Ford Health Development Event 24 September 03
Monday, September 22, 2003
P R O G R A M M E
HEALTH DEVELOPMENT DAY TO BE HELD AT HM PRISON FORD ON WEDNESDAY 24 SEPTEMBER 2003
1000 – 1600 HOURS
P R O G R A M M E
Venue: Chapel, HMP Ford
Facilitator: Mark Davison, Centre for Public Innovation
0930 – 1000 Registration and Coffee
1000 Opening Remarks and outline for the day – Paul Laxton and
Mark Davison
1015 Keynote Address – Richard Bradshaw
1045 A Quick Overview – Imogen Stephens/Stuart Paynter
v Health at Ford Prison
v Health Needs
v Priorities for change
- Primary Care
- Substance Misuse
- Mental Health
1115 Preparation for Open Space – Mark Davison
1200 Open Session 1
1300 Lunch
1400 Open Space 2
1500 Open Space 3
1545 Closing Remarks – Mark Davison and Paul Laxton
Background Reading
Briefing Paper on Prison Health in the South East
Prison Health Newsletter and Appendix, Issue 11 – Spring 2003
Transfer of Prison Health to the NHS – Update
Prison Health – Transfer of Budget Q&A
HMP Ford – HIMP Data
A QUICK OVERVIEW - HEALTH CARE AT HMP FORD
September 2003 - Dr Stuart Paynter (Specialist Registrar in Public Health)
Health needs - Priorities for Change
Primary Care
Existing problems
GPs see a high volume of patients, many for minor problems. This reduces the time they have available to diagnose, assess and treat more serious problems.
Induction screening is inadequate at present.
Exit planning is also inadequate at present (other than for inmates being seen by the CARAT team for drug misuse).
Minimal administrative input exists.
Possible solutions (for discussion)
To reduce the number of inmates seen by GPs (stepwise interventions)
Prison staff to deal with non-medical problems (e.g. new shoes)
more serious
Inmate self care:
· Inmate access to NHS direct
· Inmate “self-certification” if they are too ill to work
· Availability of over the counter medications
more serious
Nursing triage/treatment
more serious
Appointments system to see the GP
Induction/reception screening
There is a new screening tool pilot for initial reception screening (see Prison Health Newsletter issue 12). Training for this has started in a few prisons, but would probably not be available to all prisons for a while.
Need to be able to get full results of previous screening in other prisons.
How often would this level of screening need to be used during custody? It may need to be repeated in Ford for inmates having longer sentences.
Screening should be nurse led.
Exit (release) planning
Administrative support is likely to be needed for exit planning to work properly.
Primary Care Contract
A proposed service specification has been prepared reflecting the health care needs of the prison population
Mental health
Existing mental health services
GP only
Mental Health needs
Epidemiology
The health needs assessment done in 2000/2001 for Ford estimated the following prevalence of mental health problems. These were estimated from prescribing data, so are likely to underestimate total need, particularly for neurotic disorders. (This is supported by the fact that the prevalence of neurotic disorders in men in the general community is approximately 15%).
Functional psychoses 3%
Neurotic disorders (depression/anxiety) 12%
The 1997 ONS report “Psychiatric morbidity among prisoners in England and Wales” found the prevalence of mental health problems in sentenced prisoners (from Category B and C prisons) to be:
Personality disorder 64%
Functional psychoses 7%
Neurotic disorders 40%
The true prevalence at Ford probably lies somewhere between the estimates from these two methods.
The risk of self-harm was estimated to be between 0.7% and 1.7% per year from prison service data
The risk of suicide was estimated to be between 0.015% and 0.06% per year from prison service data
In contrast the ONS survey (using lay interviews) found in male sentenced prisoners that 20% have had suicidal thoughts in the last year, 7% have attempted suicide in the last year, and 7% have self harmed during their current prison term.
Further mental health needs assessment data is being collected by the prison health service, on both prevalence of disease, and appropriate mental health services needed.
Possible solutions
Added mental health services
There is enough evidence at present to justify at least 1 full time equivalent mental health worker. The current mental health needs assessment should give information on what proportions of this full time equivalent should be CPN or psychologist, for assessment of inmates, planning and developing care plans, implementing interventions, CPA liaison, liaison with primary care and secondary services.
Mental health promotion needs to be provided for the inmates, in terms of recognition of problems and stigma, and the fact that most problems can be treated in an open prison context. The CPN could provide this.
Training for prison staff on recognition of mental health problems can also be provided by the CPN.
Substance Misuse
The services for drug misuse provided by the CARAT team are adequate for the population. There are no specific services for alcohol abuse however.
The prevalence of alcohol problems is considered by prison staff to be high in Ford. The ONS survey estimated that 63% of sentenced prisoners had an Alcohol Use Disorders Identification Test (AUDIT) score of 8 or greater (indicative of hazardous drinking) in the year before imprisonment.
The 2000/2001 health needs assessment recommended a half time equivalent CPN to provide services for alcohol abuse.
Awareness of drug and alcohol abuse services should also be raised through the prison.
Training of inmates for peer support is an additional option.
Infection control, sexual health and blood borne viruses
The prison health centre performed poorly in the last infection control audit. Some of the recommendations of this audit have been addressed, but many are still outstanding. A repeat of the audit is planned for the near future to assess progress, and to prioritise changes needed.
Interventions for sexual health and blood borne viruses need improvement, and referral pathways need clarification. Home Office funding for the Hepatitis B immunisation programme has been withdrawn recently.
Others
The above are four of the highest priority issues currently identified at Ford. Other priority issues for discussion at the open space event are:
· Clinical Governance
· Pharmacy services
· Workforce Development
· IT capacity
· Dental services
· Health Promotion
· Occupational Health
Corporate needs assessments
Prison standards audit:
Deficient areas were:
Clinical supervision of healthcare workers
Infection control/communicable disease control
Pharmacy services
Health promotion
Key workers for at risk inmates with mental health problems
Inmate questionnaire 2000:
16% response rate – not representative of whole prison population
Main results:
Depression and anxiety are the most commonly reported health problems.
Consultation time with GP is thought to be too short.
There is interest in the provision of more health promotion.
Dental services are thought to be satisfactory.
Stakeholder conference 2000:
Main results:
There is a need to implement health care standards, and audit these. There was a lack of adequate clinical supervision. There is a lack of proper clinical governance. Information systems are needed to monitor quality.
There is a substantial level of unmet mental health need, due to undiagnosed disease and lack of adequate funding for provision of adequate services.
A nurse led service is needed, either through triage or nurse practitioner. An appointment system for the GP needs to be introduced.
The system for dealing with medical problems out of hours needs to be improved.
There is a lack of services for inmates with alcohol problems. Prison staff should have training about substance misuse and who to refer inmates with substance misuse problems to.
The reception process is too brief at present. More information on available services, such as CARAT should be discussed at reception.
An independent inmate drug listening service should be set up.
There is no inmate heath care user group.
The high number of sports injuries could be addressed by physiotherapy services.
There are a number of areas where healthy lifestyles can be promoted.
Inmate focus group sessions 2000 – 2001:
Main results:
There is only limited time to see the GP.
There are inadequate out-of-hours health services. It was thought that access to NHS direct would be helpful.
Mental heath needs are poorly catered for. Many inmates with mental health problems did not present themselves to health services.
Support in preparation for release was inadequate.
Substance misuse is a big problem. Many inmates are afraid to admit to problems and seek help, as they feared being sent back to closed conditions.
Drug testing was felt to lead to inmates converting to drugs that are harder to detect. Some inmates appeared to have developed drug habits since in prison.
Inmates should be able to self-certify if they need a day or two off work due to illness.
Reception screening was thought to be inadequate.
Access to over the counter medication would be useful.
Dental waiting times were too long (4-5 weeks when focus groups were running).
Health promotion (such as Well Man clinics) would be useful.
There were problems with the food supplied, both in terms of nutrients (e.g. poor fruit intake) and food safety.
Cleanliness of the health care centre was poor.
Open Space Discussion Areas
The Open Space section of the day gives participants the space to set their own agendas for discussion to ensure that you get to talk about the things that matter to you (and – if applicable – the services you are involved in).
The focus of the day is HEALTH DEVELOPMENT AT HMP FORD.
Below you’ll find 6 suggested priority areas to help guide your discussions through the day.
The first four areas look at where we are now; what works and what doesn’t and what we need to develop to improve healthcare at HMP Ford.
The second two areas are about instigating change and the developing the future of healthcare.
