NHS England kicked off the New Year by publishing The NHS Long Term Plan which sets out its priorities for the next 10 years, following a public consultation.
In October, Clinks provided a submission to the development of the plan focusing on health and justice. We called for the NHS to prioritise the continuity of care for people entering and leaving prison, mental health and stronger partnership working in their approach. We are pleased to see these themes reflected in the plan. This blog will take a look at the health and justice aspects of the plan.
Ensuring continuity of care
Our submission highlighted just how important ensuring continuity of care is for people in contact with the criminal justice system (CJS). People caught in the CJS go through many transitions, from the thousands of people given short prison sentences, to all those transferring between different custodial settings across the country, to those transitioning to the community.
People in the CJS are often amongst the most vulnerable in society, with greater and more complex health and social needs, whilst at the same time experiencing some of the most significant barriers to accessing services. They may need additional support to engage and remain engaged with health services.
As people journey through the CJS, information about their health and care needs does not get transferred with them. People find themselves having to undergo multiple assessments and retell their stories again and again. Not only is this potentially re-traumatising for people but it can lead to them disengaging from services.
It is welcome to see the NHS plan commit to health screening for all people entering prison, and a follow-up appointment within seven days, or sooner as required. This should help improve the identification of health and social care needs and ensure that appropriate pathways and services are in place. Health screening could be particularly important for identifying mental health needs ─ the review into self-inflicted deaths in custody shows that people are at increased risk of self-harm and suicide in the early days of entering prison.
We are pleased to see continuity of care set as a priority for people in prison. The plan recognises the huge numbers of people that cycle in and out of prison every year and the need to support the transition to community-based services so that people can continue to get the support they need. Over the next five years, RECONNECT – the care after custody service – will engage and support more people after custody per year. This will be supported by the full roll-out of a digital patient record system for more effective transfer of patient records before, during and after custody.
Voluntary sector organisations working with people in custody and the community are well placed to contribute to these priorities. NHS England and other health services should work closely with through-the-gate services to achieve the best possible continuity of care.
Improving support for people with mental health needs
Community Sentence Treatment Requirements (CSTRs) allow courts to require people to participate in community treatment as an alternative to imposing a custodial sentence. We found strong support for CSTRs amongst our members and their service users, and for expanding their use to encompass a greater range of people and conditions.
We welcome the NHS plan to expand CSTR provision to more women, people with learning disabilities, and people with mental health and additional requirements. In expanding provision we encourage NHS England to consider developing CSTRs suitable for people with primary care-level mental health needs, such as social anxiety; and for people with personality disorder, which we recommended in our submission.
We hope the investment in CSTR expansion signifies a shift in focus towards greater support for people in the community to prevent escalation of need and reduce the likelihood of entry into custody. We urgently need re-investment in community mental health services. Many of our members have expressed concern that lack of funding and cuts to services in the community, especially around mental health, are contributing to a rising complexity of needs among their service users.
Addressing inequalities in healthcare
There are significant inequalities in how different populations access and experience health care, and in their outcomes. This raises even greater concerns for people in the CJS, which itself continues to produce significant disparities in representation of, and outcomes for, particular cohorts of people. When the inequalities of both systems combine it puts those groups at even greater disadvantage and makes them more susceptible to unfair treatment and unequal outcomes.
We welcome the plan’s commitment to invest in additional support and develop a trauma-informed service for the most vulnerable children and young people in, or at risk of entering, the youth justice system.
Whilst we are pleased to see recognition of the vulnerability and needs of young people, we also highlighted to NHS England the health and care needs of older people in the CJS. It is disappointing not to see this reflected in the plan, particularly in light of the ageing prison population. This will require an increased focus on how health services in the CJS can respond to this population’s growing complexity of needs within an ageing infrastructure that is ill-equipped to do so.
The long term plan for health and justice also lacks a gender-informed approach. Women in the CJS have different and more prevalent health and care needs compared to men. This difference in need requires a distinct approach. As NHS England move forward with its plan for the next 10 years, it should work with and learn from specialist women’s organisations to provide health services in the CJS in a holistic way that is accessible to women.
It is concerning that the plan does not include commitments to the health needs and accessibility of services for black, Asian and minority ethnic people in the CJS given their significant overrepresentation throughout it. All sectors, including health, should be working to address racial disparities within the CJS. We recommend NHS England adopts the Lammy Review’s ‘explain or reform’ principle to identify and address disproportionality in access to, or outcomes from, health services in the justice system.
From now until the summer of 2019, local NHS teams will be working out what the long term plan means for their area and how to meet its national ambitions in their community. This will include engagement with staff, patients and the public.
As a member of the Voluntary, Community and Social Enterprise Health and Wellbeing Alliance - a national partnership between the voluntary sector and Department of Health and Social Care, NHS England and Public Health England - Clinks will continue to raise awareness of the health needs of people in the CJS, and the vital role the voluntary sector can play in addressing them. In this role we will work to understand and share with the voluntary sector the best ways that you can get involved with the local development and implementation of the health and justice elements of the long term plan in your area.