1. Fiona Grossick
National Clinical Quality Assurance Lead, Health & Justice
NHS England
Change for JW to come first

2. Our vision
To ensure that everyone in the justice system receives high quality, cost effective health care that improves outcomes and reduces inequalities
Health & Justice Commissioning, NHS England

3. What we currently commission
Budget of £533m for 2016/17 covering a population which has a changing turnover
Prisons
116 in England
Population of 85,000
Immigration Removal Centres
11 in England
Population of 3,600
Police custody, courts and Liaison & Diversion
40 police forces
1.4m go through custody suites each year
Children and young people secure estate
14 Secure Children Homes (welfare and youth justice)
3 Secure Training Centres
4 Under 18 Young Offender Institutions
Population 1,100 -1,200 occupancy beds
Public health in secure and detained settings
Public health of all prisons, children & young people secure estate and Immigration Removal Centres
Includes substance misuse
Sexual Assault Referral Centres (children and young people/adults)
43 SARCs in England
Services are commissioned from a mixed market of providers including NHS Trusts but also a large percentage of independent and private sector organisations.

4. We are responsible for commissioning care for individuals at a particular point in their life which is solely defined by the setting they are in, not by their need or the nature of the service.

5. National Quality Assurance Lead
Reducing Deaths in Custody – response to the Harris Review, Assessment Care in Custody and Teamwork Review (ACCT), learning lessons from deaths in custody, clinical reviews and implementing change
To improve standardisation of quality assurance for health care services commissioned across the secure and detained estate.

6. Health and Justice Partnership Forum – non decision making
Governance Structure
Internal to NHS England
External to NHS England
Commissioning Committee
Health & Justice Partnership Board
Health and Justice Clinical Reference
Group
Health and Justice Oversight Group
Health and Justice Partnership Forum – non decision making
Health and Justice Regional Portfolio Leads
Health and Justice CRG Expert Panels
NHS England Internal Assurance
Health and Justice Information Management Programme Board
North Regional Team meeting
Health and Justice CRG Task and Finish Groups
Partnership Assurance
Midlands Regional Team meeting
Police Healthcare Partnership Assurance Group
Ministerial Deaths in Custody Board
NHS England Immigration Removal Centres Assurance Group
South/London Regional Team meeting
Prisons Health Care Board (England).
NHS England Temporary Estate Assurance Group
Immigration Removal Centres Partnership Assurance Group
Contracted Prisons Healthcare Commissioning Group
Child and Young People Health and Justice Co-Commissioning Assurance Group
PHS7A
Public Health in Secure and Detained Settings Assurance Group (PHS7A)
Sexual Assault Services Assurance Group
(PHS7A)
Liaison and Diversion Board (inc Street Triage)

7. The Role of the Clinical Reference Group for Health and Justice
The CRG works in partnership with providers, medical bodies, partners, key stakeholders, patients, families and communities
Recently streamlined to comprise:
CRG strategic steering group; meets bi-monthly , formal agenda
Bi annual whole day workshop to enable ‘deep dives into strategic work plan areas and undertake Thematic Reviews

8. Health & Justice Update
RESUS Guidelines publication
NICE draft guidelines on physical health of adults in contact with Criminal Justice System
Smoke Free Prisons roll out of smoke free prison programme
DH Guidelines for the management of substance misuse
Health and Justice Information Systems (HJIS 2) clinical input into development of templates

9. Health & Justice key priority 16/17
Supporting Reduction in avoidable Deaths in Custody – Response to Harris Review , ACCT Review, suicide prevention in prisons
Quality and Safety How we can manage through our partnerships

10. Deaths in Custody
Change for JW to come first

11. Deaths per 1,000 prisoners by apparent cause, 12 months ending December 2000 to 12 months ending June 2016, England and Wales
In the 12 months to June 2016 there were 321 deaths in prison custody, an increase of 74 (30%) compared to the previous year. This is a rate of 3.8 deaths per 1,000 prisoners, up from 2.9 per 1,000 in the previous year. This is both the highest number of deaths in the time series, and the highest rate also, see figure 1 above. Longer term trends and greater detail are presented in the annual deaths tables .
There were 186 deaths due to natural causes in the 12 months to June 2016, up from 148 in the previous year (26%). This is the highest in the time series. Natural cause deaths were at a rate of 2.3 per 1,000 prisoners, up from 1.7 per 1,000 in the previous year. This increase in natural cause deaths is the primary contributor to the rise in deaths overall.
In the 12 months ending June 2016 there were 105 apparent self-inflicted deaths, up from 82 in the previous 12 months (28%). This is the highest number of self-inflicted deaths in the time series. On a rate basis this is 1.2 per 1,000 prisoners, up from 1.0 per 1,000 in the previous year. There were 11 female self-inflicted deaths in the 12 months to June 2016, compared to 1 in the previous year. Over 10% of self-inflicted deaths in the most recent period were female, although females account for less than 5% of the prison population .
There were 5 apparent homicides in the 12 months to June 2016, down from 7 in the previous year. Homicides in prison custody remain relatively rare, accounting for less than 2% of all deaths in the most recent period and 1% of deaths over the last ten years.
In the 12 months to June 2016, 25 ‘other’ deaths occurred, 19 of which are ‘awaiting further information’ prior to being classified. This number is not directly comparable with earlier years, as all-but one of the deaths in the prior period have now been classified. Many of the deaths in this category are likely to be reclassified following inquest.

12. Death in Custody Working Group
Purpose:
to ensure that the learnings from deaths in custody across the secure and detained estate are identified
support continuous service improvements and health outcomes for services users adopting evidence based approach.
Support NHS England’s Health and Justice priority to support the reduction in avoidable deaths in custody.

13. Health & Justice – Deaths in custody
Harris Review
Suicide and Self-Harm Project
Research:
Clinical Review reports analysis
DH Policy Research Funds

14. Work to date – 16/17 Clinical Review Training
Harris Review recommendations
Resus Guidelines
Thematic review of Self-Inflicted deaths

15. Thematic Review into Self-inflicted deaths
Reviewed:
PPO reports
PPO lessons learnt bulletins
Clinical Review reports
HMIP reports
National reports:
Independent Advisory Panel
Harris Review
academic literature

16. Thematic Review into Self-inflicted deaths
Key areas:
Measuring suicide and self-harm
Risk stratification tool
Alerts
Workforce
Induction
training
Medication
Medicines Optimisation Programme
Continuity of medication on reception into prison

17. Thematic Review into Self-inflicted deaths
Mental Health
Links with ACCT review
NICE Guidance
Information sharing and consent
Handover
Best practice Guidance
Learning
Coroner’s summary report

18. Current work
Thematic review of pre-morbidity Prevention through early detection and case finding End of Life Care Review of Macmillan Adopted Prison Standards Community of Practice

19. Questions?