Evaluation of the impact of the implementation of a national strategy for improving prison dental...
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Evaluation of the impact of the Evaluation of the impact of the implementation of a national implementation of a national strategy for improving prison strategy for improving prison
dental services in Englanddental services in England
Katie BuchananPrison Dental Research Co-ordinator
PHRN / University of Manchester
Dental TeamDental 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 deliveryStandards for service delivery
• Over £4.75M injected into prison dental services
• Has strategy \ additional funding improved prison dental services?
Evaluation BackgroundEvaluation BackgroundEvaluation BackgroundEvaluation Background
The Strategy (April 2003)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
MethodologyMethodology Protocol was peer reviewed & questionnaire was piloted at
HMP Styal & Risley
Postal questionnaire sent to all prisons in England (134) in 2006
3 waves - 5 weeks apart
Completed by Healthcare Manager
Questionnaires were returned to Prison Health, DoH in a pre-paid addressed envelope
QuestionnaireQuestionnaire
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 - responseResults - response
109/134 (81%) were returned
Item non response was an issue
Data unavailable for certain questions
Main FMain Findingsindings
Service Specification & AccessService 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 GovernanceClinical 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 EquipmentDental 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 Workforce & Additional QuestionsQuestions
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 responsesQualitative responses
Main Issues reportedMain 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’sReasons 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 evaluationKey findings of the evaluation
Data qualityData quality
Reported data
Post hoc commissioning
Data availability
Limited resources
Key findingsKey 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
RecommendationsRecommendationsNational minimum data sets are required to supportPCTs & 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
SummarySummary
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 BuchananKatie BuchananKatie BuchananKatie Buchanan
Prison Dental Research Co-ordinatorSchool of Dentistry
University of ManchesterHigher Cambridge Street
ManchesterM15 6FH
Tel: 01244 [email protected]