Unequal lives unjust deaths

Vulnerable Adults: Tackling Health Inequalities

Thursday 21 August

John PorterNational Lead Nurse for Prisoner Healthcare

Working within HIS - responsibility to NHS Director, Health and Justice

Provide support and guidance to NHS Leads responsible for Prisoner Healthcare through the National Prisoner Healthcare Network

OverviewNational Prisoner Healthcare NetworkHealth Profile of Prisoner2013 Prisoner Survey ResultsImprisonment RatesAlternatives to prisonOpportunities and challengesGoing Forward

National Prisoner Healthcare NetworkResponsibility for primary healthcare in prison transferred

from SPS to NHS Boards in November 2011.

NPHN set up in November 2011 to coincide with formal transfer

Membership included healthcare leads from each of the NHS Boards with representatives from SPS and other agencies including the third sector.

Purpose. Initially to assist the transition of prisoner healthcare from SPS to NHS by providing a strategic and national coordinating role to support the delivery of a high quality, safe, effective and consistent services to prisoners

National Prisoner Healthcare Network NPHN Workplan. Identified a number of key priority workstreams

including:

Mental Health Substance Misuse Information Governance Expert Advisory Group for Medicines Throughcare

2 year review

Appointment of New NHS Director, Health and Justice.

Senior appointment to improve health outcomes of offenders with commitment

to supporting the Scottish Government Health Inequalities agenda.

Scottish Inequalities AgendaThe reality in Scotland is that there is a significant

proportion of the population with poor health.

Despite improvements we remain the “Poor man of Europe” particularly in respect of those from deprived areas

A NES publication “Bridging the Gap” quotes;“In Scotland men in the 10% of 'least deprived areas'

can expect on average to reach an age of 81.1 years, while men in the 10% most deprived areas who could expect to live on average 67.7 years, a gap of more than 13 years.”

Health Profile of PrisonerPrisoners are likely to come from a

particularly vulnerable group in society and face a wide range of health issues that are often associated with their offending behaviour.

A strong indication of their life and health circumstances can be drawn from the prisoner survey the most recent being 2013

Prevalence on admission to Prison Prevalence in the Community

Alcohol problems 73% 12%Illegal Drug Use 56% 1.6% Smoking Rates 76% 24%Hepatitis C 20% 1% Asthma 12% 5.4% Epilepsy 2.1% 0.7% Chlamydia 12% 0.8% Severe dental decay 29% male/

42% female 10% male/3% female

Schizophrenia 9% male/36% female

0.5%

Depression 25% 5% approx Personality disorders 66% approx 5% approx

Health prevalence comparator

Prisoner healthcare in context (drawn from 2013 Prisoner Survey)The survey is conducted very two years and is sent to all

those in prison across Scotland. The questions asked most pertinent to the health and lifestyle of prisoners has been analysed and a short precis of the key themes shown;60 % of prisoners in all Scottish prisons completed the

survey

Information was sought in relation to alcohol consumption, substance misuse, mental well being and attitudes to support to address their offending behaviour.

The highest responses were from HMP Barlinnie and HMP Inverness however the lowest was from HMYOI Polmont and the Open Estate – perhaps suggesting that they are most difficult to engage with

Prisoner Survey statisticsImpact of alcohol on offending behaviour

Drunk at the time of committing offence 45% of all prisoners 50% of female prisoners 68% of young offenders

The more often an offender has been re-imprisoned the greater the association with alcohol

Prisoner Survey statisticsImpact of being in “Care” as a child

30% of all female prisoners were in care as children

30% of young offenders were in care as a child

Almost 2/3 of those who had been in care had witnessed violence as a child from a parent or a carer

Prisoner Survey statistics

Health profile of older prisoners

Over 1/3 said they had a disabilityNearly ½ said they had a long term illnessNearly 2/3 said they were smokers

Prisoner Survey statisticsLooking at the custodial history

Analysis of the results showed that there was a correlation between the chaotic lifestyles of the prisoners, their alcohol and substance abuse and their offending behaviour

Substances misuse increased the more often they were in prison however 2/3 said they would respond to assistance if it was offered

Prisoner Survey StatisticsYoung Offenders - top priority for SPSMost hopeful resultsImportant to engage with this group and help

them reach their aspirations not to reoffend

90% said they thought they would have a job, a partner and a house 2 years after release

60% said they would be free from offending 2 years after release

Prisoner Survey statistics

Helping them to meet their desire to break their offending behaviour need to be aware that;

1/5 had difficulty reading and writing½ were under the influence of alcohol or drugs at

the time of their offence 1/3 were in care as children

They expressed a desire to learn through sports, practical workshops and the internet

Imprisonment RateScotland has one of the highest imprisonment rates in Western Europe. Overcrowding, prisoner movement, the prison regime, the relatively short time that someone spends in prison, remain very challenging issues. This creates huge challenges in relation to the detection and assessment of health problems and needs, and the delivery of integrated care, both within prison and in the transition between prison and the community.

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Incarceration rate per 100,000 population

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Imprisonment rate comparator

Prisons - modelIt could be argued that Prisons should be used for

minority of cases for public safetyConsiderable financial resources spent sending

people to prison - no evidence on reducing offendingPotentially by shifting resources upstream and

making investment more productive – to concentrate on preventative / community development / early years

I look forward to further discussion on this throughout the day

OpportunitiesHealthcare provided in prisons can be the

first opportunity to receive access to health care services

The transfer of prisoner healthcare to NHS Boards places greater obligation on them to provide equivalent healthcare.

Greater degree of collaborative working and greater understanding between those responsible for justice and those responsible for health

OpportunitiesScottish Government commitment to the

Reducing Reoffending Change Fund and the maintenance of Public Social Partnerships

NHS Chief Executives commitment to the continuation of the National Prisoner Healthcare Network

Scottish Government creation of a Director, Health and Justice – now chair of the National Prisoner Healthcare Network

OpportunitiesShared governance and between NHS Boards

and SPS Strong collaboration between the network’s

responsible for prisoner healthcare, forensic and police custody

ChallengesEngagement to ensure multiple agencies

work together and in unison without duplication of effort.

Multiple Health Boards with different approaches

Need to ensure throughcare arrangements are well articulated and that prisoners are able to access vital healthcare services after release.

ChallengesCreating and sustaining systems and processes

across multiple agencies that enable the best possible healthcare to those in and leaving prison

Creating opportunities for those in the poorest of circumstances through education, employment and appropriate housing

Working towards breaking the cycle of offending behaviour with particular focus on “the early years”

Going forwardLook forward to discussing how we

collectively address the challenges and capitalise on the opportunities?