Before you join us on 24th September please think about:
· What is your assessment of healthcare HMP Ford
· What are your key questions
· How can you contribute towards understanding where we are now – and what might be some of the solutions to developing improvements
· What effective practice / answers can you bring to share with others
It would be very useful if you can bring along any information on effective practice elsewhere that might contribute to the discussions we will have.
Suggested Priority Areas
1 Healthcare at Ford
What do staff, prisoners and partner agencies think about the current provision?
What works and what doesn’t?
Are there changes to the current way of doing things that will improve services?
Are their issues with prescription drugs?
2 Health Needs
What are the health needs of prisoners?
How do we find out what the needs are?
What about health promotion?
3 Networks and Access
What can we do to improve access to healthcare? Issues:
· Assessment
· Equality of access
· Availability
· Knowledge
· Self-awareness
And who needs to be involved? – internally and externally
What health data /information is currently available to access and what information do we need to have?
4 Clinical Governance and Workforce Development
What are our systems of accountability?
Who makes sure we have good practice?
What are the staff training and development issues? – internally and externally
5 Priorities for Change
What are the issues and actions needed around these key priority areas –
· Primary care i.e.
nurse led service (triage/nurse practitioner)
induction screening
out of hours cover/services
release/discharge planning, prescribing
· Substance misuse
· Mental health
· Sexual health and HIV
What should our other priorities be?
6 Action and Resource Planning
What will our healthcare service look like in five years time – and how are we going to get their?
What actions are needed to drive forward healthcare in Ford?
Who are the key people to involve and persuade?
Who should be the lead people at Ford and across agencies to support the health team?
How do we resource the future? – staff, equipment, capacity, funding, knowledge base
Briefing Paper on Prison Health in the South East
Introduction
This brief is written for DPHs in the South East to serve two functions:
· To provide information about prison health and the changes planned for prison health and healthcare;
· To raise awareness of actions required to support the transfer of commissioning responsibility for prison healthcare to PCTs;
All PCTs can expect to be affected by the changes outlined below. If your PCT does not have a prison it is guaranteed that some of your population will be in prison at one time or another and that many family members are affected by imprisonment.
Context for the Changes
In 1996 Her Majesty’s Chief Inspector of Prisons (HMCIP), Sir David Ramsbottom, published a report “Patient or Prisoner”. In this he indicated that “All prisoners requiring health care must be seen as patients and given the same care as provided in the community.” He also made it clear that health care provided by the Prison Medical Service does not match that provided by the NHS.
This report became the starting point for the current prison health reform and initiated a Joint Health/Prison Service Working Party in 1997 to review HMCIP recommendations. The working party reported in March 1999 and found that:
•“Health care in prisons is characterised by considerable variation
in organisation, quality, funding, effectiveness and links with the
NHS.”
•“A Prison Service/NHS PARTNERSHIP AT ALL LEVELS is the
most practicable way of delivering equivalence of healthcare
to prisoners.”
In 1999 “The Future Organisation of Prison Healthcare” was published which outlined the way forward for the changes required. The infrastructure underpinning this change established a National Prison Health Task Force reporting to the Permanent Secretary at the DoH and a Prison Health Policy Unit reporting to the Director General of the Prison Service. The former was expected to be time-limited and drive the change programme while the Policy Unit was seen as a permanent fixture developing policy .
Both the Task Force and Policy unit developed a work programme encompassing three themes:
1. Developing Clinical Services:
· Primary care development;
· Mental health;
· Promoting health;
· Dental services and pharmacy services;
· Reception screening;
· Health Care Standards;
· Harm minimisation & substance misuse.
2. Developing the Workforce:
· Nursing report;
· Medical staffing;
· Scoping work for a workforce strategy.
3. Developing Performance Management:
· Clinical governance;
· Performance monitoring;
· Health information systems and policy.
The work programme also spawned a Prison Health Task Force in each Region to implement the policy change. Their role involved:
§ Co-ordinating and developing partnerships;
§ Performance monitoring the delivery of Health Needs Assessments & HImPs;
§ Fostering local professional links;
§ Supporting the development of NHS approaches;
§ Overseeing local input to the national pilot/policy work;
§ Developing links for operational support;
§ Reviewing service provision with a view to reconfiguration.
Implementing the Change Agenda
In the South East the work of the Prison Health Task Force – see Appendix 1 for membership - has focused on supporting the change agenda by facilitating the engagement of PCTs with prisons and fostering a strong local partnership. The rationale being that where engagement and a working, sustainable partnership is evident change to healthcare is possible.
