Transfer of Prisoner Health Care. To provide a briefing on the status of implementation and governance arrangements

Transcription

1 NHS Board Meeting 7 December 2011 Paper 2 NHS Board Meeting Wednesday 7 December 2011 Subject: Purpose: Recommendation: Transfer of Prisoner Health Care To provide a briefing on the status of implementation and governance arrangements For the Board to consider the transfer of Prison Healthcare to NHS Ayrshire & Arran 1. Background 1.1 From 1 November 2011 responsibility for prisoners' health care transferred to the NHS. The legislative and other changes required to implement this decision come into force from 1 November. This means that the NHS Board is legally accountable for health care provided in prisons, other than forensic psychology services. We will undertake that function in close partnership with the Scottish Prison Service (SPS), on the basis of National Memoranda of Understanding (MOU) and via a local MOU with Serco. Nine Health Boards have prisons within their boundaries, for NHS Ayrshire & Arran there is one prison,, a high security prison for a maximum of 690 male prisoners privately run by Serco on behalf of the SPS. The prison population in Scotland amounts to 8,000 people at any given time, with almost 28,000 in prison at some time in any given year. Ayrshire & Arran residents can be held in any Prison within Scotland and can be transferred within the Prison estate. This population has a particular concentration of health needs, including addictions, mental illness and blood-borne viruses, poor oral health and long term conditions. Scottish Ministers decided in 2008 to transfer responsibility for prisoner healthcare to the NHS. This change, which mirrors changes which have taken place elsewhere in the UK, will, amongst other things; help to ensure equity of care and to reduce health inequalities, in so doing the transfer will uphold European and International standards for the health care of prisoners; ensure that prisoners receive improved continuity of care on release; and help prevent professional isolation for healthcare workers. 1 of 8

2 The local management arrangements set out in the MOUs, including the establishment of a Joint Steering Group on Prisoners Healthcare, build on the Local Implementation Groups which have operated successfully over the past 2 years. Particular considerations have to be taken into account in the delivery of health care in a prison setting. This includes national consistency in areas which are important to keep the "good order" in prisons e.g. consistency in drugs available to prisoners (which have a "currency" in prisons) through a national formulary for prisoner healthcare, mental health and suicide issues, management of substance misuse, the delivery of services through some national contracts, and others. In undertaking this function, Boards will be supported by a National Prisoner Healthcare Network, facilitated by a small team within Healthcare Improvement Scotland and a small team retained within SPS, which builds on the successful working and co-operation between Health Boards at a national level to implement the transfer, through their Leads. Early tasks for this network will also include the development, agreement and implementation of a framework for continuous quality improvement and performance management of prison healthcare services. 1.2 Planning and Implementation of transfer of prisoner health care have been managed using MSP approach to Programme Management. Ongoing implementation and development require amended structures including the closure of Local Implementation Group (LIG) and establishment of the Joint Steering group co chaired by NHS Health Care Manager and the Prison Director 2. Current situation 2.1 Key Documents National MOU The national MOU was received on 02 Nov The MOU is between SPS and prisons on contract to it () and NHS Boards. There are two private prisons in Scotland. The contractual relationship is between SPS and Serco however to support clarity and partnership a local MOU between A&A and Serco is in development. Each Chief Executive is requested to sign this national MOU following local approval. Local MOU The local MOU has been developed in partnership with Serco and NHS Ayrshire & Arran and outlines the commitment of both parties to ensure healthcare can be and is delivered as well as security and good order maintained. In discussion with the Central Legal Office (CLO) the status of this MOU is not contract based it is non enforceable and does not require to be signed. Prison Rules The Prison Rules for Scottish Prisons relating to Healthcare provision have been removed or amended and reissued. Director Rules The prison currently operates under governance from SPS aligned to prison healthcare standards and rules established and inspected by SPS and Her Majesty s 2 of 8

