alcohol Teams etc. Review of all Cheshire Prison Health Needs Assessments (ie HMP Risley, HMP / YOI Styal and HMYOI Thorn Cross) 2011. Review of Probation and YOT data – see Appendix G for templates used.

Detainees Age

The predominant age range for the population of Cheshire overall is 45-64 years closely followed by 25-44 years.

The office of national statistics shows the area of Cheshire East has the highest number of people in the 45-64 years category which is reflected in the custody data collected showing Middlewich has the higher number of offenders in this age range.

The office of national statistics shows the area of Warrington has the highest number of people in the 25-44 years category, which is not reflected in the custody data collected,

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which shows that Blacon has the higher number of offenders in this age range. This age range is shown to be the predominant age range of the offenders whose data was reviewed.

The breakdown of detained persons ages can be seen below;

Age Range of persons detained and seen by Reliance Medical Services Custody in the period 1st – 31st October 2011 based on a 10% sample of records Suite 0-14 15-24 25-44 45-64 65+ Blacon 0 5 17 2 0 Middlewich 0 8 7 9 2 Runcorn 1 8 12 4 1 Total 1 21 36 15 3

Detainees Gender

The population of Cheshire is almost evenly split between male and female, apart from the over 65 years age range which shows more females in this category, as per the office of national statistics. The areas of Cheshire East and Cheshire West & Chester show the highest number of both males and females.

The custody data reviewed shows a higher number of arrested males in Middlewich, whereas both Blacon and Runcorn had an equal number of arrested females. Overall, the data collected shows there are more male offenders than female in the Cheshire area.

The breakdown of the sex of detained persons at each custody suite can be seen below;

Sex of persons detained and seen by Reliance Medical Services Custody in the period 1st – 31st October 2011 based on a 10% sample of records Suite Male Female Blacon 16 8 Middlewich 20 6 Runcorn 18 8 Total 54 22

Ethnicity of Detainees

The predominant ethnicity for detained persons in Cheshire custody suites is White / British, which is reflective of the Cheshire population based on the office of national statistics data. The breakdown of ethnicity of detained persons at each custody suite can be seen below;

Ethnicity of persons detained and seen by Reliance Medical Services Custody in the period 1st – 31st October 2011 based on a 10% sample of records Suite White / British Asian / British Black / British Other Blacon 22 0 0 2 Middlewich 26 0 0 0 Runcorn 25 0 0 1 Total 73 0 0 3

Area of Residence of Detainees

The office of national statistics shows that within Cheshire, the areas of Cheshire East and Cheshire West & Chester have the highest population density. Custody data reviewed shows that detained persons mainly reside in the areas of Runcorn and Warrington, however Blacon and Middlewich custody suites have the higher number of detained persons who

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whilst arrested in these areas reside elsewhere in Cheshire. 4% of all the custody records reviewed shows detained persons with no fixed abode and 16% from outside the Cheshire area.

The breakdown of areas of residence of detained persons can be seen below;

Area of Residence of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 based on a 10% sample of records

M

Warrington

Ellesmere Ellesmere

Winsford

Cheshire Cheshire Cheshire

acclesfield

Runcorn

No fixed No fixed

Blacon

Custody Suite abode Outof

Other Other

Area

area

Port

Blacon 6 7 0 0 0 0 1 7 3 Middlewich 0 0 6 0 0 6 0 7 7 Runcorn 0 0 0 8 9 0 2 5 2 Total 6 7 6 8 9 6 3 19 12

Smoking

The custody data collected shows that the number of detained persons who smoke is largely not known in the Blacon and Middlewich custody suites, however Runcorn shows the higher number of detained persons who were shown to have cigarettes within their property where it has been assumed they therefore smoke. For this reason, one of the key recommendations will be around more informed data collection when detainees enter custody.

