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Health Needs Assessment in Prisons: The Professional View and the Client View. Helen Thornton-Jones (h.thornton-jones@hull.ac.uk). Background. Historical weaknesses in prison healthcare Transfer of Prison healthcare to the NHS

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health needs assessment in prisons the professional view and the client view
Health Needs Assessment in Prisons: The Professional View and the Client View

Helen Thornton-Jones

(h.thornton-jones@hull.ac.uk)

Department of Public Health

and Primary Care

background
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
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
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
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

Priority Areas

Department of Public Health

and Primary Care

evidence of need
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
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

Pro-active identification of need

Review against authoritative guidance

Potential evidence sources include:

Aspect B: Prisoner perspective Direct e.g survey, focus group Indirect e.g BoV, chaplains, ex-prisoners, support groups

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

Aspect C: Local priorities e.g. review of previous needs assessments & plans etc or prison standards audit data

Aspect A: Professional perspective e.g. stakeholders survey, staff survey, current provision

Aspect D: Externalities e.g changes within prison system, rising prison population etc.

Aspect E: National priorities and imperatives

Published Guidance

based on above

SMALL-SCALE NEEDS ASSESSMENT AND PLANNING

Informs

planning

Department of Public Health

and Primary Care

defining the planning partnership
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
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
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
EXAMPLE – DATA COLLECTION

Department of Public Health

and Primary Care

published methodology
Published Methodology

Thornton-Jones H, Hampshaw S and England P

“Health needs assessment in prisons”

British Journal of Healthcare Management

2005 11 (4) 105-110

Department of Public Health

and Primary Care

round 2 2005
Round 2 - 2005
  • 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
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
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
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
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 view20
Health Needs Assessment in Prisons: The Professional View and the Client View

Helen Thornton-Jones

(h.thornton-jones@hull.ac.uk)

Department of Public Health

and Primary Care