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Evaluation of Prison Dental Services in England
 

Evaluation of Prison Dental Services in England

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    Evaluation of Prison Dental Services in England Evaluation of Prison Dental Services in England Presentation Transcript

    • Evaluation of the impact of the implementation of a national strategy for improving prison dental services in England Katie Buchanan Prison Dental Research Co-ordinator PHRN / University of Manchester
    • Dental 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 delivery
      • Over £4.75M injected into prison dental services
      • Has strategy additional funding improved prison dental services?
      Evaluation Background
    • The Strategy (April 2003)
      • Highlights 6 key areas
        • Service Specification & Access
        • Contracts & Standards
        • Commissioning
        • Clinical Governance
        • Dental Equipment
        • Workforce
    • Methodology
      • 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
    • Questionnaire
      • 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 - response
      • 109/134 (81%) were returned
      • Item non response was an issue
      • Data unavailable for certain questions
    • Main F indings
    • Service 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 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 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 Questions
      • 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 responses
    • Main 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’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 evaluation
    • Data quality
      • Reported data
      • Post hoc commissioning
      • Data availability
      • Limited resources
    • Key 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
    • Recommendations
      • National minimum data sets are required to support
      • PCTs & 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
    • Summary
      • 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 Buchanan
      • Prison Dental Research Co-ordinator
      • School of Dentistry
      • University of Manchester
      • Higher Cambridge Street
      • Manchester
      • M15 6FH
      • Tel: 01244 364705
      • [email_address]