The breakdown of this data is shown below;

Number of persons detained and seen by Reliance Medical Services Custody in the period 1st – 31st October 2011 who smoke based on a 10% Suite sample of records Smoker Non-Smoker Not Known Blacon 9 2 13 Middlewich 10 4 12 Runcorn 17 4 5 Total 36 10 30

Substance Misuse / Alcohol Issues

The data collected in October 2011 shows that it is largely not known if detained persons have issues with drugs, although it is shown that Heroin and Cannabis use is high for those detainees who admit to drug use. Blacon custody suite has the highest number of Heroin users for the Cheshire area, with Runcorn worse affected for Cannabis and Cocaine use.

Based on the records reviewed in police custody, it is shown that those detained persons who present at custody who admit to drug use do not appear to be in contact with drug services to obtain support for their problem, however this could be the Provider not collating this information.

The breakdown of drug use data is below;

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No of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 with Drug issues based on a 10% Custody sample of records Suite Heroin Cannabis Cocaine Other None Not In contact Known with Drug Services Blacon 3 3 1 3 5 9 0 Middlewich 1 2 0 0 6 17 0 Runcorn 1 3 3 0 13 6 0 Total 5 8 4 3 24 32 0

Based on the sample of records reviewed, 24% of detainees seen by Reliance Medical Services for medical treatment in the month of October 2011 were under the influence of alcohol on arrest, which may have contributed to their offence. However, it is not known for 47% of those seen by Reliance Medical Services if an alcohol problem existed, with only 21% admitting to having a problem. Again, the data collected largely shows that it is not known if detainees are in contact with services for their alcohol issues.

Middlewich and Runcorn custody suites had the higher number of detainees who were under the influence of alcohol on arrest.

The breakdown of alcohol use data is below;

No of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 with Alcohol issues based on a 10% sample of records Custody Alcoholic Under the Alcohol None Not In contact with Suite Influence Use Known Alcohol of Alcohol Services on Arrest Blacon 6 0 2 1 15 0 Middlewich 5 7 0 1 13 0 Runcorn 5 11 1 1 8 0 Total 16 18 3 3 36 0

It is understood from Cheshire Drug and Alcohol Team that Blacon, Middlewich and Runcorn custody suites operate a drug arrest referral service, Drug Intervention Programme (DiP) workers regularly visit the custody facilities to speak with detainees who may need support for their drug issues. The aim of the service is to direct detainees into treatment where the need arises, or to work with them to reduce their offending. They are commissioned with a KPI to achieve 95% of clients on the caseload to be referred into structured treatment. In Quarter 1 and Quarter 2 of 2011 they have achieved 100% and 97% respectively. The DIP will also case manage appropriate PPO's or repeat offenders and give brief interventions to alcohol clients who are subject to a conditional caution.

The area of Cheshire has had alcohol arrest referral schemes running in the custody as pilots, but these have stalled due to funding. The local PCT's commission alcohol services and have moved their focus more to the A & E departments to meet the performance target to reduce hospital admissions.

Based on the data shown above for drugs and alcohol, one of the key recommendations to be made will be to ensure referrals are made to services where this is warranted with more partnership working to be encouraged between all agencies.

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Mental Health Issues

From the records reviewed the number of detainees where it is not known if there are any mental health issues is high. However, where mental health problems have been identified the number of detainees who have a history of or currently suffer from depression is high, particularly in Middlewich and Runcorn custody areas. However, it should be noted that 47% of those who stated depression when asked about mental health issues also informed of a history of self harm. With 879 and 774 hospital stays for self harm per 100,000 population, in Cheshire East and Cheshire West & Chester respectively these are problematic areas for this issue as they are significantly higher than the national averages.

Once again, the number of detainees who are in contact with mental health services for an identified problem is low at just 12%.

The breakdown of mental health issues is below;

No of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 with Mental Health issues based on a Custody 10% sample of records Suite Depression Anxiety Self Other (ie Not In contact with Harm Psychosis, Known Mental Health Schizophrenia) Services Blacon 8 2 3 3 8 4 Middlewich 12 2 0 1 11 1 Runcorn 14 1 3 1 7 1 Total 34 5 6 5 26 6

Cheshire & Wirral Partnership and 5 Boroughs Partnership NHS Trust, two of the Mental health providers, have provided data and information on the number of referrals they received for mental health in the same period, this is shown below;

No of referrals for the period Provider 1st – 30th September 2011 Cheshire Wirral 7 Partnership 5 Boroughs Partnership NHS 4 Trust Total 11

Unfortunately, data from the other provider (Cheshire Care Foundation Trust) was not available at this time.

