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 1. Service Specification & Access 2. Contracts & Standards 3. Commissioning 4. Clinical Governance 5. Dental Equipment 6. Workforce

Methodology Protocol was peer reviewed & questionnaire was piloted at HMP Styal & Risley Postal questionnaire sent to all prisons in England (134) in 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: