Integrated drug treatment system Treatment plan 2010/11. Part 1: Strategic summary, needs assessment and key priorities

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1 Her Majesty s Prison Erlestoke Wiltshire Community Safety Partnership NHS Wiltshire Integrated drug treatment system Treatment plan 2010/11 Part 1: Strategic summary, needs assessment and key priorities The strategic summary incorporating the findings of the needs assessment, together with prison performance expectations (Part 2b), the planning grids (Part 3), and the funding and expenditure profile (Part 4), have been approved by the Prison/Primary Care Trust Partnership Board and by our respective governance structures and represent our collective action plan. Prison Governor Chair, Drugs Partnership Chief Executive, Primary Care Trust 1

2 Overall direction and purpose of the partnership strategy for drug treatment in the prison The Prison Health Partnership Board brings together key partners (prison, PCT and healthcare providers) to oversee provision of robust and high quality health and care service at Erlestoke that meets the needs of prisoners, and addresses any gaps identified in the annual health needs assessment. The Prison Health Partnership Board recognises the value of implementing an effective Integrated Drug Treatment System at HMP Erlestoke and is committed to supporting further development of the service to: - Consolidate and refine service delivery - Continuously improve clinical governance - Improve joint working - Improve continuity of care - Improve User and Carer involvement - Improve staffing capacity and competencies The likely demand for drug treatment interventions. In order to increase the profile/accessibility of the IDTS scheme and encourage wider access within the prison population, health promotion activities are to be encouraged e.g. through utilisation of peer Health Trainers, ongoing joint work with the CARATs team and re-convening the IDTS Stakeholder Group/work with the User and Carer Involvement Worker. The proportion of the population that is from minority ethnic groups in Wiltshire is relatively low compared to national averages, as the table below shows: Geographical Area Resident BME Resident % BME England % South West Region % Wiltshire County % Kennet District % North Wiltshire District % Salisbury District % West Wiltshire District % In order to increase the profile/accessibility of the IDTS scheme and encourage wider access within the prison population, health promotion activities are to be encouraged e.g. through utilisation of peer Health Trainers, ongoing joint work with the CARATs team and re-convening the IDTS Stakeholder Group/work with the User and Carer Involvement Worker. A priority has been identified by a recent NTA audit to compile a Wiltshire Directory of BME Community Services, including all faith groups to give service users being released into Wiltshire a chance to engage with BME and faith groups associated with their diverse backgrounds as another form of support. Key findings of current needs assessment. There are currently 41 prisoners on the IDTS scheme, which is more than two and a half times more than at the same time last year, and 3 awaiting 2

3 assessment. The service has been extended significanlty in the last 12 months: Prisoners being transferred in were often not stable on their script, and needed more psychosocial input than had originally been envisaged. There was a need to manage their clinical need on an individual basis; for example by increasing their Methadone dosages and also gradually reducing dosages and detoxing prisoners off Methadone altogether. There was evidence for a need to instigate substitute prescriptions at HMP Erlestoke for prisoners who had either relapsed during their time at HMP, or for those who had developed a substance misuse problem whilst at the prison Throughout the last 12 months these needs have been addressed and the IDTS service now provided at HMP includes the following: Acceptance of prisoners already on a script from other prisons Clinical management of prisoners receiving Methadone/Subutex which was commenced elsewhere, including increasing and decreasing of dosages appropriately in line with clinical guidance Instigation of substitute prescribing (Methadone or Subutex) for prisoners who have had a clinical substance misuse assessment and have been assessed as suitable for this again in line with clinical guidelines Provision of short term and medium term Subutex detoxification Provision of Methadone detoxification Provision of lofexidine detoxification Prescribing of Naltrexone both in the prison and for discharge Prescribing of Suboxone prior to discharge if considered clinically appropriate Psychosocial support provided by the CARAT team both on a 1 to 1 basis and also access for all the prisoners receiving clinical support for CARAT groups Harm minimisation both from CARATs and the clinical team around Blood Borne Viruses (BBVs), including testing for BBVs, and provision of Hepatitis B (Hep B) vaccination programme. All prisoners are offered both vaccination and testing. The provision of sterilising tablets to the wings has been introduced through the prison s Health and Safety Department. Protocols have been written for the assessment and management of prisoners who are referred to or present themselves to the IDTS service and assessments of any new IDTS prisoners coming in from other establishments are being undertaken within a few days of arrival. A full clinical substance misuse assessment is undertaken by the IDTS team, as well as a separate assessment done by the CARATs team, along with a full general health screening. In June 2009 the prison undertook a survey of the prisoners to identify the extent and nature of drug misuse within HMP. Out of a total of 470 prisoners, 40 returned the completed questionnaires, although not all respondents answered every question. It is important to note that due to the small sample size it is difficult to generalize these results to the whole prison population as the respondents are not necessarily representative of the wider population of HMP Erlestoke. The findings indicated: 1. The majority of prisoners stated that they wanted employment and accommodation advice, training and financial related services much more than they wanted drug related support such as Methadone maintenance, needle exchange or counselling. 3