One of the key recommendations will be to ensure referrals to the correct service for a mental health assessment / ongoing intervention are made for those with an identified mental health problem and to encourage more robust partnership working with agencies.

Health Interventions

The custody suites in Cheshire utilise the services of Reliance Medical Services when medical treatment is required for detainees. From the data collected 37% of the reasons for a Reliance Medical Services call out was to ascertain if a detainee was fit to be detained, closely followed by 30% of ‘Other’ callouts which may have involved dispensing medication, pain relief or referring to A&E those detainees complaining of chest pain or head injury.

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On the whole 51% of records reviewed showed a more comprehensive health history was collected.

Breakdown of Reason Reliance Medical Services called out for detainees in the period 1st – 31st October 2011 based on a 10% sample of records Custody Minor Drug / Alcohol Mental Health Fitness Other Suite Injuries Withdrawal to Detain Blacon 6 2 2 4 10 Middlewich 6 3 0 14 3 Runcorn 4 1 1 10 10 Total 16 6 3 28 23

One of the key recommendations would be to introduce a comprehensive health screening tool to be completed by the custody nurse for detainees, not just those who require medical treatment, to ascertain what health needs there may be and to refer to the appropriate services if required. This is aspirational and will require negotiation with the Healthcare Provider.

Crime in Cheshire

From the custody records reviewed most of the offences committed were Theft, Assaults, ranging in severity, and ‘Other’ offences, including Breach of the Peace, Affray and Public Order offences. As noted above, 24% of the detainees whose records were reviewed were under the influence of alcohol on arrest, which may have contributed to their committing the offence for which they were arrested.

The data collected is shown below;

Offences Committed by persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 based on a Custody 10% sample Suite Drunk & Criminal Assault & Theft Other Disorderly Damage associated (ie Breach of Peace, Affray, Public Order Offences) Offences Blacon 0 4 5 8 7 Middlewich 3 4 7 5 7 Runcorn 3 1 7 7 8 Total 6 5 19 20 22

30% of detainees were charged for the offences they committed, with 22% having no further action taken by the criminal justice system.

Disposal of persons detained and seen by Reliance Medical Services in the period 1st – 31st October 2011 based on a Custody 10% sample of records Suite Charged Caution Bailed NFA Other (ie Remand, PND, Transfer to court etc) Blacon 10 1 5 6 2 Middlewich 9 0 11 5 1 Runcorn 4 1 10 6 5 Total 23 2 26 17 8

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Data supplied by the Community Safety Partnership Strategic Assessments of 2011 / 2012;

Cheshire West & Chester All recorded crime - All APB’s exhibit a year on year decline in the gross volumes of reported incidents. Average decline year on year in the actual volumes is 10.4% - over 200 less victims of Crime. Serious Acquisitive crime exhibits significant decline across all APB’s with a year on year decline of 29.7% An overall decline in Assaults of 5.4% is observed with marginal increases in actual incidents in the Winsford and Rural APB’s. A 30% decline in burglary of a dwelling year on year with a minor increase in Winsford the favourable trend has continued into 2011–12 period. The overall number of ASB Incidents reported to the Police declined significantly over the period of this report, and has continued to decline. An analysis of the presenting needs of adult offenders over the previous year has reflected some improvements in that 10.5% fewer adult offenders than the previous year are presenting with alcohol related issues including dependency. However there has been an increase of 20% more admitting that their general lifestyle is linked to their offending.

Cheshire East Adult re-offending rates for those under probation supervision - The 09/10 target of an 8.2 % reduction in actual re-offending has been achieved with a 8.18% reduction by Qtr 4 09/10 Repeat incidents of domestic violence - Whole partnership approach, of which Multi- Agency Risk Assessment Conferencing (MARAC) is central, has been shortlisted for IdeA Innovations Award. Reported incidents of Anti Social Behaviour - Seasonal variation following Christmas period has seen reduction in reported incidents of anti-social behaviour.

