Health Needs Assessment in Prisons The Professional View

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

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

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

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

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

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

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

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

SMALL-SCALE NEEDS ASSESSMENT AND PLANNING Review against authoritative guidance Pro-active identification of need Potential evidence sources include : Drivers include: Aspect A: Professional perspective e. g. stakeholders survey, staff survey, current provision Aspect B: Prisoner perspective Direct e. g survey, focus group Indirect e. g Bo. V, chaplains, exprisoners, support groups Aspect D: Externalities e. g changes within prison system, rising prison population etc. Aspect C: Local priorities e. g. review of previous needs assessments & plans etc or prison standards audit data 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 Published Guidance Aspect E: National priorities and imperatives based on above Informs planning Department of Public Health and Primary Care

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

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

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

EXAMPLE – DATA COLLECTION Authoritative guidance reference Present situation- needs identification process Implications Health improvement plan 2003 and beyond Time-scales National guidance: Changing the Outlook 3. 3 pages 15. Presently there is no systematic mental health awareness training in place for wing officers. However, a member of Healthcare staff is appropriately qualified to deliver a series of 1 -2 hour mental health awareness course to wing based staff. In addition, the HERCH trust is running a 5 -day mental health awareness course that could be accessed by other members of the Healthcare team. Resources implications in terms of releasing both the trainer and wing officers. 18 -20 wing staff will have received mental health awareness training. By April 2004 There will be a mental health liaison officer on each wing. By April 2004 The Prison Service offers 6½ days training for all prison officers part of this will be used for mental health awareness training. In addition, to the above two members of the Healthcare team are scheduled to receive formal training. Specifically, one member of staff will undertake the HERCH trust’s 5 -day mental health awareness course and another a University run ‘mental health in a secure environment’ module. Effective mental health awareness training Department of Public Health and Primary Care By February 2003

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

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

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

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

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

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

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