Evaluation of the impact of the Evaluation of the impact of the implementation of a national implementation of a national strategy for improving prison strategy for improving prison

dental services in Englanddental services in England

Katie BuchananPrison Dental Research Co-ordinator

PHRN / University of Manchester

Dental TeamDental Team

Professor Martin Tickle

Dr Keith Milsom

Miss Katie Buchanan

Dr Liana Zoitopoulos

• Requirement of CDOs office in 2005

• Strategy for Modernising Dental Services for Prisoners in England – April 2003– Standards for service deliveryStandards for service delivery

• Over £4.75M injected into prison dental services

• Has strategy \ additional funding improved prison dental services?

Evaluation BackgroundEvaluation BackgroundEvaluation BackgroundEvaluation Background

The Strategy (April 2003)The Strategy (April 2003)

Highlights 6 key areas

1. Service Specification & Access

2. Contracts & Standards

3. Commissioning

4. Clinical Governance

5. Dental Equipment

6. Workforce

MethodologyMethodology Protocol was peer reviewed & questionnaire was piloted at

HMP Styal & Risley

Postal questionnaire sent to all prisons in England (134) in 2006

3 waves - 5 weeks apart

Completed by Healthcare Manager

Questionnaires were returned to Prison Health, DoH in a pre-paid addressed envelope

QuestionnaireQuestionnaire

Covered 4 of the 6 themes of the strategy

Plus additional questions on morale and quality of service

Asked to report situation in 2003 and in 2006

Open ended questions to obtain additional views on the prison dental services

Results - responseResults - response

109/134 (81%) were returned

Item non response was an issue

Data unavailable for certain questions

Main FMain Findingsindings

Service Specification & AccessService Specification & Access

Increase in the number of prisons that can offer urgent dental care within 24 hours (47% - 70%)

Increase in the number of prisons that can offer routine dental care within 6 weeks (48% - 65%)

Increase in the number of prisons that have an oral health promotion programme in place (10% - 40%)

Increase in the number of prisons with an agreed service specification in place (48% - 78%)

Clinical GovernanceClinical Governance

Dramatic increase in visits from Regional Dental Officer’s & General Dental Practice Advisor’s

Increase in written policies & procedures– e.g. effective complaints procedure

Crucial to audit this service to ensure written policies & procedures are being followed

Dental EquipmentDental Equipment

Considerable capital investment

Over half have had a total surgery refurbishment

Does this allay fears that the money was not going to reach the service?

Workforce & Additional Workforce & Additional QuestionsQuestions

35% of managers reported that the morale of prison dental staff appears to have improved

Subjective assessment of quality - 65% of managers reported that the service has improved

Increase in the number of prisons that have a procedure to ensure dentists are undertaking CPD & have the appropriate qualifications to practice

Qualitative responsesQualitative responses

Main Issues reportedMain Issues reported Main concern – length of the waiting lists

Prisons where escorts are not needed - shorter waiting lists

Number of sessions available is inadequate for this high need population

Under resourced service with no ‘real’ investment

Inefficiencies in the services - wasted dental appointments

Reasons for wasted appt’sReasons for wasted appt’s Appointment slips not being given to prisoners or given too late

Prisoners refusing or failing to attend

Prisoners being discharged – appointment book not being updated

Prison role incorrect

Insufficient staff to man the healthcare department

Prison officers not bringing prisoners to their appointments

Key findings of the evaluationKey findings of the evaluation

Data qualityData quality

Reported data

Post hoc commissioning

Data availability

Limited resources

Key findingsKey findings

Things appear to have improved in all areas– E.g. Dramatic increase in the number of prisons with a

clinical governance programme in place (28% - 84%)

But still room for improvement– E.g. 1/3 still don’t meet the target for access to urgent

& routine dental care

Lack of standardised data to support local commissioning of service by PCTs

RecommendationsRecommendationsNational minimum data sets are required to supportPCTs & prison healthcare services, these include:

Health Needs Assessment – a group of key indicators to assess health care needs of prisoners.

Agreement on key measures to assess service delivery. These must relate to the standards set out in the national strategy (April 2003), which can act as a commissioning framework for prisons strategy.

A standardised dental service inspection proforma for GDPAs to ensure quality standards are being met

SummarySummary

In over 80 % of prisons there seems to have been marked improvement in the service in all areas identified by the national strategy.

Significant challenges for PCTs as commissioners

of these services.

Standardised data sets and information systems are needed to to support strategic development and enable efficient management of prison dental services.

Katie BuchananKatie BuchananKatie BuchananKatie Buchanan

Prison Dental Research Co-ordinatorSchool of Dentistry

University of ManchesterHigher Cambridge Street

ManchesterM15 6FH

Tel: 01244 364705katie.buchanan@manchester.ac.uk