Let me in!

1. Let me in! Sue Cobbold Diabetic Eye Screening Service – NHS Suffolk

2. PSI – Prison Service Instruction, Feb 2002 - In line with the overarching Health Services for Prisoners Standard to provide prisoners with access to the same range and quality of services that the general public receives from the National Health Service. National Service Framework for Diabetes: Standards

3. PSI – Prison Service Instruction, Feb 2002 - Diabetes does not affect everyone equally. Significant inequalities exist in the risk of developing diabetes, in accessing health services and in health outcomes. The burden of disease falls disproportionately on people from minority ethnic and socially excluded groups. National Service Framework for Diabetes: Standards

4. ‘NSF - Who gets diabetes – Health Inequalities, paragraph 9’ Less affluent and socially excluded communities High risk, hard to reach groups are overrepresented in the prison population.People with diabetes living in custodial settings should be managed in line with the standards set out in this NSF.Close partnership working between the prison health care team and local NHS diabetes services is essential.

5. PSI – Prison Service Instruction, Feb 2002 - There are no additional staff or non-staff resources required to implement this PSI.

6. April 2006 – responsibility for prison healthcare is transferred from HMPS to NHS. PCT’s responsible for delivery of care. Engagement of screening programmes with prison healthcare departments becomes compulsory.

7. What is the scale of the task?

8. We screen: Pop DESS % Cat A Whitemoor 450 11 2.4 Cat B Littlehey 716 26 3.6 Cat B/C Highpoint 920 23 2.5 All prisons 3154 80 2.5 QOF data 2008, national average = 3.9%

9. Diabetic Eye Screening Service • Make contact with PCT prison DSN. • Determine number prisons within your area and establish a named contact in each one. • Arrange to visit the healthcare department. • Organise screening.

10. Visit to Prison Healthcare. • Rapport with healthcare staff • Security/ID requirements • Familiarise yourself with prison layout • View screening room to establish needs • Discuss timetable for day

11. Organise screening: • Good communication is vital. • Ask for list of prisoners – use nhs.net email. • May have no unique identifier. • Alias commonly used.

12. Send an inventory of equipment and summary:

13. Screening in prison...... • Really isn’t too bad or scary! • Only take bare essentials, clear clutter from van and kit. • Be prepared to be searched • Keep NHS ID card with you • You will not be left alone with patients • You will hear some stories!

14. Admin • All correspondence is sent to Prison Healthcare. • Referrals too.

15. Breakdown of screening outcomes Referral rate = 16%

16. Challenge: Are we doing enough? We know: Prisoners are amongst high risk groups. Referable retinopathy is more prevalent. Prison population is very fluid. Most sentences are approx six months duration. Lack of continuity in medical records.

17. Good news! SystmOne rolled out to 60 prisons in the North, Midlands and East of England from 6th July, 2009. Approval now gained to extend this to London and the South where 8 prisons are already online.

18. In conclusion: A different approach?

19. Annual visits don’t guarantee annual screening for eligible patients. More frequent visits are impractical. Impossible for prisoners to attend venues outside prison.

20. Slit lamp biomicroscopy performed by a trained, accredited screener (SLE) who visits each prison more frequently – perhaps quarterly.