Quality Improvement in the Northern Ireland Prisons Ruth Gray Clinical Lead in Prison Dentistry Clinical Lead in Quality Improvement SEHSCT ruth.gray@setrust.hscni.net
NI Prisons • Northern Ireland Prison Service are responsible for Four prisons • Maghaberry Prison- 855 (Category A+B) • Magilligan Prison - 474 (Category B+C) • Hydebank College - 154 (Men 18-21) • Hydebank Wood Women’s Prison - 57 Prison Healthcare responsibility of SEHSCT from 2008.
Rationale for Quality Improvement First law of improvement is • Committal Process- Complex 'Every system is perfectly designed to achieve exactly the results it gets’ • PHC Criticized by Inspections • Self Harm& Deaths in Custody • Joint Strategies • Staff Priority • Culture Shift • Systematic Transformation
Patient Requirement 10000 Voices-What Mattered Most • Co-production • Importance of Narrative • Pt Experience • Pt Expectations • Regional Survey • SensemakerTechnology • 100+ people Interviewed
Prescribing Time Delay • Reduction in Waste Medication Time Delay at Committal- X-Bar Chart TIME • Reduction in Re-work Loops 40 Meds. R Admin. Meds. Recon. 35 • Medicine Reconciliation UCL Co-Location P.G.D. 30 • Co-Location of Team 25 • Change Team Skill Mix 20 15 • Introduction of PIPs LCL 10 5 • Omitted Meds 89% to 30% 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 WEEK • Advice and Support from 5 Nations
Peer Support Hub • Partnership Design • Co- Design New Support Hub with People in Custody • Monthly Peer-Led Support Meetings- Belonging • Qualifications in Literacy, Citizens Advice and Advocacy • Linking with Organizations for Work Placements • Healthcare Navigators- ASK HIM
Transformation of the System • GovTECH UK Cabinet SBRI Funding • £1.5 million over 2 phases • SBRI- Development of Tech Solutions • Agile System Design in Public Sector AIM • Pull System- Front Load Information for committal team • Improve Information Transfer- Court/ PSNI/ FMO/NIPS
Customer- Supplier Relationships Gov Tech Information Flow Interface Between Organizations Court Clerk Court hearing Causeway updates held interface update ICOS PACE 15 Medical Concern raised generated PECCS review Assessment during court (limited medical docs and custody? (Adastra) info) complete PER Understanding Process PECCS form Yes Yes Prisoner remanded Paper notification Prisoner relased No or sentenced? Initiate SPAR of court decision Evolution Medication reqired? (Currently paper Yes but IT to roll out) PECCS phone PACE 15/15(1) receiving prison PACE 16 PRISM Notified with prisoner Patient’s own PACE Form- Audit PACE 15 (1) details medication in Person enters No Prescription form sealed bag to court custody handwritten PECCS without being in PACE 15/15(1) & 16, PER, spar Evo PSNI custody Yes concern (if approp) and prisoner’s own medication handed over to NIPS Documents to Progression to reception staff PSNI Custody PECCS Custody? officers Information Sharing Across PACE 15/15(1) & 16, PER, spar Evo No concern (if approp) and prisoner’s PSNI Referral to Police Boundaries own medication handed over to Custody Interview Yes Custody Nursing? SEHSCT Committal nurse (NICHE) Documents to PSNI Custody officers Contact Community No Check ECR GP/ Pharmacy/ addictions Process Mapping Re-referral during Update EMIS police custody record Information flow Information transfer across organisations
GovTECH- Progress • Building partnership • Inter-organisational working • Understanding roles and requirements • Information Sharing Agreements • Patient Centred Design • 5 IT suppliers currently working on prototypes
Regional Service Transformation MATT/ “Street Triage” scheme pilot Health in Police Custody pilot to develop nurse led service Community Support Hubs – partnership PSNI, HSC trusts, local councils Target individuals who present frequently to emergency response services. Mental Health and Drug Misuse Courts developed by Probation
MATT Multi Agency Triage Team Mental Health Team, Police Officers and Paramedics (NIAS) Most Appropriate Care MATT aims to support individuals and their families through mental health crisis. Deliver Safe, Effective, Timely, High Quality client focused care • Psychiatric triage assessment by a Mental Health Practitioner • Onward referral to community/voluntary services • Access to toxbase • Access to legal powers and procedures pertaining to the CJS • Telephone advice to NIAS clinicians and PSNI officers
How well did we do Is Anyone Better off Outcome of Face to Face Outcome of Telephone Diversions, ED avoidance & CBYL reduction Contacts Contacts Was Article 130 considered? No. of Assessments completed//not required 95.4%clients diverted from an article 130 Advice to client Advice to NIAS Advice to PSNI Would ED have been considered? Arrested Deaf (needed a signing) Declined 38% 89.4% clients avoided an ED attendance Detained under 130 Unable to contact 62% Follow up by keyworker Inappropriate Would CBYL have been considered? Transported to ED Unknown 0 5 10 15 20 25 30 35 98.9% clients did not require a CBYL
Project ECHO E XTENSION OF C OMMUNITY H EALTHCARE O UTCOMES • Telementoring Network • A Movement to Improve Care • Democratising Specialist Knowledge • Community of Practice • Building Capacity • Collaborative problem solving • Reducing Variation • Continuous Improvement
Project ECHO Prison WHOLE PRISON APPROACH to HEALTH PROJECT ECHO • HUB- Senior Management from SET & NIPS N.IRELAND SPOKES- 3 NI Prisons-M/D Teams H&J E xtension of C ommunity H ealthcare O utcomes • UK- HMP Whatton Utilising technology to deliver specialist training and support to practitioners • Cardiff Prisons Establishing communities of practice to shape the • Representative IRCR transformation of services • Chief Inspector of Prisons Increasing the knowledge and confidence of • Commissioners practitioners to manage patients in primary care • Police Custody Nurses • People in Custody • Psychological Safety- Improvement Opportunities Improving the Supporting R educing care delivered the localisation demand on • Self-Harm/ Towards Zero Suicide to patients of care secondary care • WEPHREN- International Network
5 Nations Collaboration Shared Learning 5 Nations membership facilitates sharing of best practice nationally South Eastern HSC Trust is the sole provider of all health services in NI Prisons 5 Nations membership critical in facilitating a National benchmark and standards for service delivery Shared Ambition 5 Nations membership critical in promoting a National Public Health model for health in justice Membership has raised the profile of health in justice and the needs of individuals across the full justice pathway, promoted a shared narrative. Shared Presentations WHO Collaborating Centre has circulated International best practice WEPHREN providing a worldwide prison health research and engagement network has created a platform for knowledge exchange
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