This partnership work is ideally reflected in the Health Needs Assessments and Health Improvement Plans which are in their second iteration in 2002/03. At this point in time PCTs should be linking prisons into mainstream developments like the NSFs and other initiatives rolled out in the community. The less isolated the prison health economy is from the local community the less the possibility for duplication of effort.
Although the prisons are a discrete and isolated population with significant health needs, there is potential for health gain. Their populations can also contribute to local targets like smoking cessation and cervical screening.
Significant workforce challenges face most prisons in the South East not least the continuing problems associated with recruiting and retaining medical and nursing staff. In fact the prisons and NHS are fishing in the same pond for these staff but they fare less well given their poor professional image, the rural siting of many establishments and inevitably, the negative images of the clientele served.
Addressing workforce matters requires creativity and breaking new ground particularly in obtaining the services of GPs. For instance, the use of salaried doctors and joint appointments are being developed in some PCTs.
The Role of the PCT
The most relevant document that outlines the role of the PCT in relation to the change agenda is the “Guidance on Developing Prison Health Needs Assessment and Health improvement Plans” Jan 2002 which appears on the following web site: http://www.doh.gov.uk/prisonhealth/publications.htm. This provides the guidance on establishing the Prison Health Steering Group to take forward the partnership work.
Transfer of Prison Health Commissioning to PCTs
On September 5th 2002 it was announced that prison health would in future be commissioned by the PCTs. This prompted a “scoping exercise” by the Prison Service to identify the budgets associated with healthcare provision in all the prison establishments that might be handed over. This has meant teasing out what constitutes “healthcare”, i.e. within scope. For example, escorting prisoners to hospital or providing bed watches while in-patients tend to fall into a grey area that are both healthcare and security related. The extent to which substance misuse services are considered “healthcare” is yet to be determined, but detoxification will be within scope. It is anticipated that an indicative budget will be available for all PCTs by April 2003.
Healthcare capital schemes will not be within scope, but it should be noted there is a major capital scheme for prison healthcare currently at the development stage on the Isle of Wight. HMP Parkhurst is expected to see a new healthcare centre within the next 2 years. In addition, we anticipate about £1M to be available nationally to bid against for small schemes, e.g. equipment and upgrading of facilities.
Prison Health, the revamped and integrated national Prison Health Policy Unit and Task Force based at Wellington House, have indicated that in the first year of operation (2004/5) prison health budgets will be ring-fenced and monitored centrally. The potential risks associated with this budget transfer have yet to be detailed but it is crucial that PCTs understand what they are taking on and that budgets reflect what has been provided and the arrangements for any changes in the population.
Adjustments to PCT Baselines
The funding of primary care services within the prisons has always been the responsibility of the Prison Service in that local PCTs did not have the budget within their baselines to address this population. To prepare the way for the transfer and to acknowledge the local prison population within PCTs, an exercise has been conducted to readjust PCT budget baselines. This has led to a planned redistribution to PCTs, with inevitable gainers and losers.
From April 2003 PCTs with prisons will have adjusted baselines allocating average per capita costs for their prison populations. This adjustment does not take account of secure mental health services costs, which will continue to be met by the PCT from where the prisoner originates, or PCT of court of appearance for those of no fixed abode. Guidance on this is available from the following DoH website: http://www.doh.gov.uk/pricare/responsiblecommissioner
Equity and Redistribution Issues
There is significant disparity in prison healthcare funding throughout the country. The differences have been variously described but the 8 to 1 disparity in healthcare costs between say, HMP Pentonville in London and HMP Exeter gives some idea of the range. This will be a pace of change issue with large disparities being addressed through differential growth. The anticipated £46M increase in prison health funding over the next 3 years will play a part in this.
The Impact of the Growth of Prisoners
The judiciary’s love affair with custodial sentences has fuelled a growth in the prison population. This pressure is driving a number of capital schemes. In addition to new prisons, like Ashford in North Surrey, many existing establishments are developing extra capacity. The Isle of Wight is expected to take an additional 120 places through a combination of “Ready to Use” prefabricated units and refurbishing wings.