3 Chief Inspector of Prison (HMIP). Each The Prison Governor or in the case of, Prison Director, creates a set of operational rules in response to the National Prison Rules. These national rules have been updated to reflect the transfer of healthcare to NHS. The local MOU describes where there is joint accountability to meet these rules. Post transfer of healthcare to the NHS, effective and robust governance will be key to ensuring continuity of services. Health Board Provision of Healthcare in Prisons (Scotland) Directions 2011 & Guidance These Directions were developed following consultation with NHS Boards and will be monitored and amended by the Scottish Government via the National Prisoner Healthcare Network the first amendment will be considered after three months following implementation. Her Majesty s Inspector of Prisons (HMIP) In September 2011 was inspected. The formal report will be published early Clinical Governance The clinical services provided to prisoners is delivered in the main by directly managed services all of which are accountable directly to their service clinical governance group but also report to the Prison Clinical Governance Group chaired by the Associate Medical Director Primary Care. Contracted services namely Pharmacy Service and Optometry Service will be accountable to the Prison Clinical Governance Group. Example 1: prison dental service provided by NHS managed dental service and accountable to Dental Clinical Governance Group but also reporting via the dental clinical director to the prison clinical governance group. Example 2: Lloyds Pharmacy will account via the Lead Pharmacist Public Health & Community and to the prison clinical governance group Example 3: Prison Nursing and Medical services will be accountable to the prison clinical governance group. A full briefing and report will be provided to the clinical governance committee. Working closely with Head of Patient and Community relations a complaints protocol has been agreed and implemented. Complaint rates have traditionally been high and will be closely monitored for both operational demand and service improvement. 2.3 Staff Governance Recruitment & Retention All staff; The nurses, GP and addiction team have been met by the interim senior manager, HR and staff side and have TUPE transferred on their existing terms and conditions. All have the option to transfer to NHS terms and conditions and if opting in this will be effective from 1 st April Health & Safety of NHS Staff The H&S department have been fully involved as part of the local implementation 3 of 8

4 planning providing overall assessment and supporting services in their own workplace risk assessments. The department are committed to continue to advise and support as part of existing Mental Health Services governance structure. All areas where NHS staff will work have been assessed. Approval for Serco provided training packages which incorporates Violence & Aggression and security maintenance training has been recommended and provided for all staff providing care in the prison or regularly attending. Following H&S assessment and assessment by Infection Control a number of building / infrastructure changes have been agreed by Serco this includes removal of dead legs in (water) pipework, reconfiguration of traige rooms in each wing, increase in working space for physiotherapy/podiatry room by removal of fixed cabinetry. In addition a new dental chair and physiotherapy plinth will be installed. Even though NHS A&A staff have been providing health care in the prison for many years (e.g. BBV, Public Health, Psychiatry, Tissue Viability) the prison environment and security will be new to many of the staff. Additional training and familiarisation sessions have been delivered to inform staff in more detail from an NHS perspective. The staff TUPE transferring from Serco healthcare to NHS are have a range of experience working in prison healthcare the shortest service being a newly qualified nurse appointed less than 3 months ago to staff who have worked there since the prison opened. The induction of these staff to NHS is planned and an assessment of a range of skills and competencies are being assessed in order to develop clinical, professional, e-health and other skills. All staff have participated in the recommended HR transfer process. 2.4 Information Governance A national Information Sharing Protocol was finalised on 2 nd November. This is being reviewed by our Information Governance officer in conjunction with the Caldicott Guardian and will also be reflected in the local MOU specifically due to partnership requirements with Serco. Standard Operating Procedures were developed in draft and implemented from 1 st November while awaiting the final ISP and can now be finalised. IM&T/ E-health is the only Scottish prison without an e -health clinical patient management system, most other prisons have GPASS all prisoner health records are manual. Locally, should be connected to NHS A&A network in November giving access to all core systems, , Athena, Datix etc. Nationally the role of VISION is scheduled from April Financial Governance An annual allocation of 1.4m recurring has been made to NHS A&A. Actual spend will be monitored nationally. The core budget is held within the Mental Health Directorate or allocated direct to services. Due to being a private prison has not benefitted from the SPS national contracts. (e.g. pharmaceutical supplies & services, oxygen, radiation 4 of 8

5 protection assessments), Current commissioning of these contracts is the responsibility of NHS Ayrshire. On expiry, the national contracts will be commissioned by NHS Boards with the option to do this jointly or separately giving NHS Ayrshire & Arran the opportunity to jointly procure a more cost effective service. Current financial projection is that an overspend will occur mainly due to cost of our contract for Out of Hours Medical provision, high use of nurse bank and GP Locums. As it has not been possible to project the likely cost of the pharmaceutical contract this may also potentially contributing to the overspend. An estimated overspend of 100K is anticipated and will be very closely monitored. 2.6 Other Governance Risk Management / Programme Risk An implementation risk log details and records all programme/project risks and mitigation. This approach will be continued. Operational/clinical risk The use of Datix will commence on installation by e-health department and build/training by Datix team and will be incorporated into Mental Health Services governance structures. Clinical risk is managed via clinical governance structures previously outlined. 2.7 Service Delivery All clinical services have confirmed readiness to provide the agreed models of care. Physiotherapy and podiatry are delayed slightly awaiting the conversion by Serco of the room and have informed the prisoner consultation group. 3. Proposal 3.1 Local Operational Arrangements The operational and professional structure is shown in the diagram below. 5 of 8

