Evaluation of Prison Dental Services in England


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Evaluation of Prison Dental Services in England

  1. 1. 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
  2. 2. Dental Team <ul><li>Professor Martin Tickle </li></ul><ul><li>Dr Keith Milsom </li></ul><ul><li>Miss Katie Buchanan </li></ul><ul><li>Dr Liana Zoitopoulos </li></ul>
  3. 3. <ul><li>Requirement of CDOs office in 2005 </li></ul><ul><li>Strategy for Modernising Dental Services for Prisoners in England – April 2003 </li></ul><ul><ul><li>Standards for service delivery </li></ul></ul><ul><li>Over £4.75M injected into prison dental services </li></ul><ul><li>Has strategy additional funding improved prison dental services? </li></ul>Evaluation Background
  4. 4. The Strategy (April 2003) <ul><li>Highlights 6 key areas </li></ul><ul><ul><li>Service Specification & Access </li></ul></ul><ul><ul><li>Contracts & Standards </li></ul></ul><ul><ul><li>Commissioning </li></ul></ul><ul><ul><li>Clinical Governance </li></ul></ul><ul><ul><li>Dental Equipment </li></ul></ul><ul><ul><li>Workforce </li></ul></ul>
  5. 5. Methodology <ul><li>Protocol was peer reviewed & questionnaire was piloted at HMP Styal & Risley </li></ul><ul><li>Postal questionnaire sent to all prisons in England (134) in 2006 </li></ul><ul><li>3 waves - 5 weeks apart </li></ul><ul><li>Completed by Healthcare Manager </li></ul><ul><li>Questionnaires were returned to Prison Health, DoH in a pre-paid addressed envelope </li></ul>
  6. 6. Questionnaire <ul><li>Covered 4 of the 6 themes of the strategy </li></ul><ul><li>Plus additional questions on morale and quality of service </li></ul><ul><li>Asked to report situation in 2003 and in 2006 </li></ul><ul><li>Open ended questions to obtain additional views on the prison dental services </li></ul>
  7. 7. Results - response <ul><li>109/134 (81%) were returned </li></ul><ul><li>Item non response was an issue </li></ul><ul><li>Data unavailable for certain questions </li></ul>
  8. 8. Main F indings
  9. 9. Service Specification & Access <ul><li>Increase in the number of prisons that can offer urgent dental care within 24 hours (47% - 70%) </li></ul><ul><li>Increase in the number of prisons that can offer routine dental care within 6 weeks (48% - 65%) </li></ul><ul><li>Increase in the number of prisons that have an oral health promotion programme in place (10% - 40%) </li></ul><ul><li>Increase in the number of prisons with an agreed service specification in place (48% - 78%) </li></ul>
  10. 10. Clinical Governance <ul><li>Dramatic increase in visits from Regional Dental Officer’s & General Dental Practice Advisor’s </li></ul><ul><li>Increase in written policies & procedures </li></ul><ul><ul><li>e.g. effective complaints procedure </li></ul></ul><ul><li>Crucial to audit this service to ensure written policies & procedures are being followed </li></ul>
  11. 11. Dental Equipment <ul><li>Considerable capital investment </li></ul><ul><li>Over half have had a total surgery refurbishment </li></ul><ul><li>Does this allay fears that the money was not going to reach the service? </li></ul>
  12. 12. Workforce & Additional Questions <ul><li>35% of managers reported that the morale of prison dental staff appears to have improved </li></ul><ul><li>Subjective assessment of quality - 65% of managers reported that the service has improved </li></ul><ul><li>Increase in the number of prisons that have a procedure to ensure dentists are undertaking CPD & have the appropriate qualifications to practice </li></ul>
  13. 13. Qualitative responses
  14. 14. Main Issues reported <ul><li>Main concern – length of the waiting lists </li></ul><ul><li>Prisons where escorts are not needed - shorter waiting lists </li></ul><ul><li>Number of sessions available is inadequate for this high need population </li></ul><ul><li>Under resourced service with no ‘real’ investment </li></ul><ul><li>Inefficiencies in the services - wasted dental appointments </li></ul>
  15. 15. Reasons for wasted appt’s <ul><li>Appointment slips not being given to prisoners or given too late </li></ul><ul><li>Prisoners refusing or failing to attend </li></ul><ul><li>Prisoners being discharged – appointment book not being updated </li></ul><ul><li>Prison role incorrect </li></ul><ul><li>Insufficient staff to man the healthcare department </li></ul><ul><li>Prison officers not bringing prisoners to their appointments </li></ul>
  16. 16. Key findings of the evaluation
  17. 17. Data quality <ul><li>Reported data </li></ul><ul><li>Post hoc commissioning </li></ul><ul><li>Data availability </li></ul><ul><li>Limited resources </li></ul>
  18. 18. Key findings <ul><li>Things appear to have improved in all areas </li></ul><ul><ul><li>E.g. Dramatic increase in the number of prisons with a clinical governance programme in place (28% - 84%) </li></ul></ul><ul><li>But still room for improvement </li></ul><ul><ul><li>E.g. 1/3 still don’t meet the target for access to urgent & routine dental care </li></ul></ul><ul><li>Lack of standardised data to support local commissioning of service by PCTs </li></ul>
  19. 19. Recommendations <ul><li>National minimum data sets are required to support </li></ul><ul><li>PCTs & prison healthcare services, these include: </li></ul><ul><li>Health Needs Assessment – a group of key indicators to assess health care needs of prisoners. </li></ul><ul><li>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. </li></ul><ul><li>A standardised dental service inspection proforma for GDPAs to ensure quality standards are being met </li></ul>
  20. 20. Summary <ul><li>In over 80 % of prisons there seems to have been marked improvement in the service in all areas identified by the national strategy. </li></ul><ul><li>Significant challenges for PCTs as commissioners of these services. </li></ul><ul><li>Standardised data sets and information systems are needed to to support strategic development and enable efficient management of prison dental services. </li></ul>
  21. 21. Katie Buchanan <ul><li>Prison Dental Research Co-ordinator </li></ul><ul><li>School of Dentistry </li></ul><ul><li>University of Manchester </li></ul><ul><li>Higher Cambridge Street </li></ul><ul><li>Manchester </li></ul><ul><li>M15 6FH </li></ul><ul><li>Tel: 01244 364705 </li></ul><ul><li>[email_address] </li></ul>