Ensuring Patient Safety in Custodial Healthcare: Challenges and Strategies

1. Patient Safety in Secure Settings Helen Parker – Head of Healthcare, HMP Frankland 1st April 2015

2. Aims • Overview of Offender Health services • Patient safety issues in a custodial setting • Questions

3. UK / Regional Context Nationally: • 123 prisons in England and Wales • Males – 81,815 • Females – 3,886 • Usable Operational Capacity – 87,720 • Projected increase to 95,000 by 2017 Regionally: • 7 prisons in the North East of England with a population of 5,500 • HMP Frankland • HMP Low Newton • HMP Durham • HMP Deerbolt • HMP Northumberland • HMP Holme House • HMP Kirklevington Grange

4. Overview of Services • Primary Care • Reception Screening • GP services • Nursing services • Mental Health including Severe Personality Disorder • Pharmacy • Dentistry • Optician • Secondary Care services – Visiting Consultants and Specialists • Inpatient Facilities • Telemedicine • Palliative care / Complex cases / End of Life care

5. Health Needs – no different to you or I?? • Chronic Disease Management • Mental Health • Severe Personality Disorder • Sexual Health • Non Cancer / Cancer screening programmes • Palliative care / End of Life Care management • Secondary Care provision

6. Patient Safety Issues Medicines Management: • Inappropriate / inconsistent prescribing practices – NICE Guideline i.e. lower back pain. • Abuse of prescription medication such as Tramadol, Pregablin and Gabapentin. • Trafficking prescription medication • Safer Prescribing in Prisons – RCGP

7. Patient Safety Issues Secondary Care: • The patient vs the prisoner • Health vs public protection – balancing public protection against patient need – delivering more services in-house • Environment • Restraints • Data Protection / Confidentiality / Information Governance • Record Keeping • Deaths in Custody / Prison and Probation Ombudsman reviews • Discharge Planning • Service Level Agreement • PARTNERSHIP AND MDT WORKING – EVERYONE IS ACCOUNTABLE!!

8. Patient Safety Issues Self Harm and Suicide Prevention: • Assessment, Care in Custody and Teamwork (ACCT) monitoring system • ACCT was developed in response to the recommendations outlined by the Prison and Probation Ombudsman. It was also intended to ensure that the changes that came into effect in 1999, when the NHS and Prison Service entered into a formal partnership to provide healthcare services in prisons, were in line with current NHS policy and national Prison Service frameworks. These included proposals for developing better ways of identifying mental health issues in prison reception, the use of the NHS Care ProgrammeApproach, and adopting a community care service model, i.e., encouraging mental health work on residential wings. • ACCT was developed in partnership with the Department of Health.

9. Patient Safety Issues – cont’d • The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness have published a national study of self-inflicted deaths in prisons between 1997 and 2007.  Some of the key findings of the study were: • 766 self inflicted deaths occured among prisoners in 110 prisons, averaging 85 deaths per year. • 9 self-inflicted deaths occured under the care of the Prison Escort Custody Service and the majority of these were in court cells • 705 self inflicted deaths were by hanging or self strangulation • 696 self inflicted deaths were male, and there was a male to female ratio of nearly 10:1 • 102 prisoners were from a Black and Minority Ethnic (BME) group. • 361 prisoners had one or more psychiatric diagnosis/es recorded.  • 226 prisoners had a history of NHS mental health service contact.

10. Patient Safety Issues Deaths in Custody: • All prisoners are subject to a Prison and Probation investigation and Clinical Review, commissioned by NHS England. This is regardless of the cause of death and place of death!! • Level of investigation is in line with National Guidelines and SUI reporting frameworks. • Local Root Cause Analysis completed with the given timescales. • All Deaths in Custody are heard before a Coroner, however some do not require the need of a jury. • Partnership working between secondary services – we are there to help and support you.

11. Thank you for listening Questions??? Contact Details: Helen.Parker10@nhs.net