CQC and HMIP call for improvements in healthcare for adults in the prison system

The Care Quality Commission (CQC) and Her Majesty’s Inspectorate of Prisons (HMIP) are calling for improvements in NHS healthcare provided for adults in the prison system in a joint report published today.

The findings of the 2008/09 report are based on a sample of 21 PCTs that commission healthcare for prisons. It indicates progress has been made in embedding management and clinical governance systems and also in the way IT systems are used to record and analyse information on the quality of care.

But CQC and HMIP say clear improvements must be made in broader arrangements to monitor the quality of care and to ensure care is centred on patients’ needs. The review flags up particular concerns over arrangements for continuity of healthcare around prisoners’ transfer and release. The report describes it as inadequate and says it appears to be getting worse.
There has also been no improvement in the provision of drug treatment systems, a potentially critical resource within a prison environment.

CQC programme manager, Alex Baylis, said: ‘We are encouraged to see some improvement in the standards of healthcare provided to adults in the prison system over the last year, but significant improvements still must be made.

‘CQC particularly wants to see improvements around arrangements for adults’ transfer and release, which appears to be getting worse. People in prison are often not registered with a doctor and have a high prevalence of chaotic lifestyles, which can involve – for example – substance misuse and mental health issues. Expecting them to make their own arrangements can mean they may end up without access to healthcare.’

Alex Baylis explained that healthcare in prisons was now covered by CQC’s new system of registration: ‘It is now a legal requirement for the NHS to meet essential standards of quality and safety and the independent sector will be subject to the same law from October.

‘This means we will be monitoring these services on an ongoing basis to ensure both are compliant with the regulations set out in the new system of registration.

‘If providers breach standards they will be committing an offence. If this happens, we will use our wide range of enforcement powers to prompt action. These escalate from warning notices to fines to cancellation of registration and the closure of services.’

The review assesses care provided and commissioned by a sample of primary care trusts (PCTs) over 2008/09 and compares them to the 2007/08 results.

Recommendations include:

- PCTs must develop the information they collect on the quality of service provision and on health promotion so they can better detect and correct unsatisfactory practice and better demonstrate that individual services they commission achieve their objectives for quality of care.
- PCTs must be able to show information systems are used for regular review of clinical standards and that these reviews are followed up with action where needed.

- PCTs must prioritise continuity of care at transfer and release and show that services for each prison in their area join-up effectively with other services.

- PCTs should be able to show they act on complaints in how they commission and monitor services.

This year providers of healthcare in prisons are subject to a new tougher system of statutory registration and must apply to CQC for a licence to provide services, declaring they meet legal essential standards. This system of registration gives CQC new powers to carry out enforcement action against providers if the quality of services falls below required levels. Providers of healthcare in prisons are subject to fines or legal proceedings if they fail to meet the required standards.

Although the registration system applies to providers and not to the commissioners of services, commissioners should play a major role in helping services improve and ensure they are giving top priority to monitoring quality of care, according to the report.