Might as well be on the moon?

In HMP Frankland, there are 16 times the expected number of people with diabetes. 4

In Deerbolt YOI there are 1.5 times more people with asthma than expected.5

From a comparative perspective…

The health needs assessments’ sponsor said,“Your work is hugely appreciated and will make a difference I am sure. I am so relieved that at last we have a quality product we can trust in!”3

People in prison …

are more likely than the general population to have a mental illness. In prison 72% of men and 70% of women suffer from two or more mental disorders compared to 5% of men and 2% of women in the general population,1

experience poor dental health. “The amount of untreated dental disease amongst all prisoners is approximately four times greater than the level found in the general population coming from similar social backgrounds.” 2

Health needs assessments for the four

prisons in Durham

A survey by Cornford et al6

showed there were 1.6 GP surgeries per week per 100 prisoners. In HMP Frankland the comparative figure was 1.

In Low Newton the number of dental sessions is almost at the level required to give equitable provision compared to the other Durham prisons.

From a corporate perspective….

Prisoners in HMP Frankland suggested a well-man clinic would improve their health.

Prison officers frequently cited drug and alcohol problems as the most pressing health need of prisoners.

From an epidemiological perspective…

The message Prisons are places that are physically

separated from the rest of society although they are in the same geographical area, Durham.

There are health and social inequalities between people in prisons and the general population.

In terms of health service provision, prisoners are entitled to equivalence of care.7

The image

Visiting prisons for the first time, I was struck by the physical and mental separation that occurs when walking through the security checks. It sometimes felt like I was on another planet in terms of the different cultures and societal norms in each of the prisons.

The remoteness and isolation of the moon from the earth captures the concept that although people in prisons are in the same world as the rest of society, in many ways they inhabit a different space.

Decision-making

The health needs assessments (HNAs) were carried out for all four prisons in the Durham area. Each prison has a distinct population. The HNAs make specific recommendations, based on the information gathered, for commissioners and services providers to consider.

These four documents will be considered by the Regional Offender Health Commissioning Board on 28th January 2010.

Public health competencies (1 of 2)

Thirty-seven people from 12 different organisations were involved in gathering and preparing the information used in the health needs assessments.

Competency 4 Collaborative working for health and wellbeing

I used data and information from a range of sources including; national and local strategy documents, prison data, published research; surveys, systematic reviews, meta-analyses, communicable disease data and qualitative information from focus groups. Comparisons were made between levels of ill health in the prison and general population.

Competency 1 Surveillance and assessment of the population’s health and wellbeing

Public health competencies (2 of 2)

I was working to a very tight timescale and had to prioritise the work since it was not possible to thoroughly analyse all the information and meet the deadline. I agreed this with the project sponsor.

Competency 10 Ethically managing self, people and resources to improve health and wellbeing.

Prisoners’ views were sought though focus groups. The views’ of prison and health care staff were sought through a questionnaire.

Competency 7

Working with and for communities to improve health and wellbeing.

The HNAs highlighted inequalities in health between the prison and general population.

Competency 5

Developing health programmes and services and reducing inequalities

References

1 Social Exclusion Unit, 2002, Reducing re-offending by ex-prisoners.2 Harvey S, Anderson B, Cantore S, King E, Malik F. Reforming prison dental services in England A guide to good practice,

July 2005.3 Julie Dhuny, Head of Commissioning, North East Offender Health Unit.4 The National Quality Outcomes Framework in which GPs in England record prevalence for coronary heart disease gives an

overall prevalence rate of 3.5. This rate was applied to the average population of the last day of each month for the six months from April to September. http://www.ic.nhs.uk/webfiles/publications/qof0405/QOF0405_Statistical_Bulletin.pdf5.

5 Expected rates taken from Singleton, N, Meltzer, H, Gatward, R, Coid, J, and Deasy, D. Psychiatric morbidity among prisoners in England and Wales: The report of a survey carried out in 1997 by Social Survey Division Of the Office for National Statistics on behalf of the Department of Health. 1998. London: The Stationery Office cited in Marshall T, Simpson S, Stevens A, 2000, Toolkit for health care needs assessment in prisons, The University of Birmingham.

6 Cornford C, Mason J, Buchanan K, Reeves D, Kontopantelis E, Sibbald B, Thornton-Jones, Williamson M, Baer M, 2008, A survey of primary and specialised health care provision to prisons in England and Wales, Primary Healthcare Research and Development, 9, 126 – 135.

7 Recommendation R(98)7 of the Committee of Minister to member states concerning the ethical and organisational aspects of health care in prison, accessed 23.11.09, https://wcd.coe.int/com.instranet.InstraServlet?command=com.instranet.CmdBlobGet&Instranetimage=530914&SecMode=1&Docld=463258&Usage=2.

HMP Frankland HMP Durham HMP Low Newton Deerbolt Young

Offenders Institution