1. Insert name of presentation on Master Slide Health Needs Assessments – Learning from South Wales Prison Health and Equity: Meeting the Public Health Challenge - Tuesday 3rd February 2015 Presenter: Tracey Taylor, Public Health Wales Senior Public Health Practitioner

2. Health Needs Assessments – Learning from South Wales In this session, I will... Provide background to prisons and health needs assessments in Wales Look at some of the approaches to Prison Health Needs Assessments in England and Wales Provide a brief summary of the key findings from Health Needs Assessments undertaken across the Welsh prison estate.

3. THE PRISON SERVICE IN WALES Health Needs Assessments – Learning from South Wales

4. Self-rated health of prisoners compared to general male population Health Needs Assessments – Learning from South Wales

5. Prison health in general Poorer physical, mental and social health compared to general population. Their lifestyles are more likely to put them at risk of ill health Little or no regular contact with health services before entering prison It is estimated that 90% of prisoners have at least one mental health illness, with 70% having two, with suicide and self harm rates higher than that in the community. 80% prisoners smoke

6. Health Needs Assessments – Learning from South Wales Background Health Need Assessments in Wales Health Needs Assessment (HNA) is a systematic method for reviewing the health issues facing a population, leading to agreed priorities and resource allocation that will improve health and reduce inequalities (NICE, 2005).

7. Background Health Need Assessments in Wales AIM OF HNA In general, the aim of a HNA is to: Provide information in order to plan, negotiate and change services for the better and to improve health in other ways. To build a picture of current services – the baseline. To identify unmet health needs among prisoners. Health Needs Assessments – Learning from South Wales

8. A brief history of prison HNA’s in Wales Based on variations of the 2000 Birmingham University’s ‘Toolkit for health needs assessment in prisons’ Focused on individual prisons They used a classic combination of HNA methods involving quantitative and qualitative data –Epidemiological where numerical data such as incidence or prevalence of issues are used to build a ‘snap shot’ picture of prisoner health unique to that prison –Corporate where stakeholders or others with special knowledge (prisoners, health staff, custodial staff) are canvassed on what they think is needed –Comparative where current health status and health care provision is compared with service provision in other matched prisons Health Needs Assessments – Learning from South Wales

9. A brief history of prison HNA’s Prior to 2011, full HNA’s undertaken on a 3 yearly basis. Option appraisal produced on Prison HNA’s Sept 2011 PLA between WG and PHW to deliver a rolling programme of thematic HNA’s across the prison estate, as well as a full prison HNA every five years.

10. Health Needs Assessments – Learning from South Wales A brief history of prison HNA’s (cont.) Thematic HNA’s were as follows Pharmaceutical (pilot)11/12 Mental Health12/13 Dental Health13/14 Substance misuse14/15 Full prison HNA15/16

11. Approaches to Prison HNA Health and Justice Health Needs Assessment Toolkit for prescribed Places of Detention Part 1: Introduction and getting started Engaging stakeholders Setting up working group Governance mechanism for overseeing HNA Who is responsible for developing recommendations Timescales Data sources Health Needs Assessments – Learning from South Wales

12. Approaches to Prison HNA Health and Justice Health Needs Assessment Toolkit for prescribed Places of Detention Part 2: Health ands Justice Needs Assessment Toolkit - provides a description of a standard report for adult prisoners (18+) and includes: Description of population and suggestions of useful data sources Provides information on Health Performance and outcomes Looks at Health met and unmet needs – providing info on data sources and what that data will tell you. Provides background to necessary provision in relation to preventing ill health and promoting well-being and sources of data Needs of Specific populations – generic information and data sources Current health care service provision – suggested table format Case studies for Effective and innovative services Consultation – Who to consult - prisoners/stakeholders/staff Gap analysis and summary findings Conclusion and recommendations Health Needs Assessments – Learning from South Wales

13. Pharmaceutical Health Needs Assessment (Swansea prison only) The aims of the PNA were: To examine the pharmaceutical needs of the prison population To build a picture of current pharmaceutical services, to provide a baseline To assess the extent to which the pharmaceutical needs of prisoners were being addressed To provide information in order to identify any priorities for development and change in order to meet pharmaceutical needs

14. Health Needs Assessments – Learning from South Wales PNA Methodology A variety of methods were used to inform the pharmaceutical needs assessment including: prisoner demographics, main health needs medicines usage data professional perspectives prisoner perspectives response to the latest HM Inspectorate of Prisons report.

15. Health Needs Assessments – Learning from South Wales Pharmaceutical Health Needs Assessment (Swansea prison only)

16. Pharmaceutical Health Needs Assessment Health Needs Assessments – Learning from South Wales

17. Pharmaceutical Health Needs Assessment Health Needs Assessments – Learning from South Wales

18. Results of Pharmaceutical HNA Nearly two-thirds of prisoners (64.8%) reported using drugs in the month prior to imprisonment One in four prisoners (29.3%) had self-harmed during their lifetime Around three out of four prisoners reported smoking (79.5%) Nearly 1 in 2 (42.3%) of prisoners reported that they were taking prescribed medicines at the time of entry into the prison.

