Katie Buchanan Prison Dental Research Co-ordinator PHRN / University of Manchester

1. Evaluation of the impact of the implementation of a national strategy for improving prison dental services in England Katie Buchanan Prison Dental Research Co-ordinator PHRN / University of Manchester

2. Dental Team • Professor Martin Tickle • Dr Keith Milsom • Miss Katie Buchanan • Dr Liana Zoitopoulos

3. Evaluation Background • Requirement of CDOs office in 2005 • Strategy for Modernising Dental Services for Prisoners in England – April 2003 • Standards for service delivery • Over £4.75M injected into prison dental services • Has strategy \ additional funding improved prison dental services?

4. The Strategy (April 2003) Highlights 6 key areas • Service Specification & Access • Contracts & Standards • Commissioning • Clinical Governance • Dental Equipment • Workforce

5. Methodology • Protocol was peer reviewed & questionnaire was piloted at HMP Styal & Risley • Postal questionnaire sent to all prisons in England (134) in 2006 • 3 waves - 5 weeks apart • Completed by Healthcare Manager • Questionnaires were returned to Prison Health, DoH in a pre-paid addressed envelope

6. Questionnaire • Covered 4 of the 6 themes of the strategy • Plus additional questions on morale and quality of service • Asked to report situation in 2003 and in 2006 • Open ended questions to obtain additional views on the prison dental services

7. Results - response • 109/134 (81%) were returned • Item non response was an issue • Data unavailable for certain questions

8. Main Findings

9. Service Specification & Access • Increase in the number of prisons that can offer urgent dental care within 24 hours (47% - 70%) • Increase in the number of prisons that can offer routine dental care within 6 weeks (48% - 65%) • Increase in the number of prisons that have an oral health promotion programme in place (10% - 40%) • Increase in the number of prisons with an agreed service specification in place (48% - 78%)

10. Clinical Governance • Dramatic increase in visits from Regional Dental Officer’s & General Dental Practice Advisor’s • Increase in written policies & procedures • e.g. effective complaints procedure • Crucial to audit this service to ensure written policies & procedures are being followed

11. Dental Equipment • Considerable capital investment • Over half have had a total surgery refurbishment • Does this allay fears that the money was not going to reach the service?

12. Workforce & Additional Questions • 35% of managers reported that the morale of prison dental staff appears to have improved • Subjective assessment of quality - 65% of managers reported that the service has improved • Increase in the number of prisons that have a procedure to ensure dentists are undertaking CPD & have the appropriate qualifications to practice

13. Qualitative responses

14. Main Issues reported • Main concern – length of the waiting lists • Prisons where escorts are not needed - shorter waiting lists • Number of sessions available is inadequate for this high need population • Under resourced service with no ‘real’ investment • Inefficiencies in the services - wasted dental appointments

15. Reasons for wasted appt’s • Appointment slips not being given to prisoners or given too late • Prisoners refusing or failing to attend • Prisoners being discharged – appointment book not being updated • Prison role incorrect • Insufficient staff to man the healthcare department • Prison officers not bringing prisoners to their appointments

16. Key findings of the evaluation

17. Data quality • Reported data • Post hoc commissioning • Data availability • Limited resources

18. Key findings • Things appear to have improved in all areas • E.g. Dramatic increase in the number of prisons with a clinical governance programme in place (28% - 84%) • But still room for improvement • E.g. 1/3 still don’t meet the target for access to urgent & routine dental care • Lack of standardised data to support local commissioning of service by PCTs

19. Recommendations National minimum data sets are required to support PCTs & prison healthcare services, these include: • Health Needs Assessment – a group of key indicators to assess health care needs of prisoners. • Agreement on key measures to assess service delivery. These must relate to the standards set out in the national strategy (April 2003), which can act as a commissioning framework for prisons strategy. • A standardised dental service inspection proforma for GDPAs to ensure quality standards are being met

20. Summary • In over 80 % of prisons there seems to have been marked improvement in the service in all areas identified by the national strategy. • Significant challenges for PCTs as commissioners of these services. • Standardised data sets and information systems are needed to to support strategic development and enable efficient management of prison dental services.

21. Katie Buchanan Prison Dental Research Co-ordinator School of Dentistry University of Manchester Higher Cambridge Street Manchester M15 6FH Tel: 01244 364705 katie.buchanan@manchester.ac.uk