Health Needs Assessment in Prisons: The Professional View and the Client View

1. Health Needs Assessment in Prisons: The Professional View and the Client View Helen Thornton-Jones (h.thornton-jones@hull.ac.uk) Department of Public Health and Primary Care

2. Background Historical weaknesses in prison healthcare Transfer of Prison healthcare to the NHS Requirement for health improvement plans underpinned by needs assessment Lack of suitable needs assessment tools Department of Public Health and Primary Care

3. Traditional HNA in the NHS is • Geared to large, stable populations of many thousands • Mainly epidemiological • Specialist-led (mainly Public Health Specialists) • Not readily linked to planning Department of Public Health and Primary Care

4. NEEDS ASSESSMENT IS NOT... • Only about health and health care • Only about counting how many people will benefit from a service • Only about collecting data Department of Public Health and Primary Care

5. Particular Prison Issues • Small size and high turnover of population – measures of incidence and prevalence are not very meaningful. • Different categories of prisons – not easy to generalise • Lack of useful, available quantitative data Department of Public Health and Primary Care

6. Department of Health Primary care Substance use Mental health Dental Health promotion Workforce development HMP Hull Substance use Mental Health Communicable Diseases Dental Services Workforce development IM & T Priority Areas Department of Public Health and Primary Care

7. Evidence of need • Expert opinion • Professional judgement • Results of audit • Adherence to authoritative guidance Department of Public Health and Primary Care

8. Develop a new approach to HNA • Recognise lack of data • Recognise lack of research evidence • Recognise alternative measures of “need” • Focus on unmet need • Note authoritative guidance in key priority areas • Use adherence to guidance as a measure of need Department of Public Health and Primary Care

9. Pro-active identification of need Review against authoritative guidance Potential evidence sources include: Aspect B: Prisoner perspective Direct e.g survey, focus group Indirect e.g BoV, chaplains, ex-prisoners, support groups Drivers include: New research evidence e.g.evaluations of interventions in prisons or the community, systematic reviews etc. Best practice examples e.g. published examples of evaluated initiatives within prison setting Aspect C: Local priorities e.g. review of previous needs assessments & plans etc or prison standards audit data Aspect A: Professional perspective e.g. stakeholders survey, staff survey, current provision Aspect D: Externalities e.g changes within prison system, rising prison population etc. Aspect E: National priorities and imperatives Published Guidance based on above SMALL-SCALE NEEDS ASSESSMENT AND PLANNING Informs planning Department of Public Health and Primary Care

10. Defining the Planning Partnership Range of • Organisations (prison, PCTs, acute trust, community trust etc.) • Professionals (custody officers, prison HC staff, doctors, nurses NHS managers etc.) • Specialisms (MH, CDC, HP, HR, IT etc) • Special interest groups (charitable organisations, prisoner representatives, advocates etc) Department of Public Health and Primary Care

11. OUR APPROACH – round 1 (2002) • Need identified by… • Review of last health improvement plan • Assessing current services in priority areas against authoritative best practice guidance • Incorporated material from other sources that might reveal shortfalls in services e.g. prison standards audit • Using a series of group interviews… • Prison health steering group (PHSG) • Input from expert witnesses • ‘Conversation with a purpose’(Burgess, 1984) • Recorded by research team … Department of Public Health and Primary Care

12. Key questions • Does this apply to HMP Hull? • Does HMP Hull comply with it? • If not, is alternative ‘good practice’ in place? (and if so has it been evaluated)? • If not, what would make compliance feasible? • What (if any) action needs to be taken, by whom and by when? Department of Public Health and Primary Care

13. EXAMPLE – DATA COLLECTION Department of Public Health and Primary Care

14. Published Methodology Thornton-Jones H, Hampshaw S and England P “Health needs assessment in prisons” British Journal of Healthcare Management 2005 11 (4) 105-110 Department of Public Health and Primary Care

15. Round 2 - 2005 • Is the method resilient given changes to staffing, establishment, policy etc • How far is it possible to incorporate the client (prisoner) view Department of Public Health and Primary Care

16. Patient Perspective Focus group with 14 serving prisoners i.e. • Prison listeners • Patient forum • Orderlies • ‘frequent users’ Anonymous written comments via Healthcare Department of Public Health and Primary Care

17. Issues in capturing patient view • Representative sample • Ethics • Security • Equipment • Presence of prison officer • Support from prison staff • Respondent Validation • Feedback – what happened as a result Department of Public Health and Primary Care

18. User Issues • Waiting times • Low immunisation rates • Communication • Respect • In-possession medication especially pain relief • Priorities (methadone) Department of Public Health and Primary Care

19. Conclusions • Effective means of needs assessment • Importance of the patient perspective – similarities and differences between patient and staff views • Helped by strong partnerships Department of Public Health and Primary Care

20. Health Needs Assessment in Prisons: The Professional View and the Client View Helen Thornton-Jones (h.thornton-jones@hull.ac.uk) Department of Public Health and Primary Care