Department of Public Health and Primary Care Health Needs Assessment in Prisons: The Professional View and the Client View Helen Thornton-Jones

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 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

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 Informs planning Potential evidence sources include : Pro-active identification of need Aspect A: Professional perspective e.g. stakeholders survey, staff survey, current provision Aspect C: Local priorities e.g. review of previous needs assessments & plans etc or prison standards audit data Aspect B: Prisoner perspective Direct e.g survey, focus group Indirect e.g BoV, chaplains, ex- prisoners, support groups Aspect E: National priorities and imperatives Aspect D: Externalities e.g changes within prison system, rising prison population etc. Review against authoritative guidance 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 Published Guidance based on above

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 ImplicationsHealth improvement plan 2003 and beyond Time-scales National guidance: Changing the Outlook 3.3 pages 15. Effective mental health awareness training 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. The Prison Service offers 6½ days training for all prison officers part of this will be used for mental health awareness training wing staff will have received mental health awareness training. There will be a mental health liaison officer on each wing. 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. By April 2004 By April 2004 By February 2003

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

Department of Public Health and Primary Care Round 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