Title: Measuring and improving the health and quality of healthcare for people on probation: Developing data collection and quality indicators
Funder: Department of Health and Social Care

Abstract: Background: The limited research available suggests that people on probation have a higher level and complexity of health need than the general population. However, they often encounter barriers to accessing health and social care, including a lack of appropriate provision to meet their needs. There is currently a lack of systematically collected data on the health and social care needs of this group, the extent to which they are met, and their patterns and experiences of accessing services. Consequently, it is difficult to achieve evidence-based commissioning of appropriate and accessible services, and for probation staff to identify unmet need and make appropriate referrals to services. In addition, there are no specific indicators for the quality of care that people on probation receive, making it difficult to identify high quality service provision and areas requiring improvement or intervention. Aims and objectives: To improve the measurement, understanding and recording of health and social care needs by introducing a research-informed way of screening to identify needs and measure if they have been met. To develop quality indicators to measure and monitor the quality of care received. Methods: We have worked with the National Probation Service (NPS) Health Leads group to investigate what data they already collect and where improvements could be made. Objective one (months 1-13): we will introduce a consistent and research-informed measure of need by administering established measures across four NPS Local Delivery Units (two urban and two rural). Data will be weighted to represent the national probation population using propensity score weighting methodology. They will be analysed using descriptive statistics to show the prevalence of needs, patterns of service access, and the extent to which needs are being met. Variation in prevalence rates by service user and Local Delivery Unit characteristics will also be investigated. Objective two (months 3-17): we will use a modified Rand method to produce evidence-based quality indicators. This approach combines a systematic review of the literature with input from both a service user panel and an expert panel. Anticipated impact and dissemination: This project will provide an improved approach to screening for health and social care needs that the NPS could employ nationally, and which will enable probation Local Delivery Units to share a report on the needs of their caseload with commissioners and those producing Joint Strategic Needs Assessments. It will also provide a set of quality indicators developed with service users and a multi-agency expert panel, which could be used nationally and may also be relevant to an international audience. Together, these elements will support identification of where current practice is suboptimal, where it works well, and where improvements could be made to ensure that people can access appropriate care. The quality indicators will be made freely available online, and together with findings from the research, will be shared through social media and with the NPS, Public Health England, the Ministry of Justice, HM Inspectorate of Probation, the Probation Institute, the Confederation of European Probation, and through journal articles and conferences.

Lay abstract: Background: Many people on probation are in poor health, but do not access care until crisis point. Often, services do not meet their needs. To change this we need to know more about these individuals' health and social care needs, what services they access, their experiences when accessing services, and which of their needs are met and unmet. We need to: Improve data collection - introducing a research-informed way of screening to identify needs and measure if they have been met. Develop quality indicators (QIs) &ndash; ways to measure and monitor the quality of the care that people receive. This research will provide: An accurate picture of health and social care needs, and where there may be gaps in service provision to meet them A way for people to continue to assess need and care quality, ensuring that services are commissioned from an evidence-base, and probation staff can support access when needed. These are essential steps towards ensuring that the right processes are in place to reduce health inequalities and offending, and provide appropriate and accessible services that meet the needs of this vulnerable group. Objectives: Improve the measurement, understanding and recording of the health and social care needs of people on probation (better data collection) Develop QIs for the quality of the care that people on probation receive Methods: The Health Leads group at the National Probation Service (NPS) have told us what data they already collect, and where improvements could be made. Objective one: we will introduce a method of routine screening and assessment of need using research-informed screening tools. We will use this in four probation Local Delivery Units and analyse data to give a picture of needs and the extent to which they are being met. Objective two: we will conduct a literature review to identify existing QIs used elsewhere in the criminal justice system, or in probation in countries outside of England and Wales. We will consult an expert panel and a service user panel to see what they think excellent health and social care looks like, and what QIs they think would be useful and work well. PPI: This application was developed with support from probation staff and people with experience of the criminal justice system. They helped decide the focus of the study and write this summary. They will be part of the project team, co-producing participant information resources, recruiting and co-facilitating a service user panel to help us make the QIs, reflecting on our analysis, and supporting sharing of findings. Dissemination: Findings and QIs will be shared with the NPS, Public Health England, the Ministry of Justice, HM Inspectorate of Probation, CEP and the Probation Institute; and through journal articles and conferences.

Research activity codes: 8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES);4.4 POPULATION SCREENING
Health categories: GENERIC HEALTH RELEVANCE