You need to be mindful of this growth when negotiating healthcare budgets for the existing and planned populations of prisoners. Also be aware that the profile of prisoners can have a significant impact on their healthcare needs, For instance, a male prison housing a remand and sentenced population will make more demand on healthcare than a jail for sentenced-only prisoners. Similarly, with the female estate healthcare demands tend to be at their highest, again reflecting what is found in general practice in the community.
Transferring the Commissioning Responsibility to PCTs
The key issue is the role the PCT will play in commissioning health and healthcare for their prisoners. PCTs are also in a position to decide how much of the services going into establishments they wish to provide themselves. There is no preferred model since much will depend on local circumstances and availability of appropriate providers. What is worth noting is that a “mixed economy” of provision is possible. This means that the PCT has a number of options in fulfilling its commissioning responsibility: use existing HM Prison arrangements; all NHS provision; private providers; a combination of providers. The importance of continuity of provision to these vulnerable and marginalized populations suggests a pragmatic and sensitive approach will be required to any change.
An outline of the transfer programme has been made available by John Boyington – see Table 1 below.
April 2003/04 Preparatory/developmental work for 1st wave PCTs through a collaborative
April 2004 Commissioning responsibility devolved to 1st wave PCTs
October 2004 2nd wave PCTs
April 2005 3rd wave PCTs
April 2006 Commissioning responsibility devolved to all PCTs
Table 1: Programme and Chronology for Devolving Commissioning to PCTs
The criteria for inclusion in the 1st wave of PCTs and their prisons to pilot the transfer are outlined in Appendix 2. All those PCTs and prison establishments included in first wave will be expected to be part of a Development Network to share the learning gained piloting the transfer of commissioning.
Early indications are that at least one prison health economy from each DHSC will go through in the first wave. It is also likely that the spread of pilots will represent all areas of the prison estate including juvenile/young offender institutions, the high secure and female prisons. In the South East, strong contenders for the first wave are the Isle of Wight PCT (3 male prisons); Reading PCT (1 male prison including Young Offenders); Brighton & Hove PCT (1 male prison); Medway PCT (1 male Young Offender and I female prison); Swale PCT (3 male prisons) and Milton Keynes PCT (1 high secure male prison with Young Offenders).
All PCTs and their prisons have been invited to make known their intention to be considered for inclusion in the 1st wave to the Regional Task Force. Closing date for registering interest is the 14th March.
The Future of the Regional Prison Health Task Force
The existing Prison Health Task Force needs to review its role and placement in the light of the transfer programme outlined above. Nurturing the partnership between the NHS and the Prison Service as well as performance development has been the responsibility of the Prison Health Task Forces to date. The integration of prison healthcare within PCT health economies brings to the fore the performance management of PCTs. Normalising the arrangements for prison health would indicate a devolvement of the responsibility for much of the work of the Task Forces to Strategic Health Authorities.
A consultation exercise is being undertaken with each of the SHAs and Prison Area Management in the South East to determine the future of the budgets and functions while the development revenue remains . Any devolvement could be managed within 2003/04 whilst supporting and preparing the SHAs to assume responsibility for the Prison Health agenda as the transfer gains momentum.
PCTs without Prisons
Even if you do not have a prison on your patch you still need to ensure that the necessary links are made by your mental health and drug/alcohol treatment providers with prison establishments caring for your population. The Mental Health NSF requires all Local Implementation Teams to address this issue particularly in respect of CPA arrangements. Similarly, DATs should be making arrangements for prisoners with drug problems to access rehabilitation and ongoing support upon their release. This population is also at risk from blood borne disease transmission particularly Hepatitis and HIV.
The South East establishments receive prisoners from all over the South particularly metropolitan London. For instance, HMPs Send, East Sutton Park, Cookham Wood and Downview receive almost exclusively from HMP Holloway. Together with colleagues in the Government Office, the Regional Task Force is attempting to obtain a more sophisticated mapping of this traffic to assist planning investment in provision.
Prison Health and the Role of Public Health
Public Health Departments have played a prominent role in developing the partnership between prisons and the NHS. While this duty of partnership is now enshrined in legislation, it is worth acknowledging the ongoing role that PH has in developing strategies to reduce social exclusion and health inequalities. This builds on the significant role DPHs played in conducting Health Needs Assessments in their local prisons, producing prison HImPs and their associated Action Plans.