Data from Warrington and Halton was not available at this time, it is expected to add this information in once it is provided.

Current Healthcare Provision in Prison

The healthcare of prisoners is an integral part of the services provided within prison establishments and the responsibility for this provision sits with the NHS. In the area of Cheshire, Cheshire East Community Health and NHS Warrington are currently the lead providers for health for the three prisons. CRI provide clinical IDTS in HMP Risley and HMYOI Thorn Cross.

All prisoners are seen by a member of the healthcare team as part of their reception into the prison and an assessment is undertaken of their existing health issues including mental health and substance abuse. Any further primary care treatment / support required will be available to the prisoner for the duration of their stay in the establishments. External health provision may be sourced should the need arise.

The Department of Health in conjunction with the National Offender Management Service publish Prison Health Performance Indicators on an annual basis for each individual prison. These indicators are used to drive forward and improve the standards of all areas of prison healthcare in order to improve quality – see Appendix H for the latest PHPQI Guidance.

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All prisons are also under the scrutiny of Her Majesties Inspector of Prisons who conduct regular audits and inspections of all areas of each prison in England and produce reports and recommendations for service improvements.

Current Healthcare Provision in Probation

There are 6 Probation Offices in Cheshire and in quarter 2 of 2011 (1st July – 30th September 2011), there were 3,701 convicted cases open to Probation. Probation use OASYS to assess the following areas;

 Case Identification.  Offending Information.  Analysis of Offences.  Accommodation.  Education, training & employability.  Financial management & income.  Relationships.  Lifestyle & associates.  Drug misuse.  Alcohol Misuse.  Emotional health & wellbeing.  Thinking & behaviour.  Attitudes.  Heath & other considerations e.g. general health, LD, communication problems, interpreter, phone line etc.

The OASYS system scores as follows; Drug Misuse - 0 - 10 with a criminogenic need being assessed as those with scores of 2+. Alcohol - 0 - 8 with a criminogenic need being assessed as those with scores of 24+. Emotional Health and Wellbeing - 0 - 12 with no criminogenic need score. Health - No score at all but questions on general health are asked.

We have therefore interpreted the data supplied by Cheshire Probation as follows; an OASYS score of 0 equals no issues and an OASYS score of 1 or more equals issues identified.

The following table shows the OASYS scores of those open cases in the quarter 2 period;

Score 0 Score 1 Drug Misuse 1,874 1,033 Alcohol 981 1,926 Emotional Health & Wellbeing 2,665 242 Health & Other Considerations 1,731 1,176

As can be seen from the data above, most of the cases through probation for quarter 2 scored 0 ie no issues identified, however it should be noted that Probation only score these areas as an identified issue if it has impacted on criminal activity. This is highlighted in the case of alcohol, where the number of cases where alcohol is an issue is high, which supports the custody data above which shows that 24% of detainees requiring medical treatment in custody were intoxicated on arrest.

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Current Healthcare Provision in Youth Offending Services

There are 2 main Youth Offending services in Cheshire;

Cheshire Halton & Warrington

Data was requested of the 2 main services in Cheshire around the number of convicted cases in quarter 2 (1st July – 30th September 2011), along with the number of those cases who scored 0 – 4 on ASSET and the number of cases who were referred to other agencies for support.

The ASSET form reviews the following areas;  Offending behaviour  Living arrangements  Family & personal relationships.  Education, training & employment.  Neighbourhood.  Lifestyle  Substance Misuse.  Physical Health.  Emotional & Mental Health.  Perception of self & others.  Thinking & behaviour.  Attitudes to offending.  Motivation to change.  Positive factors.  Indicators of vulnerability.  Indicators of serious harm to others

The ASSET scores from 0 – 4, with 0 as no issues, 1 - 2 infrequent / minor issues identified and a score of 3 – 4 shows moderate to severe problems identified. (Information from ASSET guidance: http://www.justice.gov.uk/downloads/guidance/youth-justice/assessment/asset-young- offender-assessment-profile/2CoreProfileGuidance.pdf)

