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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

No health without justice, no justice without health

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The reason for targeting health interventions at offenders is that poor health is often interlinked with offending. Offenders are known to suffer disproportionately from multiple and complex health issues which are often exacerbated by the difficulties they experience in accessing health and social care services in the local community.

PHE Health and Justice Team

The Public Health England Health and Justice report for 2014 has just (11 June 2015) been published. It details the work of the PHE Health and Justice Team which is responsible for providing expert public health advice guidance and support tools to NOMS and NHS England to support commissioning for offenders. It doesn’t actually commission or manage any services. The team focuses on people in “Prescribed Places of Detention”; that new piece of jargon can be translated into:

• Prisons (public and privately managed)
• Immigration removal centres
• Children and young people’s secure estate
• Police custody suites
• Liaison and diversion services

The PHE remit also includes those in contact with the CJS in the wider community and therefore addresses much broader issues than custodial settings. The lack of dedicated healthcare for offenders in the community is addressed in a post which will be published next week in which I summarise Professor Charlie Brooker’s latest research.

The reason for targeting health interventions at offenders is that poor health is often interlinked with offending. Offenders are known to suffer disproportionately from multiple and complex health issues which are often exacerbated by the difficulties they experience in accessing health and social care services in the local community.

PHE also makes a very good case that developing and delivering health interventions in prisons not only benefits prisoners but also delivers a “community dividend” in addressing issues in under-served populations by having beneficial impacts on wider health and offending behaviour.

PHE community dividend

Outcomes

PHE works in quite a formal manner to prescribed outcome indicators for the whole population, the Health & Justice team highlight 14 of these indicators as being particularly relevant to offenders:

  1. self-harm
  2. smoking prevalence – adults
  3. successful completion of drug treatment
  4. people entering prison with substance dependence issues who are not previously known to community treatment
  5. alcohol related admissions to hospital
  6. self-reported wellbeing
  7. people presenting with HIV at a late stage of infection
  8. treatment completion for Tuberculosis
  9. mortality rate from causes considered preventable
  10. under 75 mortality rate from liver disease
  11. under 75 mortality rate from respiratory diseases
  12. mortality rate from infectious and parasitic diseases
  13. excess under 75 mortality rate in adults with serious mental illness
  14. suicide rate

PHE develops policies to ensure that offenders receive appropriate services to achieve these outcomes, such as the recent paper on reducing smoking in prisons.

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Monitoring performance

One piece of work which the Health and Justice team highlight in this report is the recent overhaul of the performance indicators used to measure the effectiveness of different health services in prison. Until March 2014, performance was measured by Prison Health Performance Quality Indicators (PHPQIs). PHE were not satisfied with these indicators as they were not sufficiently focused on outcomes, being qualitative measures that largely relied on self-assessment by providers themselves stop

So PHE introduced a new set of indicators known as “Health and Justice Indicators of Performance” (HJIPs). It’s hard to know how effective these new indicators are since PHE have so far not made performance data publicly available.

Many established providers of general healthcare and substance misuse mental health services in prison have expressed a degree of disgruntlement at not being consulted about the development of the new indicators. I know several who do not feel that the indicators are any more outcome focused than their predecessors.

PHE has been working in partnership with NOMS, NHS England and prisons to test a new brief interventions approach to working with alcohol misusing offenders in prisons and follow up in the community with offenders to try to take advantage of the new “through the gate” provisions of Transforming Rehabilitation.

PHE’s slogan is:

[alert-announce]No health without justice, no justice without health[/alert-announce]

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Conclusion

Although it is positive to see PHE’s commitment to publish an annual report on offender health and to list the various initiatives that it is involved in, it is to be hoped that next year’s report details progress against the HJIPs.

 

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