While PCTs have developed their role Public Health have worked closely with prisons in balancing the strategic change agenda with the mundane operational pressures associated with prisons. This has included anything from developing policies for health protection to advising on the management of TB to obtaining the services of GPs on a Friday afternoon. It is likely that this range of intervention will continue. In addition, providing effective leadership for change management as healthcare in prisons is modernised will fall in large part to Public Health. This is likely to go beyond the usual expert advice and up-to-date evidence base and encompass integrating the prison with the local health economy including making connections with local networks like Social Services and NGOs.
The Public Health Group in the South East will be available to provide ongoing assistance and support on this broad agenda.
David Sheehan
February 2003
APPENDIX 1.
The Prison Health Team in the South East
David Sheehan Team Leader Tel: 07884 473 363david.sheehan@doh.gsi.gov.uk
Emma Bradley Thames Valley, Hants & IoW Prison Area Health Co-ordinator Tel: 01296 390675Mob: 07968 909471emma.bradley2@hmps.gsi.gov.uk
Yvonne Willmott Kent, Surrey & Sussex Prison Area Health Co-ordinator Tel: 07808 394758yvonne.willmott@hmps.gsi.gov.uk
Dr Joseph Blackburn Primary Care Development Adviser (including clinical governance and supporting medical staff) Tel: 01784 456619joseph.blackburn@lineone.net
Dr Stephen Lawrence Primary Care Development Adviser (including clinical governance and supporting medical staff) Tel: 01634 890712stephenlawrence@supanet.com
Sarah BeechRevolving Doors Non statutory Mental Health Tel: 020 7242 9222sarahb@revolving-doors.co.uk
Dick FrakRethink Non statutory Mental Health Tel: 020 7330 9127dick.frak@rethink.org
Jan Palmer Detoxification Adviser for the female prisons Tel: 020 7607 6747/2352Jan@palmer.fsbusiness.co.uk
Sian West Prison Governor – female prison Tel: 01634 840160sian.west@hmps.gsi.gov.uk
Steve Tyman Health Co-ordinator for Female Prisons Tel: 07703 547992steve.tyman@virgin.net
Steve Appleton Secure Mental Health Commissioning and link to NHS Tel: 0118 9822907steve.appleton@tvha.nhs.uk
Hugo Luck SE Region - National Treatment Agency Manager Tel: 0786 7538097mailto:Hugo.Luck@nta.gsi.gov.uk
Evelyn Ogilvie Nutrition and Dietetics Adviser Tel: 01634 833719evelyn.ogilvie@tgt.sthames.nhs.uk
APPENDIX 2.
Selection Criteria for 1st Wave Transfer
Organisational and managerial capacity: can the PCT and prison(s) concerned cope with the service change work required and participate effectively in the Network process?
Current state of services: is participation in the Network manageable set against the service development task in hand? Are there any serious service problems that could slow or derail progress?
Financial status: are both the PCT and the prison(s) in a reasonable state of financial health and is existing investment on prison health running at a broadly satisfactory level, given the overall resource context?
Senior managerial commitment: is there both a proper understanding of, and a full commitment to, this work at Board / CE level in the PCT and Governing Governor level in the prison(s)?
Track-record of joint working: do the PCT and the prison(s) concerned have a good record or partnership working? Is there evidence of a shared vision of the prison health development agenda? How robust are existing partnership working arrangements and what have they delivered to date?
Clarity of service vision / likely service improvements: is there evidence of a clear vision of the service improvements that PCT commissioning from 2004 will help to deliver, including evidence of a patient-centred ethos and an understanding of links to the wider health agenda?
Geographic and prison type spread: potentially to include local, closed trainer, high secure, open, female and YOI.
Wider system ownership: in particular, do the organisations concerned have the support of the relevant SHA / DHSC (PCTs) and Area Manager (prisons)?
APPENDIX 3.
Headline Statistics
In the South East:
• 29 establishments – including 5 YOIs, 5 female, 1 high
secure and 2 detention/removal centres – see Map;
• Total operational capacity of c12,416 places and growing;
• 4 SHAs and 19 PCTs involved in Prison Health directly;
• In addition, the South East Task Force is responsible for
developing the female estate (19 establishments).