6 Jim Crichton Jim Crichton Director of Primary Care & Mental Health Director Services MHS Linda Boyd Health Care Manager, Adult Mental Health Services Ann Gow Assistant Nurse Director, Primary Care Health Care Manager (vacancy) Derek Barron Associate Nurse Director, Mental Health Services NHS Addiction Services Peter McArthur, Acting Service Manager Addiction Services Vacancy Deputy Health Care Manager Medical Practitioner Dr Grant McHattie Assistant Medical Director and Primary Care lead for Clinical Governance / Medical lead Nursing Team 1 Nursing Team 2 Nursing Team 3 Organisational Chart as of 1 st November 2011 KEY CODE = Direct Line Management = Matrix reporting This is interim operational management structure is further detailed in the diagram below. Associate Nurse Director Linda Boyd Health Care Manager Adult Mental Health (and Prisoner services) Craig Stewart Locality Manager & Interim Head of Prisoner Health Care Associate Medical Director Laision with all clinical services Interim RGN lead RMns s Admin team GP OOH GP Addictions team leader RGN s RMNS s Addictions Team 3.2 Local Development of Service The main areas of development within the programme plan will include:- Nursing & Medical workforce models, Clinical skills and competencies, Admin and IT skills, Throughcare 3.3 National Arrangements The National Prisoner Healthcare Network has been established supported by a small team retained by SPS to support and advise NHS Boards on local and national development. Each Board is represented on this network 4. Engagement and consultation on development of the proposal 4.1 All key stakeholders have been consulted in the development of this paper. 6 of 8

7 5. Resource implications and identified source of funding 5.1 Detailed in Financial Governance section above 6. Risk assessment and mitigation 6.1 The following are the top 10 risks identified in partnership via the LIG prior to implementation are summarised below alongside mitigation. A number of additional risks are emerging since implementation and will be added. A full risk log and mitigation plan has been approved by LIG. 1. Financial constraints pose a risk to the future development of healthcare services within the prison. The inadequacy of the current services has been highlighted in the past mainly due to the large number of prisoners with mental health conditions and addictions. a. Redesign and or identification of funding gap 2. The current health care environment within the prison poses a risk to the quality and range of service. There is a lack of clinical space. a. Tripartite working group to agree framework for developments/changes 3. Competing operational demands High number of complaints, rigid prison regime require to be managed to ensure capacity for staff development occurs a. Additional operational capacity using staff on interim basis, streamlining and preventing complaints 4. Continuity of service the aspiration to maintain a business as usual approach to minimise prisoner disruption may conflict with clinical /staff governance requirements a. In partnership with Prisoners consultative Group and Serco outline issues and seek agreement to required amendments to models of care 5. Models of core medical provision and senior nursing managerial structures require to be reviewed in light of resignations of these staff. a. Interim structure in place as per contingency plan. Devise new models for internal approval 6. Financial risk due to additional cost of OOH medical and replacement in hours medical cover. a. Risk identified early and via close monitoring and feedback to national level and board 7. High nursing staff turnover (and absence) may result in reduced safe and effective care due to lack of continuity and inexperience of new recruits, inability for bank to supply. a. Work in partnership with staff and staff representatives & staff support to identify reasons and improvements, encourage staff to transfer to NHS Terms & Conditions, induction to prison environment,safety and security training 8. Delay in local or national IM&T infrastructure and application rollout/installation a. Initially focus on improving manual standards 7 of 8

8 9. The National or Local MOU or Directions are insufficient to robustly support the partnership between NHS and Serco a. Raise at national network and review local MOU regularly 10. The change in management from Serco to NHS with loss of senior nursing and managerial leadership may result in staff anxiety or lack of information /consultation regular staff meetings, briefings, management of change processes, staff support, sensitive interim leadership, OD dept support. 7 Impact assessment and consequential changes proposed to mitigate adverse impacts identified 7.1 The overall LIG Plan has been diversity impact assessed. 7.2 A number of groups/fora are currently being established to provide ongoing management and guidance to the implementation and development of prison health care services and will report via Director of Primary Care & Mental Health Services. 8. Conclusion 8.1 The Transfer of Prisoner Healthcare will now move into a phase of more detailed implementation and development grounded in partnership and robust Governance Jim Crichton, Director Primary Care & Mental Health Services [Linda Boyd] 8 November of 8