4 2. There is a perception that there is more help and support available for prisoners taking drugs than for non drug takers and that prison life is geared towards prisoners with drug misuse related problems. This meant that prisoners without drugs misuse problems felt they did not receive the same level of support as those with a drug misuse problem. Improvements to be made in relation to the impact of treatment in terms of its outcomes. Benzodiazepine detoxification provision The issue of benzodiazepine detoxification has been highlighted through a recent NTA Self Assessment Audit as a requirement in Local Prisons for prisoners coming in from Court or on first night reception. Therefore, this will be monitored over the next 12 months to establish need by recording any requests from prisoners, and new receptions, requiring a benzodiazepine detoxification with a view that if a substantial need is identified that this service is provided on a case by case basis. Staffing resources With increasing numbers on the clinical substance misuse team s caseload, the clinical provider has identified the need for an urgent review of staffing levels, with a view to making the case to commissioners for increasing both the administrative support and also the clinical staffing resource. Psychosocial support The imminent increase in CARATs staffing levels is a very positive development. By utilising this together with the suggested increase in the clinical resources, further work via joint group sessions on such topics as harm minimisation and BBVs can be developed. Work needs to be considered between the clinical providers and CARATS as to how to address the perception issues of some prisoners about the imbalance of services to drug misusers i.e. a programme to explain the importance of drug treatment. Key priorities for 2010/11 Commissioning a local drug treatment system: Reconvene the IDTS stakeholder group to meet regularly to monitor and oversee the provision and development of IDTS as part of the generic healthcare and CARAT services which will feed in to the established strategic partnerships and commissioning mechanisms Develop an annual plan for developing the IDTS Needs Assessment and Treatment Plan in line with NTA Guidance including holding expert groups involving key stakeholders and collating a range data to evidence identified needs. Review data recording systems to ensure that they meet all requirements and are fit for purpose. Revive effective Service User involvement up on recruitment of new User and Carer Involvement Co-ordinator, post the required security clearance Identify how to engage with, and involve carers and family members in service planning, development and delivery. On recruitment of a new community User and Carer Involvement Worker, reestablish effective user Involvement in the Stakeholder Monitoring Group. 4

5 Identification of key priorities following needs assessment relating to access and engagement with the drug treatment system Agree and implement care pathways to support Re-induction Protocols. Continue a programme of drug awareness training for prison staff. Retention in and effectiveness of the drug treatment system: New CARAT staff to be trained to satisfactory level of competence. Continue to develop and review clinical governance in line with 2007 Clinical Guidelines. Ratify Draft IDTS Workforce Plan, and implement. Outcomes, discharge and exit from the drug treatment system: Improve the links with the Offender Management Unit to consolidate aftercare/resettlement arrangements and link them in to Loose Ends, a Erlestoke specific reintegration initiative. Strengthen links to community services and CJITs 5

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