Morbidity (general):
• 60% of prisoners are under 30
• 3% are age 15-17
•13% are age 18-20
• Nearly 95% are male but increasing number of female prisoners – 6% by Feb 2002
• Prisoners – a socially excluded population
• 138 prisons in England and Wales
• Average daily population has risen rapidly to around 73,000
• Nearly 15% are on remand
• 80% are in prison for less than 6 months
• 3,000+ prisoners are released each week
• 150,000 people flow in and out of prison each year
• Up to 1 million people a year are affected if you include families
• 90% have a diagnosable mental health problem, substance misuse
problem or both
• 6:10 used drugs in month prior to custody
• 80% of prisoners smoke
• About 0.3% of male prisoners and 1.2% of females are HIV +ve
• 24% of prisoners have ever injected drugs. Of these 20% are
infected with Hep B and 30% with Hep C
• Around 2% of remand prisoners attempt suicide in any one week
• Long standing physical disability: 33% men & 40% women
• Commonest disorder: musculo-skeletal (men) & respiratory (women)
• Adult male reconviction = 58%
• Youth Offender reconviction = 72%
Useful Websites:
Home Office www.homeoffice.gov.uk
HM Inspectorate of Prisons www.homeoffice.gov.uk/hmipris/hmipris.htm
HM Prison Service http://www.hmprisonservice.gov.uk/
Prison Health Dept www.doh.gov.uk/prisonhealth
Youth Justice Board http://www.youth-justice-board.gov.uk/
Board of Visitors http://www.homeoffice.gov.uk/bov/main.htm
Prisoners http://www.prisonreformtrust.org.uk/links.html
National Treatment Agency www.nta.nhs.uk
Drug Prevention Advisory Service www.dpas.gov.uk
Directions to Ford Prison
HM PRISON FORD – POSSIBLE ROUTES
FROM SOUTHAMPTON AND SOUTH WEST:
M27/A27, signposted Portsmouth, Chichester, Brighton. Upon reaching first roundabout at Arundel, take 4th exit, signposted Ford. The prison is situated approximately 2 miles down here on left hand side of road (parking on the right).
FROM BRIGHTON AND SOUTH EAST:
A27, signposted Chichester, Portsmouth and Southampton. Upon reaching outskirts of Arundel, at second roundabout take first exit, signposted Ford. The prison is situated approximately 2 miles down here on left hand side of road (parking on the right).
FROM LONDON
From the M25 take exit 7/8 (M23) towards Brighton. Follow this all the way until signposted A27 for Worthing, Chichester and Portsmouth. Follow A27 west through Worthing; upon reaching the outskirts of Arundel at the second roundabout take the first exit signposted to Ford. The prison is situated approximately 2 miles down here on the left hand side (parking on the right)
Notes
Meet at 8.30 am in the Chapel
Jo deCourcy offered to help Anne run registration
Bill to invite Prison Service Panel
Thursday, September 11, 2003
To: FordHealthNet + MHNet
Hope to see you at our Open Space event on 24 September
Delegate packs will be sent shortly
Apologies have been received from: David Hagen, Dr Browne, Jill Frayne, Sue Durrant, Alan Rosenbach, William Botley, Philippa Gibson, Claire Holloway, Rosemarie Standen and David Sheehan, Samantha Allen, Sara Weech, Andrew Foulkes
We have 20 places still available so please pass on to colleagues who may be interested if you have time.
Keep in touch
John
01243 770794 or 07899 956254
http://prisonhealth.blogspot.com/
Health Development Event - Ford Prison
24 Sept 03
Programme
Venue: The Chapel, HMP Ford
Facilitator: Mark Davison, Centre for Public Innovation
0930-1000 registration and coffee
1000 Opening Remarks - and outline for the day - Paul Laxton and Mark Davison
1015 Keynote address - Richard Bradshaw, Director of Nursing, Prison Health Service
1045 A Quick Overview - Imogen Stephens, Director of Public Health & Stuart Paynter, Specialist Registrar in Public Health
o Health at Ford Prison
o Health needs
o Priorities for Change
§ Primary Care
§ Substance Misuse
§ Mental health
§ Others
1115 Preparation for Open Space
1200 Open Space session 1
1300 Lunch
1400 Open Space session 2
1500 Open Space session 3
1545 Closing Remarks - Mark Davison & Paul Laxton
Friday, September 05, 2003
To FordHealthNet Event Planning Team
Next meeting: Wednesday 10 Sept at 10am in the Governors Office @ HMP Ford
The FordHealthNet meeting will follow at 11am
AGENDA
Apologies
1 Dates
2 Invitation List
3 Chair, Speaker, Facilitator
4 Programme
5 Facilities
AoB
24/09/03 1000 Health Development Day Plan
Topic: 24/09/03 1000 Health Development Day Plan
Subject: 24/09/03 1000 Health Development Day Plan
Planning Group > John Parsons, Paul Woodcock, Bill Smith, Barbara Hayman, Anne Lindgren, Ken Kan, Jo-anne deCourcy Notes from 07/08/03 1000 @ HMP Ford
Present: John Parsons, Stuart Paynter, Mark Davison, Ken Kan, Barbara Hayman, Paul Woodcock, Frances Stewart, Anne Lindgren
Apologies: Jo deCourcy, Bill Smith
Noted that Ken Kan would be leaving for a new job at the end of August. Paul Laxton would act as Governor until a substantive appointment was made.