The breakdown of this data is shown below;

Cheshire number of convicted cases in quarter 2: 360 Score 0 Score 1 Score 2 Score 3 Score 4 Physical Health 264 75 16 4 1 Emotional & Mental Health 90 115 97 50 8 Substance Misuse 82 72 125 59 22

Halton & Warrington number of convicted cases in quarter 2: 173 Score 0 Score 1 Score 2 Score 3 Score 4 Physical Health 162 11 0 0 0 Emotional & Mental Health 58 40 50 24 1 Substance Misuse 54 28 54 26 11

As can be seen from the data above, whilst most cases through the Youth Offending Services for quarter 2 who completed the ASSET scored 0 ie no issues identified, 59% of cases in Cheshire and 52% of cases in Halton & Warrington scored 1 – 2 for Emotional and Mental Health. 16% of cases in Cheshire and 14% in Halton and Warrington scored 3 – 4 for Emotional and Mental Health.

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In Cheshire 23% of cases who completed the ASSET scored 0 for Substance Misuse, with 55% scoring 1 – 2 and 22% scoring 3 - 4. In Halton and Warrington 31% of cases who completed the ASSET scored 0 for substance misuse, with 47% scoring 1 – 2 and 21% scoring 3 – 4, a score of 3+ as per the ASSET Guidance may show their offending behaviour was as a result of their substance misuse issues.

Number of convicted CYP referrals made in quarter 2;

Referrals to: Cheshire Halton & Warrington Generic YOT Health Workers N/A N/A Substance Misuse Staff / Services 117 91 CAMHS YOT Health Workers / CAMHS Service 146 75

Number of convicted CYP referrals made by Health staff to other health providers;

Referrals to; Cheshire Halton & Warrington GUM 9 N/A Speech & Language Therapy 7 N/A Learning Disability Services 3 N/A Dental 15 N/A Opticians 2 N/A GP 6 N/A Stop Smoking Service 1 N/A FACTS Team 1 N/A Tier 4 Service 2 N/A Dietician 1 N/A CAMHS / MH Services 4 N/A Counselling 2 N/A LAC Nurse 1 N/A Neuro Psychological Testing 1 N/A Paediatrician 3 N/A Psychiatric Assessment 3 N/A Immunisation 19 N/A

The main reason for onward referral in Cheshire is for Dental intervention and Immunisation.

Current Health Provision in the Cheshire area

Health Care; Four Primary Care Trusts have clustered to become the Cheshire NHS Cluster. This cluster consists of the following; Warrington, Central and Eastern Cheshire, Western Cheshire, and Wirral PCTs.

This Cluster is responsible for 254 GP Practices, 256 Dental Practices.

It should be noted that Halton comes under the Merseyside Cluster which includes Halton & St Helens PCT, Knowsley PCT, Liverpool PCT and Sefton PCT.

Halton & St Helens PCT are responsible for 89 GP Practices and 48 Dental Practices.

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Acute Services:

4 Acute Trusts; East Cheshire NHS Trust, Mid Cheshire Hospitals NHS Foundation Trust, Warrington and Halton Hospitals Foundation Trust, Countess of Chester Hospital NHS Foundation Trust,

4 A&E Departments; Countess of Chester Hospital NHS Foundation Trust Mid Cheshire Hospitals NHS Trust (Leighton Hospital) North Cheshire Hospitals NHS Trust (Warrington Hospital and Halton Hospital)

Drug Action Teams (DATs):

Commissioners; Cheshire DAT Halton DAT Warrington DAT

Mental Health Services:

Provider; Cheshire Care Foundation Trust Cheshire and Wirral Partnership NHS Foundation Trust 5 Boroughs Partnership NHS Trust

Overview of Custody HMIC Inspection Expectations

In 2008 HM Inspectorate of Prisons and HM Inspectorate of Constabulary began a programme of joint inspections of police custody suites in England and Wales.

In line with standard inspection methodologies, the two inspectorates have devised detailed inspection criteria, or Expectations, against which to assess the practice found in police custody. Expectations are informed by, and referenced against, the Police and Criminal Evidence Act (PACE) codes (1984) and Home Office guidance on the safe detention and handling of persons in custody (2006).