19. Health Needs Assessments – Learning from South Wales Age of prisoners in HMP Swansea

20. Health Needs Assessments – Learning from South Wales Drug and alcohol results

21. Recommendations: Pharmacy staffing is at a level to be able to provide an effective responsive pharmaceutical service. Pharmaceutical staff have access to training to support them in carrying out core and enhanced roles within the prison. Implement electronic procurement of medication and stock control, and develop electronic prescribing and transfer of medication information on release. Sufficient access to staff by prisoners Increase number of prisoners who are eligible for in-possession medication Exploration of ways in which night time management of medicine can best be facilitated. Review of verification process for prescribed medicines Ensure that there is protected time available for pharmacist input into producing and updating standard operating procedures and patient group directions. Health Needs Assessments – Learning from South Wales

22. Mental Health Needs Assessment Epidemiological element used both quantitative and qualitative data and included: Prison population Estimated mental health need Time available for assessment and treatment Current staffing and service provision Mental health assessments Mental health referrals Waiting times Plans Adverse events (e.g. sectionings, self-harm incidents, suicides) Protocols and pathways

23. Health Needs Assessments – Learning from South Wales Mental Health Needs Assessment The corporate element consisted of two strands Strand one consisted of two stakeholders workshops; the first to agree the focus and tools for the HNA, and the second to discuss the recommendations and their implementation. The second strand used informal discussions with the prison mental health leads to gain insight into the SystmOne data quality and findings, and also the delivery of mental health care within each establishment.

24. Health Needs Assessments – Learning from South Wales Mental Health Needs Assessment The comparative element compared the needs, staffing and services available at each of the Welsh prisons with each other to identify areas of weakness and strength. looked at data from HMP Liverpool and HMP Nottingham, using these prisons as external comparators (both Cat B, remand and convicted, operational capacities >1,000)

25. Health Needs Assessments – Learning from South Wales Mental Health Needs Assessment

26. Estimated number of prisoners in each of the five Welsh Prisons with selected mental health problems, based in estimated prevalence provided by ONS Health Needs Assessments – Learning from South Wales

27. Mental Health Needs Assessment

28. Health Needs Assessments – Learning from South Wales Mental Health Needs Assessment Recommendations Pathways and Procedures Staffing Treatment Services Training Assessments SystmOne Research

29. Health Needs Assessments – Learning from South Wales Mental Health Needs Assessment Prioritised recommendations Implement NICE Guidelines on the provision of mental healthcare in prisons across welsh prison estate when published. Personality Disorder training identified/delivered to healthcare staff electronic or face to face. Standardised self harm/suicide screening assessment to be adopted. Universal assessment tools to be adopted by all prisons in Wales eg PQH9 Appropriately qualified mental health staff to undertake primary and secondary health screens. Agreement to use specific read codes across Welsh prison estate Adoption of supported living plans for prisoners with Learning disabilities or specific mental health issues

30. Oral Health Prison Needs Assessment. Aim To undertake an assessment of the oral health needs of the prison population in Wales to inform the future planning and development of prison dental services. Objectives The key objectives of the HNA were to:- access information on the oral health status of prisoners review current dental service provision determine the main factors that affected prisoners’ oral health make recommendations to improve prisoners’ oral health and the future delivery of prison dental services Health Needs Assessments – Learning from South Wales

31. Oral Health Prison Needs Assessment Health Needs Assessments – Learning from South Wales

32. Oral Health Prison Needs Assessment Health Needs Assessments – Learning from South Wales

33. Oral Health Prison Needs Assessment Health Needs Assessments – Learning from South Wales

34. Oral Health Prison Needs Assessment Health Needs Assessments – Learning from South Wales

36. Oral Health Needs Assessment Recommendations Formation of steering group to implement recommendations Improving Oral Health The Provision of Dental Services Improving Care Pathways Dental Surgery Estate and Environment Information Technology and Data Health Needs Assessments – Learning from South Wales

37. Summary of Prison HNA’s The key requirements are as follows: The HNA is a process, not a document. The process should be led by each Prison Health Partnership Board / Local Health Board, so that the HNA is linked to operational discussions, including the planning and allocation of resource The HNA needs to be fit for the purpose for which it is intended, namely advising commissioners, in order to improve the health of prisoners. The process needs to be efficient, including defined roles for those involved / common template / use of routine data sources / common reporting of findings. The process should be standardised, where possible including prisoner and staff surveys. Health Needs Assessments – Learning from South Wales

38. Thank you Tracey Taylor tracey.taylor4@wales.nhs.uk Health Needs Assessments – Learning from South Wales