Correlaciones Estratigráficas en Pozos Someros

and not separate to it.

Dr Simon Tanner, Regional Director of Public Health, South East Region, London event chair – 24 September 2008

There are a number of existing mechanisms already in place, such as Local Criminal Justice Boards that co-ordinate the work of criminal justice agencies, which can provide crucial input to ensure effective commissioning. In addition, health, social care and criminal justice agencies have a range of levers and incentives already in place to develop services in partnership, for the benefit of their local communities. Public Service Agreements,211 _{Local Area Agreements}212 _{and Joint Strategic Needs}

Assessments213 _{are key tools for enabling commissioners and providers, along with}

other local partners, to effectively identify and prioritise the health and well-being needs of their local populations.

Those PCTs that have prisons in their area will already be more familiar with our target population; however, anecdotal evidence suggests that some PCTs are still struggling to understand commissioning services for them. In terms of improving commissioning at a local level, under World Class Commissioning,214 _{it may be}

appropriate for there to be a nominated PCT within a local area that could build up the relevant expertise.

Recommendations

- Primary care trusts (PCTs) and partners should jointly plan services for offenders to ensure effective commissioning and delivery of services. - Consideration should be given to a lead PCT commissioning offender

mental health and learning disability services on behalf of a cluster of local PCTs in each area.

The NHS Operating Framework215 _{is one of the key levers for driving improvements}

in the area of health and social care services for those with mental health problems and learning disabilities who are in contact with the criminal justice system. It would be helpful if the next framework could recognise that offenders and those in contact with the criminal justice system are not a distinct population, but are part of existing socially excluded groups already covered by the framework.

Recommendation

- The Department of Health should include explicit reference to the needs of offenders with mental health problems or learning disabilities in future NHS Operating Framework documents.

There are also a range of measures resulting from the NHS Next Stage Review that are designed to improve the quality of services in the NHS. One example of these is the Commissioning for Quality and Innovation (CQUIN) framework, which gives greater recognition for innovative work being developed. I welcome the development of approaches that incentivise innovation and suggest that further examination of CQUIN and other initiatives is undertaken to find new opportunities for improving services for the offender population.

Patient and public involvement

The NHS has for some time been developing mechanisms for patients and the public to feed back on the services they receive. This includes a duty216 _{to consult on}

service planning and operation, and in the development of proposals for changes to services. I know from talking to stakeholders that the offender population is very often not included in the patient and public involvement agenda. The benefit this review gained from the insight and experience of those who had been through the system was invaluable; and it is vitally important that such a group, historically hard to engage with services, is able to have its voice heard.

An example of these mechanisms is Local Involvement Networks (LINks). Based in local authorities, LINks are currently being developed as the key mechanisms for local patient and public involvement. LINks will aim to:

- provide everyone in the community with the chance to say what they think about local health and social care services;

- give people the chance to influence how services are planned and run; and

- feed back to services what people have said so that things can be improved.

Recommendation

- The NHS must engage offenders with mental health problems or learning disabilities with current patient and public involvement mechanisms.

Inspection and regulation

Inspection and regulation for the criminal justice system are currently undertaken by inspectorates for each of the sectors: police, courts, prison and probation. For health, responsibility for this currently falls to the Healthcare Commission. Later this year, the Healthcare Commission will merge with the Commission for Social Care Inspection to become the new Care Quality Commission. This represents a significant opportunity to ensure that the needs of offenders with mental health problems or learning disabilities are on the agenda of this new organisation.

It will also be important to explore whether existing arrangements with HM Inspectorate of Prisons (via the current Memorandum of Understanding) can be continued and strengthened to include the other criminal justice inspectorates, so that offenders’ health needs, in particular mental health, can be scrutinised at each stage of the offender pathway.

Recommendation

- Inspectors and regulators involved in the criminal justice system in partnership with the new Care Quality Commission should determine how they will ensure quality assurance for services provided to offenders with mental health problems or learning disabilities, with a particular focus on joint inspections.

The benefit of undertaking joint inspections should not be underestimated. There is ample evidence, from work undertaken by HM Inspectorates of Prisons, Probation, Court Administration and Constabulary, that by working together, inspectorates can obtain a unique perspective and understanding of complex situations that would have been impossible working in isolation.

IT infrastructure

If we are expecting stakeholders to improve the way in which information is shared, they must be supported in this by provision of the necessary IT infrastructure. The Connecting for Health217 _{project is intended to deliver a National Programme for IT to}

give electronic access to the NHS National Care Records Service (NCRS), including access by prison-based healthcare staff. Further adaptation of the NCRS would be required to allow access by health workers in Criminal Justice Mental Health Teams located at police stations, courts and other criminal justice settings.

Currently, health information regarding mentally disordered offenders can be

accessed locally within the NHS and within prisons, on electronic and/or paper-based records systems. However, these systems have been developed locally and are not generally nationally compatible, which makes it very difficult for other organisations to obtain the information they require. This has a particular impact on the rehabilitation of offenders with mental health problems or learning disabilities, as they are routinely difficult to engage with services on release and follow-up is often missed.

My report identifies the importance of transferring and sharing information between each stage of the criminal justice system to ensure that continuity of care is

maintained and unnecessary delay or risk is avoided. This could not be effectively achieved without the use of an electronic information system, such as that being deployed by Prison Health IT. It is now important for the programme to consider how health records might be transferred electronically in and out of prison to include the wider NHS and police, courts, and probation services.

Recommendation

- Connecting for Health, primary care trusts and strategic health authorities should work together to roll out integrated information systems to health services provided in all criminal justice settings.