Future Planning meetings· 10/09/03 1000 at HMP Ford > Apols Paul Woodcock ·
10/09/03 1100 HMP Ford Health Network meeting ·
24/09/03 0930 Development Day
Invitation List > actions for Anne·
60 invitations had been sent out ·
Add Director of Finance, Sussex Downs & Weald PCT ·
Also invite Arun CVS ·
Send copy of list to JAP ·
check mental health invitees with Dominic Ellett
Chair, Guest Speaker and Faciltator·
Ken to talk to Paul Laxton about chairing the event ·
Ken to contact Richard Bardshaw to confirm attendance and requirements ·
Ken to submit bid for funding the event
Programme·
Minor ammendements agreed see http://ford.westsussextoday.co.uk/discuss/msgReader$36?mode=day ·
Delegate pack to include
o Letter
o Programme
o Open Space notes
o Directional map
o Background reading
§ Briefing Paper on Prison Health in the South East
§ Prison Health Newsletter and Appendix, Issue 11 - Spring 2003
§ TRANSFER OF PRISON HEALTH TO THE NHS > Update
§ PRISON HEALTH – TRANSFER OF BUDGET Q&A
§ HMP Ford – HIMP Data > update by Stuart
o Packs to be sent out by anne week commencing 8 Sept > nb Anne in on leave week commencing 15 Sept.
o JAP to email Open Space template to Anne for copying
Facilities·
Venue and catering had been booked ·
11 x flip charts + pens + post it notes > Francis Stewart to organise ·
Overhead projector and screen > Frances? ·
Presentation panel x 6 > Paul Woodcock to organise ·
Laptop with downloaded website > Bill Smith to organise ·
2 extra breakout rooms are available in the drug strategy centre
Health Development Day 24 Sept 03
By John Parsons; 22/04/2003; 13:44:02 [reads: 107]
To: Ford HealthNet
Please note that the Ford Prison Health Development Day is scheduled for Wed 24 Sept 2003 > from 10am to 4pm
Please put the date in your diary now and pass this date on to anyone else who may be interested
Confirmed > Imogen Stephens, John Parsons, Claire Holloway, Andrew Wood, Rosemary Cornish, Adrian Smith, Ken Kan, Keith Bell, Paul Woodcock, Barbara Hayman
Apologies >
Plan
Outline Agenda
Venue: The Chapel, HMP Ford
Facilitator: Mark Davison, Centre for Public Innovation
0930-1000 registration and coffee
1000 Opening Remarks - and outline for the day - Paul Laxton and Mark Davison
1015 Keynote address - Richard Bradshaw
1045 A Quick Overview - Imogen Stephens/Stuart Paynter
o Health at Ford Prison
o Health needs
o Priorities for Change
§ Primary Care
§ Substance Misuse
§ Mental health
§ Sexual Health & HIV
§ Others
o Networks & Access
o Clinical Governance & Workforce Development
o Action & Resource Plan
1115 Preparation for Open Space
1200 Open Space session 1
1300 Lunch
1400 Open Space session 2
1500 Open Space session 3
1545 Closing Remarks - Mark Divison & Paul Laxton
Background Reading
· Briefing Paper on Prison Health in the South East
· Prison Health Newsletter and Appendix, Issue 11 - Spring 2003
· TRANSFER OF PRISON HEALTH TO THE NHS > Update
· PRISON HEALTH – TRANSFER OF BUDGET Q&A
· HMP Ford – HIMP Data
