ITEM 7 Prisoner Healthcare Feb 25
North Lanarkshire Council · 19 March 2025
Back to Health and Social Care Integration Joint Board — 19 March 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 IJB Reporting Template REPORT Item No: 7 SUBJECT: Prisoner Healthcare TO: IJB Performance Finance Audit Committee Lead Officer for Report: Maggs Thomson, Head of Health, NL HSCP Author(s) of Report Tracey Hughes, Senior Nurse Jamie Quin, General Manager Contact details for Author(s) of Report Tracey.hughes@lanarkshire.scot.nhs.uk Jamie.Quin@lanarkshire.scot.nhs.uk DATE: 19 March 2025 1. PURPOSE OF REPORT This paper is coming to the IJB for noting. This paper is to inform the Board of the continuing health service improvements undertaken within HMP Shotts. It will explore the compliance with the local Service Model Review, and in parallel with the HIS recommendations. Also to note on-going work around the National Target Operating Model and next steps. This paper is coming to the IJB for: For Approval: ☐ For Endorsement: ☐ To Note: ☒
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2 2. ROUTE TO THE BOARD This paper has been: prepared by Tracey Hughes, Senior Nurse and reviewed by Jamie Quin, General Manager, AHSU and Maggs Thomson, Head of Health, NHSCP Prepared By: ☒ Reviewed By: ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB note the contents of the report. (1) It is recommended that the IJB recognise the service changes and continuous improvements made within prisoner healthcare at HMP Shotts in accordance with the recommendations made by HIS. (2)) It is recommended that the IJB recognise the service changes and continual improvements made within prisoner healthcare at HMP Shotts in accordance with the local recommendations and actions identified in the Local Service Model review, including the efforts made by the AHSU to address the recruitment & retention issue within Prisoner Healthcare. (3) It is recommended that the IJB endorse the future work streams of the Prisoner healthcare team and to achieve all recommendations within the National Target Operating Model 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND The Prison Health centre based within HMP Shotts serves a population of 540 male patients. The service is to provide these patients, many with advanced Mental Health and Addictions issues, with a primary care level service, equivalent to that of patients Yes ☐ No ☒ N/A ☐
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3 in the community. In terms of health equalities, it is estimated that the prison population has an average health age of 10 years higher than their actual age. The service has continued to be managed within the Adult Health Services Unit (AHSU) and has delivered on all Service Model Review recommendations. The 2022 HIS review led to 64 recommendations of which there are only 2 outstanding in relation to pharmacy and are part of the ongoing pharmacy review 5.1 Target Operating Model In 2024 the National Prison Care Network at NHS National Services Scotland (NSS) developed the Target Operating Model for prisons to support a “Once for Scotland” approach to the planning, design and delivery of an integrated, holistic, person- centred care pathway across the healthcare system for people living in prison. HMP Shotts are making great progress with this utilising various workstreams across NHS Lanarkshire Key recommendations have been made around; • Governance and Leadership • Workforce and Education/Training • Health Improvement • Emergency Response • Admissions • Mental Health • Addictions • Primary Care • Sexual Health • Learning Disability • Pharmacy • AHPs • Technology A National overview of current services that have been fully implemented is outlined below.
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4 The summary above indicates NHS Lanarkshire current status towards achieving the Target Operating Model. The areas that require improvement have been highlighted around AHPs, Health Improvement, Pharmacy and Sexual Health. There are various improvement workstreams feeding into this. 5.2 Workforce The workforce has continued to stabilise and there has been no use of agency within this service over the last 6 months. 5.3 Finance The financial position as at Month 9 2024/2025 financial year is as follows: t The Pays budget is reviewed/scrutinised/managed accordingly in-line with allocated funds. The £217k overspend within non-pays is within the Medicines Management/Pharmacy remit of the prison health centre, to be discussed below. All other areas of the prisoner healthcare budget are reviewed and managed accordingly within the SFIs and allocated budget.
