Title: Measuring and Improving the Health and Quality of Healthcare for Offenders on Community Sentences: Developing Recommendations for Commissioners and Practitioners
Funder: Department of Health and Social Care

Abstract: Background: Offenders in the community are often deprived and vulnerable. Research shows a high prevalence and complexity of health problems in this population, but disproportionately low access to healthcare. Often, offenders only access services at crisis point. Ensuring accessible healthcare provision that meets offenders’ needs would contribute to reducing health inequalities and reduce inappropriate use of expensive crisis services. There are concerns that changes to the structure of probation and commissioning arrangements may result in deterioration of provision for this group. For example, healthcare for offenders in the community should be commissioned by CCGs but many of them do not realise that this is their responsibility. No-one has systematically mapped the service provision currently received by this group, or examined the literature to identify the most effective ways of providing healthcare to maximise health benefits for offenders in the community. Aims: To conduct a systematic review to explore what research tells us about the most effective ways of providing healthcare for offenders to achieve good health outcomes. To systematically map for the first time the range of systems, policies and procedures that exist across probation providers to deliver healthcare under the new probation structure and commissioning arrangements. To investigate routine data being collected by the new probation providers and what should be collected, to develop quality indicators for offender health and healthcare. To use findings from the above to create a toolkit for commissioners and practitioners detailing examples of best practice and recommendations for ensuring accessible evidence-based healthcare that meets offenders’ needs and maximises good health, and how quality indicators could be developed to measure achievements in this area in the future. Plan of investigation: We will take a mixed-methods approach combining a narrative systematic review with a brief online survey of all key stakeholders in England, analysis of policies and procedures, telephone interviews, and the creation of case studies in a purposive sample of six areas. Together, these methods will enable us to systematically map how healthcare is provided for offenders in the community across England and what the literature tells us about best practice in this area, and to explore the policy context within which delivery is taking place. We will also be able to provide detailed case studies of activities in six areas to show both what works well and where people have encountered barriers. Finally, we will be able to make recommendations around the development of quality indicators for offender health and healthcare. As well as disseminating findings through academic papers, we will produce an easy-read summary of findings and a toolkit for commissioners and practitioners. Summary of potential benefits: Findings and the toolkit will be shared with all participants and key stakeholders from both criminal justice and health organisations. Thus, we will increase stakeholders’ knowledge of offenders’ health needs, optimal commissioning strategies, and how quality indicators for offender health and healthcare can be developed. Through actively involving representatives from key groups (including service users) throughout the research, we will ensure that our findings are relevant and accessible, and that we develop a clear route for encouraging uptake of the toolkit. Ultimately, the work will lead to these patients receiving evidence-based healthcare that is accessible and meets their needs as best practice spreads across England, a reduction in health inequalities, an increase in the proportion of CCGs that are aware of their responsibility to commission healthcare for this group, and a reduction in the use of costly crisis services. The study will also give us a basis from which to explore the development and testing of quality indicators for offender health and healthcare in future research.

Lay abstract: Background: There are over 200,000 offenders on probation in the UK. People in this group are often deprived, vulnerable and have more health needs (e.g. mental health, drug and alcohol problems) compared to the general population. Many offenders are not registered with a GP, and/or only access healthcare during crises. To reduce health inequalities, we first need to understand how healthcare is provided to offenders, and how its quality can be measured and improved. This is important because providing better, evidence-based healthcare will improve offenders’ health, increase their chances of completing probation, and reduce their risk of reoffending, with potential cost savings to the NHS from less unnecessary use of urgent and emergency services. Aims: To produce a toolkit helping people to measure and improve offenders’ health and the quality of their healthcare. Our questions are: How can healthcare best be provided to achieve good health outcomes for offenders? (E.g. less drug use/symptom improvement) What are the current ways that healthcare is delivered to offenders? (By probation, through local partnerships, or through clinical commissioning groups)? What data are already available to measure and improve offenders’ health and the quality of healthcare for offenders? Methods: We will do a literature review and use surveys, examination of written documents and telephone interviews with probation and health staff. PPI: Probation workers and ex-offenders have helped to develop this application, helping with the focus of the study and the lay summary. They will be on the project steering group to advise and help with making participant information resources, interviewing, and sharing the findings of the study. Dissemination: We will ask key people to identify the best ways to make improvements to practice happen, and we will share our findings with all participants, relevant organisations and policy makers as a toolkit and through journal articles.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: DISPUTED AETIOLOGY AND OTHER