HC 1048-III Health CommitteeWritten evidence from Lynn Emslie (PH 22)

Offenders and Those at Risk of Offending

Evidence showsi, ii, iii that the offending population (prisoners and those exhibiting offending behaviour), have very high rates of physical and mental morbidity and are socially excluded. Their access to health and social care services is poor.

It has been announcediv that all healthcare in custodial settings will be commissioned by the National Commissioning Board. However, the needs of offenders will overlap with the proposed Health Equalities role of Public Health England.v Governance and scrutiny structures for the above, through the National Commissioning Board and Health and Well Being Boards, are still being debated.

Care pathways for vulnerable adults and those with complex needs, span organisational, governance and geographical boundaries and so a commissioning structure which can accommodate the development of care pathways and partnership working will be required.vi

1. In order to continue and further develop the Public Health role of reducing Health Inequalities, the needs of offenders and those at risk of offending should be an integral part of the strategic thinking and local planning for the development of Public Health England.

2. The needs of individuals and groups who exhibit chaotic lifestyles, complexity of need and poly morbidity; including mental health, learning disability, learning difficulty, illicit drug use, prescribed medication abuse, alcohol dependence and physical disability/long term conditions are not mainstream and may require a more focussed and proactive approach. Development of an effective care pathway which cuts across agencies and organisational boundaries is key to effective engagement and outcomes. People with complex needs frequently need support with housing, budgeting, basic education and employment services, which are traditionally provided by social care services, including the voluntary sector. Bringing Public Health England into the Local Authority framework could create a positive environment for integrating these services, based upon identified need.

3. Under the current proposals, custodial healthcare (prison and police custody) will be commissioned by the National Commissioning Board, which may also have a monitoring function. Offender healthcare in the community will probably be commissioned through the General Practitioner Consortia and Public Health England, with the Health and Well Being Boards having a locality needs assessment (Joint Strategic Needs Assessment) role and also providing the forum for local scrutiny (the public voice, HealthWatch and Local Authority processes). This fragmentation of commissioning, delivery and accountability could be counter-productive to the care pathway/integrated approach which is vital for increased access to services and the continuation of care for people with complex needs. Existing partnership working with criminal justice colleagues will also require further development in order to achieve positive outcomes.

4. Current economic pressures provide an opportunity for working collectively, not in silos, in order to be more efficient and cost effective. Integrated management, joint commissioning and clearer outcomes could be developed and refined in order to provide early interventions and reduced escalation of need. Marginal groups, especially those perceived to be non-compliant or challenging should not be further excluded from services as their issues will potentially escalate and be even more complex and expensive. Including the needs of offenders within the scope of Public Health England would provide an appropriate philosophical base and organisational structure for the future development of this work.

5. Significant momentum has been gained over recent years in identifying and increasing access to services for offenders and those at risk of offending and this should be further developed. The “localism” agenda requires organisations to have the capacity and capability to respond to the needs of excluded groups as well as the mainstream population but duplication of services, multiple governance frameworks and the growth of local infrastructures could be prolific; especially if there is division between the role and function of the National Commissioning Board (NCB), Specialist Commissioning, General Practice Consortia and Health and Well Being Boards. The potential for fragmentation of existing services is a challenge so operational frameworks need to be clear enough to ensure effective delivery of agreed policy, standards and priorities but sufficiently flexible for local interpretation, innovation and cost effectiveness. The role and function of Public Health England could provide a championing and co-ordinating role which focuses on the outcome of reducing health inequalities. Evidence-based practice and epidemiological intelligence would inform the work.

6. There is a need for ownership of the demands placed upon the NHS by individuals and all groups of people; some of whom may be outside the remit and expertise of mainstream services. These people require systems which will support and encourage their access to services, in the context of their complex needs, and local services may need to draw upon specialist hubs or services in order to help them achieve positive outcomes. The integration of care pathways with partner agencies may enhance the outcomes to treat and care for individuals in an effective and compassionate way but they may also achieve a reduction in anti-social behaviours and prevent offending/reduce reoffending.vii, viii

June 2011

References

i Singleton et al, Psychiatric Morbidity among Prisoners in England and Wales, London: Office for National Statistics, 1998.

ii Goggins, P, former minister for prisons and probation speaking in a debate on prisons and mental health, Hansard, 17 March, 2004.

iii Bromley Briefings: Prison fact File, Prison Reform Trust, London, July, 2010.

iv Burstow, P, MP, Minister of State for Care Services, speech to Revolving Doors Conference, London, 16 March, 2011.

v Marmot, M, The Marmot Review, a strategic review of health inequalities in England, post 2010, London, February 2010.

vi Department of Health, The Bradley Report, Lord Bradley’s report of people with mental health problems or learning disabilities in the criminal justice system, London, 2009.

vii Loucks, N, No One Knows: Offenders with Learning Difficulties and Learning Disabilities, A Review of prevalence and associated needs, London: Prison Reform Trust, 2007.

viii HM Chief Inspector of Prisons for England and Wales, Annual Report 2008 – 2009, London, 2009.

Prepared 28th November 2011