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5 5.4 Pharmacy Pharmacy costs have traditionally been the highest area of non-pay spend nationally in all prisons. The nature of the patient cohort results in high volumes of prescribed medication for Mental Health, Pain, & Addictions purposes. The non-pay spend relating to Pharmacy/Drugs is as below: The actual spend for medicines was only £15,773, with the £250k miscellaneous (other supplies) overspend being the management fees for the pharmacy contract with M+D Green. Prior to 2023 the National contract for pharmaceutical supplies was held by Lloyds group. Upon expiry of this contract Lloyds did not want to renew this, Boots uninterested in tendering also. Upon first tender request no supplier submitted any interest. With time against the national team, and a high risk raised on the SPS register regarding potential prisoner riots, a second attempt at sourcing a contracted supplier was met with a bid from M&D Green. This new bid came in 2 parts, the processing and management of drugs by M&D Green, and the delivery from Phoenix Healthcare. This new contract came with an almost 22% increase in costs, as well as a £35k per month management fee. This contract came into effect from June 2023 and none of these factors were uplifted in the Annual budget, creating a potential £600k annual cost pressure. A Pharmacy Medicines Action Group has been created. Chaired by Senior Nurse and consisting of Senior Clinical Pharmacists, Lead GP, Prison sessional GPs, Team Leaders, ANP and the Consultant Psychiatrist. The main focus is to perform polypharmacy reviews within the principles of Realistic Medicine. There is a clinical focus to reduce prescribing volumes and costs and improve safety within the prison for diverted drugs. 5.5 Chronic Disease Management/National Screening The nursing team continue to deliver all key aspects of the CDM and National Screening requirements. The following services are delivered within the prison Health Centre • Diabetes (clinics & awareness)
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6 • Sexual Health (clinics & awareness) • Keep Well clinics • Asthma – initial stages of implementation • Hypertension • National Bowel Screening • Prostate Screening • Routine eye tests • Treatment Room service 5.6 Deteriorating Patient and Emergency Response Senior Nurse has implemented NEWS2 and a prison specific structured response document within the prison To ensure compliance to the escalation policy and for consistency in care this is audited on a monthly basis which has in turn improved patient outcomes and compliance with National Excellence in Care standards. Noted below, the service achieved 95-100% compliance consistently across the year. 5.7 Staff Training As part of the programme to fully utilise new increased staffing has been devised in collaboration with the Practice Development & Organisational Development teams. This includes Mandatory and other relevant desired training, including both practical on-line sessions. Outlined below there is noted 85-100% compliance with all training
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7 5.8 Call before you Convey This is now business as usual and all non life threatenting patients are now being safely navigated through FNC There was a total of 185 Ed attendances from HMP Shotts over 2024. The most common presenting complaint is suspected illicit drug overdose. This is also impacting nursing resources with increased illicit drugs within the prison at the moment. Harm reduction interventions are in place in collaboration with SPS 5.9 Associated Risk As the improvements undertaken above were all necessary for patient care, staff governance, and as per HIS recommendations, any reduction to staffing levels in relation to proposed 10% financial savings within the prison would create a clinical 0%10%20%30%40%50%60%70%80%90%100% HMP Shotts Learnpro Compliance % Oct Nov Dec 0 5 10 15 20 25 30 35 HMP Shotts ED Presentations 23-24
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8 risk to the successful delivery of the service. This will be discussed as per the finance cluster review meetings. 6. SUMMARY OF KEY ISSUES Next Steps • Continue to provide service delivery as per new model • Continue to work collaboratively with SPS • Continue progressing to achieve the National Target Operating Model • Represent the Prison Healthcare service at finance cluster review meeting • Complete MAT standards benchmarking and evidence gathering • Continue to develop the workforce and role diversification 7. CONCLUSIONS The AHSU, in collaboration with SPS and on-site staff, have successfully implemented a new service model to deliver excellence in health care to the people who live within HMP Shotts. 8. IMPLICATIONS As previous mentioned in section 6.9, any reduction in budget to the Prisoner Healthcare service, could result in a significant adversity in the ability to fulfil the service provision as per national guidelines. The fragility of the staffing budget would not allow for any reduction in FE otherwise the implication of reverting to an unsatisfactory outcome for patients. 8.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒
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9 People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 8.2 ASSOCIATED MEASURE(S) • HIS Recommendations • NSS published guidance for prisoner health • MHWC Recommendations • Safe Staffing Legislation • NSS Target Operating Model 8.3 FINANCIAL Any reduction in staffing budget would adversely affect service provision and performance. £600k annual cost pressure in drug/medicines management provision. The prescribing review group has a target saving of £43k (realised by Jan 26). This will include reviewing items prescribed, formulary switches, developing pain pathways, reviewing Gabapentanoids, reviewing the PRN medications, and also promoting use of “in-possession” 28 day prescriptions where safely possible as opposed to supervised and daily bags. This paper has been reviewed by Finance: Yes No N/A 8.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner 8.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken.
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10 Objectives Further details ☐ Involve stakeholders in the development work aimed at achieving the national outcomes ☐ Provide stakeholders with information on how to get involved ☒ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs Staff, patients & SPS involved in service review process ☒ Measure how well we involve community stakeholders in the planning, design and delivery of our services IPMs, SPS and patients involved ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Monthly meetings with SPS and review meetings with HIS and NSS ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☐ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 8.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A
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11 9. BACKGROUND PAPERS HIS inspection report available on request 10. APPENDICES Nil Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Members seeking further information about any aspect of this report, please contact the following; Tracey.Hughes@Lanrakshire.scot.NHS.UK Lorraine.Smith@lanarkshire.scot.mnhs.uk Jamie.Quin@lanarkshire.scot.nhs.uk
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12 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction
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13 10 Performance Management / Governance arrangements 11 Date direction will be reviewed