Cheshire Custody Suites have not yet had an inspection by the above Inspectorate, however based on Section 4 (Healthcare), of the Expectations document of 2009 we know that with regards to health the following areas will be reviewed by the inspectors;

Clinical Governance 1. Detainees are treated by healthcare professionals and drug treatment workers in a professional and caring manner that respects their decency, privacy and dignity and is sensitive to their situation and diverse needs, including language needs. 2. Clinical Governance arrangements include the management, training and supervision and accountability of staff. 3. Patients are treated by healthcare staff who receive on-going training, supervision and support to maintain their professional registration and development. Staff have the appropriate knowledge and skills to meet the particular healthcare needs of detainees in police custody. 4. Clinical examinations are conducted confidentially unless risk assessment suggests otherwise. Treatment rooms provide conditions that maintain decency, privacy and

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dignity. Infection control facilities are implemented. There is at least one room that is capable of being used for the taking of forensic samples and it is clean. 5. All medications are on site stored safely and securely and disposed of safely if not consumed. There is safe pharmaceutical stock management and use. 6. All equipment (including resuscitation kit) is ready for use and regularly checked and maintained and all staff (healthcare and custody staff) understand how to access and use it effectively.

Patient Care 7. Detainees are asked if they wish to see a healthcare professional and are able to request to see one at any time, for both physical and mental health needs. 8. Detainees continue to receive prescribed medication for any clinical condition and to receive medication to provide relief for drug and alcohol withdrawal symptoms if needed. 9. Each detainee seen by healthcare staff has a clinical record containing an up to date assessment and any careplan conforms to professional guidance from the regulatory bodies. Ethnicity of the detainee is also recorded. 10. Any contact with a doctor or other healthcare professional is also recorded in the custody record and a record made of any medication provided. The results of any clinical examination are made available to the detainee and with detainee consent his / her lawyer.

Substance Use 11. Detainees are offered the services of drugs or alcohol arrest referral worker when appropriate and referred on to community drugs / alcohol teams or prison drugs workers as appropriate.

Mental Health 12. A liaison and / or diversion scheme enables detainees with mental health problems to be identified and diverted into appropriate mental health services, or referred on to prison health services. 13. Police custody is not used as a place of safety for Section 136 assessments.

Cheshire Police Force have been provided with an action plan by the NW ROHT to help them ready themselves for the HMIC process.

Recommendations

Based on the data collected by the Team for the period 1st – 31st October 2011 the following recommendations are made;

Better record keeping and data collection for all detainees in custody and by all parties to ensure compliance with professional standards. Use of a health screening tool for detainees, not just those seen by the healthcare provider for medical treatment, although as noted above this is aspirational. Appropriate referrals to relevant services for detainees with an identified health need ie drugs, alcohol, mental health. More robust partnership working. An annual refresh of the Health Needs Assessment using more concise data as per the recommendations above.

Scope and Limitations for the Report

The author was commissioned to undertake a review of healthcare provision within Cheshire Custody Suites and to provide recommendations for service development within Custody and

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the community. This report includes all areas of healthcare provision within Cheshire Police Custody.

References

Bradley Report 2009 Healthy Children, Safer Communities 2009 Improving Health Supporting Justice 2009 HM Prison Service Data HMCIP Inspection Reports Prison Reform Trust Bromley Briefings Factfile December 2010 Assessment of alcohol problems using AUDIT in a prison setting: more than an 'aye or no' question, Susan MacAskill, Tessa Parkes, Oona Brooks, Lesley Graham, Andrew McAuley and Abraham Brown (2011) HMYOI Hindley HNA 2010 HMP Styal HNA 2009 McManus, J (2000a) Health & crime: some issues from the literature, London: Nacro, Robinson, F, Keithley, J, Robinson, S and Childs, S (1998) Exploring the Impacts of Crime on Health and Health Services: A Feasibility Study, Durham: University of Durham Office of National Statistics 2010 Public Health Observatory Health Profile of Cheshire 2011 www.chlamydiascreening.nhs.uk Health Protection Agency Emerson, E et al (2001) Learning Disabilities the Fundamental Facts London The foundation for People with Learning Disabilities Safer Detention and Handling of Prisoners (SDHP) Police and Criminal Evidence Act (PACE) Cheshire Police Custody Suite Detainee Records Data Data collected from Cheshire Probation Service for Quarter 2 (July – September 2011) Data collected from Cheshire Youth Offending Services for Quarter 2 (July – September 2011) Community Safety Partnerships Strategic Needs Assessments 2011 / 2012 Prison Health Performance & Quality Indicator (PHPQI) Guidance 2011. OASYS Guidance ASSET Young Offender Assessment Guidance HMIC Expectations for Police Custody document

Who was involved in the process: Cheshire Police Reliance Medical Services Rachel Watkin, Public Health Intelligence Specialist; NHS Bury Nicola Ellis, Primary Care Lead; NW ROHT Tracy Wilson, Business Administration Manager; NW ROHT

Gap analysis

Data currently available on the health status of detainees in custody is minimal as record keeping needs to be more robust to allow for a more informed referral process to health services for detainees.

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Appendix A

Sites Accepted for Early Adopters

West Midlands Staffordshire West Yorkshire Greater Manchester Cheshire Cheshire Northumbria Devon and Cornwall Derbyshire Kent

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Appendix B

Map of the Cheshire area and police stations / custody suites within

Appendix C – Data required to complete the HNA

Custody Population: Number through custody (Data obtained via Ages of detained persons Cheshire Police) Sex of detained persons Offence committed / Disposal Category Area detained person resides Identified health need ie drugs, alcohol, mental health, physical health, sexual health Ethnicity of detained person

Local Area Population: Total population number (ie geographical area of Breakdown of the population by age Cheshire via Office of Breakdown of the population by ethnicity National Statistics) Breakdown of population by sex Prevalent health needs in the area Deprivation status of the population

Regional Comparison: Prevalent health needs in this area compared with overall (ie North West area via regional health needs and priorities. Public Health Observatory data 2011 for Cheshire)

National Comparison Prevalent health needs nationally compared with regional (ie England via Public Health and local needs and priorities. Observatory data 2011)

Appendix D

All people Females Males Percentage aged: Percentage aged: Percentage aged: Population Population Population 15- 25- 45- 15- 25- 45- 0- 15- 25- 45- (thousands) 0-14 65+ (thousands) 0-14 65+ (thousands) 65+ 24 44 64 24 44 64 14 24 44 64

Cheshire 363.8 16.9 11.0 24.3 28.5 19.4 185.1 16.1 10.4 24.2 28.2 21.1 179.1 17.6 11.6 24.5 28.8 17.5 East Halton 119.2 19.1 13.0 25.8 27.5 14.6 61.6 18.2 12.5 26.0 27.6 15.7 58.0 20.0 13.6 25.5 27.4 13.4 Warrington 198.9 17.9 11.9 27.0 27.1 16.1 100.6 17.3 11.2 26.7 26.9 17.8 98.5 18.6 12.5 27.2 27.3 14.4 Cheshire West and 327.3 16.9 12.6 24.5 27.6 18.5 167 16.0 12.2 24.1 27.4 20.2 160.3 17.7 12.9 24.9 27.8 16.7 Chester

Cheshire 1009.2 17.3 11.9 25.1 27.8 17.9 514.3 16.6 11.4 24.9 27.6 195 495.9 18.1 12.4 25.3 28.0 16.2

Data supplied via the Office of National Statistics – mid year population estimate 2010

Population Pyramids depicting the above information are below.

