Fiona Grossick National Clinical Quality Assurance Lead, Health & Justice NHS England Change for JW to come first

Our vision To ensure that everyone in the justice system receives high quality, cost effective health care that improves outcomes and reduces inequalities Health & Justice Commissioning, NHS England

What we currently commission Budget of £533m for 2016/17 covering a population which has a changing turnover Prisons 116 in England Population of 85,000 Immigration Removal Centres 11 in England Population of 3,600 Police custody, courts and Liaison & Diversion 40 police forces 1.4m go through custody suites each year Children and young people secure estate 14 Secure Children Homes (welfare and youth justice) 3 Secure Training Centres 4 Under 18 Young Offender Institutions Population 1,100 -1,200 occupancy beds Public health in secure and detained settings Public health of all prisons, children & young people secure estate and Immigration Removal Centres Includes substance misuse Sexual Assault Referral Centres (children and young people/adults) 43 SARCs in England Services are commissioned from a mixed market of providers including NHS Trusts but also a large percentage of independent and private sector organisations.

We are responsible for commissioning care for individuals at a particular point in their life which is solely defined by the setting they are in, not by their need or the nature of the service.

National Quality Assurance Lead Reducing Deaths in Custody – response to the Harris Review, Assessment Care in Custody and Teamwork Review (ACCT), learning lessons from deaths in custody, clinical reviews and implementing change To improve standardisation of quality assurance for health care services commissioned across the secure and detained estate.

Health and Justice Partnership Forum – non decision making Governance Structure Internal to NHS England External to NHS England Commissioning Committee Health & Justice Partnership Board Health and Justice Clinical Reference Group Health and Justice Oversight Group Health and Justice Partnership Forum – non decision making Health and Justice Regional Portfolio Leads Health and Justice CRG Expert Panels NHS England Internal Assurance Health and Justice Information Management Programme Board North Regional Team meeting Health and Justice CRG Task and Finish Groups Partnership Assurance Midlands Regional Team meeting Police Healthcare Partnership Assurance Group Ministerial Deaths in Custody Board NHS England Immigration Removal Centres Assurance Group South/London Regional Team meeting Prisons Health Care Board (England). NHS England Temporary Estate Assurance Group Immigration Removal Centres Partnership Assurance Group Contracted Prisons Healthcare Commissioning Group Child and Young People Health and Justice Co-Commissioning Assurance Group PHS7A Public Health in Secure and Detained Settings Assurance Group (PHS7A) Sexual Assault Services Assurance Group (PHS7A) Liaison and Diversion Board (inc Street Triage)

The Role of the Clinical Reference Group for Health and Justice The CRG works in partnership with providers, medical bodies, partners, key stakeholders, patients, families and communities Recently streamlined to comprise: CRG strategic steering group; meets bi-monthly , formal agenda Bi annual whole day workshop to enable ‘deep dives into strategic work plan areas and undertake Thematic Reviews

Health & Justice Update RESUS Guidelines publication NICE draft guidelines on physical health of adults in contact with Criminal Justice System Smoke Free Prisons roll out of smoke free prison programme DH Guidelines for the management of substance misuse Health and Justice Information Systems (HJIS 2) clinical input into development of templates

Health & Justice key priority 16/17 Supporting Reduction in avoidable Deaths in Custody – Response to Harris Review , ACCT Review, suicide prevention in prisons Quality and Safety How we can manage through our partnerships

Deaths in Custody Change for JW to come first

Deaths per 1,000 prisoners by apparent cause, 12 months ending December 2000 to 12 months ending June 2016, England and Wales In the 12 months to June 2016 there were 321 deaths in prison custody, an increase of 74 (30%) compared to the previous year. This is a rate of 3.8 deaths per 1,000 prisoners, up from 2.9 per 1,000 in the previous year. This is both the highest number of deaths in the time series, and the highest rate also, see figure 1 above. Longer term trends and greater detail are presented in the annual deaths tables . There were 186 deaths due to natural causes in the 12 months to June 2016, up from 148 in the previous year (26%). This is the highest in the time series. Natural cause deaths were at a rate of 2.3 per 1,000 prisoners, up from 1.7 per 1,000 in the previous year. This increase in natural cause deaths is the primary contributor to the rise in deaths overall. In the 12 months ending June 2016 there were 105 apparent self-inflicted deaths, up from 82 in the previous 12 months (28%). This is the highest number of self-inflicted deaths in the time series. On a rate basis this is 1.2 per 1,000 prisoners, up from 1.0 per 1,000 in the previous year. There were 11 female self-inflicted deaths in the 12 months to June 2016, compared to 1 in the previous year. Over 10% of self-inflicted deaths in the most recent period were female, although females account for less than 5% of the prison population . There were 5 apparent homicides in the 12 months to June 2016, down from 7 in the previous year. Homicides in prison custody remain relatively rare, accounting for less than 2% of all deaths in the most recent period and 1% of deaths over the last ten years. In the 12 months to June 2016, 25 ‘other’ deaths occurred, 19 of which are ‘awaiting further information’ prior to being classified. This number is not directly comparable with earlier years, as all-but one of the deaths in the prior period have now been classified. Many of the deaths in this category are likely to be reclassified following inquest.

Death in Custody Working Group Purpose: to ensure that the learnings from deaths in custody across the secure and detained estate are identified support continuous service improvements and health outcomes for services users adopting evidence based approach. Support NHS England’s Health and Justice priority to support the reduction in avoidable deaths in custody.

Health & Justice – Deaths in custody Harris Review Suicide and Self-Harm Project Research: Clinical Review reports analysis DH Policy Research Funds

Work to date – 16/17 Clinical Review Training Harris Review recommendations Resus Guidelines Thematic review of Self-Inflicted deaths

Thematic Review into Self-inflicted deaths Reviewed: PPO reports PPO lessons learnt bulletins Clinical Review reports HMIP reports National reports: Independent Advisory Panel Harris Review academic literature

Thematic Review into Self-inflicted deaths Key areas: Measuring suicide and self-harm Risk stratification tool Alerts Workforce Induction training Medication Medicines Optimisation Programme Continuity of medication on reception into prison

Thematic Review into Self-inflicted deaths Mental Health Links with ACCT review NICE Guidance Information sharing and consent Handover Best practice Guidance Learning Coroner’s summary report

Current work Thematic review of pre-morbidity Prevention through early detection and case finding End of Life Care Review of Macmillan Adopted Prison Standards Community of Practice

Questions?