Quality statement 2: Second-stage health assessment | Physical health of people in prisons | Quality standards

Quality statement

People entering or transferring between prisons have a second-stage health assessment within 7 days.

Rationale

Carrying out a second-stage health assessment within 7 days of entering a prison means people's health problems can be explored in more detail than during the initial health assessment and they can receive the necessary treatment and support. During the assessment appropriate testing can be discussed and if the person is due to undergo any routine health screening this can be arranged. For people with multimorbidities or long-term conditions, this is an opportunity to discuss their conditions and ensure that the correct care and treatment are provided.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that prison healthcare services are available to carry out a second-stage health assessment within 7 days of people entering or transferring between prisons.

Data source: Local data collection including assessment protocols and audits.

Process

Proportion of prison stays where a second-stage health assessment takes place within 7 days of arrival in prison.

Numerator – the number in the denominator where a second-stage health assessment takes place within 7 days.

Denominator – the number of prison stays which last for more than 7 days.

Data source: Local data collection including healthcare records and audits.

Outcome

a) Uptake rates of national screening programmes in prison (for example retinal screening, breast, cervical and bowel cancer screening).

Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on the uptake of cancer and non-cancer screening.

b) Number of deaths in prisons.

Data source: Local data collection. The Ministry of Justice safety in custody statistics include data on deaths in prisons.

c) Number of people in prison engaging with healthcare services.

Data source: Local data collection including healthcare records.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for people to have a second-stage health assessment within 7 days of entering prison, including people who are transferred between prisons. This should include having staff available to carry out the assessments within this period, having a medicines reconciliation completed before the assessment takes place and, if appropriate, having already obtained relevant medical records or information.

Healthcare professionals (such as GPs, nurses and mental health and substance misuse practitioners in prisons) ensure that they carry out a second-stage health assessment within 7 days for people entering prison, including people who are transferred between prisons. During this assessment they can offer or refer people for treatment and support for identified health problems and identify any screening that is due. They can also provide information and support to maintain and improve health, including where people can obtain additional information.

Commissioners (NHS England) ensure that contracts with prison healthcare services include providing people with a second-stage health assessment within 7 days of entering prison, including people who are transferred between prisons. This can be monitored through contract management.

People going into prison or moving to a new prison have a second health assessment within 7 days of arriving at the prison. At this assessment they can discuss their existing health conditions and have tests for other conditions they might have. They can also find out about ways to improve their health, for example through diet, exercise and stopping smoking, and where they can get extra information about staying healthy.

Source guidance

Physical health of people in prison. NICE guideline NG57 (2016), recommendation 1.1.13

Definitions of terms used in this quality statement

Second-stage health assessment

A health assessment carried out within 7 days of a person's first-stage assessment (which takes place upon entry into prison). This assessment includes, as a minimum:

reviewing the actions and outcomes from the first-stage health assessment
asking the person about:
- any previous misuse of alcohol, use of drugs or improper use of prescription medicine
- if they have ever had a head injury or lost consciousness, and if so:
  - how many times this has happened
  - whether they have ever been unconscious for more than 20 minutes
  - whether they have any problems with their memory or concentration
- smoking history
- the date of their last sexual health screen
- any history of serious illness in their family (for example, heart disease, diabetes, epilepsy, cancer or chronic conditions)
- their expected release date (if less than 1 month a pre-release health assessment should be planned)
- whether they have ever had a screening test (for example, a cervical screening test or mammogram)
- whether they have, or have had, any gynaecological problems
measuring and recording the person's height, weight, pulse, blood pressure and temperature, and carrying out a urinalysis.

[Adapted from NICE's guideline on physical health of people in prison, recommendation 1.1.13]

Equality and diversity considerations

People should be provided with information that they can easily read and understand themselves, or with support, so they can communicate effectively with health services. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and should be culturally appropriate. People should have access to an interpreter or advocate if needed.

Mental health should be considered during the assessment and support and treatment should be provided to people with mental health problems.

The clinical needs of older people in prison, particularly the possibility of chronic illness or deterioration of health, should be considered during the assessment.

The clinical needs of people in prison who are undergoing or have undergone gender re-assignment, particularly medicines continuity and specialist support, should be considered during the assessment.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's accessible information standard.