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Appendix E – Public Health Observatory, Health Profile of Cheshire 2011 Data

Communities

Indicator Local Value Local England England % Value Value % Worst % (Cheshire) % (NW) Deprivation 15.1 31.8 19.9 89.2 GCSE Achieved 5 A-C 58.6 55.2 55.3 38.0 Violent Crime 13.4 14.8 15.8 35.9 Long Term Unemployment 4.5 6.9 6.2 19.6 Teenage Pregnancy (under 18)* - 45.6 40.2 69.4

Adult Health & Lifestyle

Indicator Local England England Value Value % Worst % % (NW) Adults Smoking 23.4 21.2 34.7 Increasing & Higher Risk Drinking 25.6 23.6 39.4 Obese Adults 23.4 24.2 30.7

Disease & Poor Health

Indicator Local Value Local England England % Value Value Worst (Cheshire) % (NW) Hospital Stays for Self Harm* - 263.2 198.3 497.5 Hospital Stays for Alcohol - 2295 1743 3114 Related Harm* Drug Misuse 10.0 11.5 9.4 23.8 People diagnosed with Diabetes 5.6 5.7 5.40 7.9

Life Expectancy & Causes of Deaths

Indicator Local England England Value Value Worst % (NW) Excess Winter Deaths 17.6 18.1 32.1 Life Expectancy – Male 76.6 78.3 73.7 Life Expectancy – Female 80.8 82.3 79.1 Smoking related Deaths 264.9 216.0 361.5 Early Deaths: heart disease and 86.5 70.5 122.1 stroke Early Deaths: Cancer 124.9 112.1 159.1

*It has not been possible to obtain a value

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Appendix F

SDHP

Adobe Acrobat Document

PACE (code C)

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Appendix G – Templates used to collate data from Probation / YOT Services

Request for Probation / Health information for the purposes of the Police Health Needs Assessments.

Probation Office______Person completing the form______

Please could you complete the request for data below as fully as you can based upon Quarter 2 (July, Aug & Sept 2011) Including PSR requests that do not go on to conviction.

Total number of all convicted cases open to Probation in Q2

Number of total convicted cases open to Probation in Q2 that have scores of 0 on OASYS: Drug Misuse Alcohol Emotional Health & Wellbeing Health & other considerations

Number of total convicted cases open to in Q2 that have scores of 1or more on OASYS: Drug Misuse Alcohol Emotional Health & Wellbeing Health & other considerations

Number of referrals made by Probation staff to health providers:: GUM SLT LD Dental Opticians GP Other (please state)

Many thanks for completing this form, please could it be sent back by the 30th NOVEMBER 2011 to:

[email protected] Or [email protected]

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Request for YOT / Health information for the purposes of the Police Health Needs Assessments.

YOT Name______Person completing the form______

Please could you complete the request for data below as fully as you can based upon Quarter 2 (July, Aug & Sept 2011)

Prevention (i.e. those CYP at risk of offending, but NOT on any orders to the YOT)

Total number of all prevention cases open to the YOT in Q2

Number of total prevention cases open to the YOT in Q2 that have scores of 0 on ONSET / ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have scores of 1 on ONSET / ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have scores of 2 on ONSET / ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have scores of 3 on ONSET / ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have scores of 4 on ONSET / ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of prevention case referrals made in Q2 for: Generic YOT Health Workers Substance Misuse staff / services CAMHS YOT Health Workers / CAMHS service

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Number of referrals made by Health staff to other health providers for CYP on prevention interventions: GUM SLT LD Dental Opticians GP Other (please state)

Convicted cases (i.e. those CYP who are on an order to the YOT including Final Warnings but EXCLUDING those in custody at any period in Q2)

Total number of all convicted cases open to the YOT in Q2

Number of total convicted cases open to the YOT in Q2 that have scores of 0 on ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores of 1 on ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores of 2 on ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores of 3 on ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores of 4 on ASSET: Physical Health Emotional & Mental Health Substance Misuse

Number of convicted CYP referrals made in Q2 for: Generic YOT Health Workers Substance Misuse staff / services CAMHS YOT Health Workers / CAMHS service

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Number of referrals made by Health staff to other health providers for convicted CYP: GUM SLT LD Dental Opticians GP Other (please state)

Many thanks for completing this form, please could it be sent back by the 30th NOVEMBER 2011 to:

[email protected] Or [email protected]

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Appendix H – Prison Health Performance & Quality Indicators 2011-12

PHPQI Guidance 2010-11final.doc

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