/CKWCB-12-101_Prison_Inpatients_

The funding stream for this area of commissioning comes from Offender Health, which is a directorate of the DH, which deploys allocations to those PCTs with prisons in their patch. The resource envelope for this tender will be from the re-engineer of service provision and funded from the existing baseline allocation for HMP Wakefield. The telemedicine provision will be funded by Regional Innovation Fund (RIF) monies.

NHS Wakefield District (NHSWD) receives a ring-fenced allocation to commission primary care and in-reach secondary care provision for the prisoner population of HMP Wakefield. Going forward this will be ‘direct commissioning’ by the NHS CB. Prisoners’ hospital secondary care will be funded by the local Clinical Commissioning Group (CCG).

Commissioned service provision currently leaves a gap in terms of intermediate care, falling between primary care and secondary care provision for the prisoner population.

The new service delivery model aims to address this gap. Another key driver supporting the case for change is the necessity to reduce secondary care activity which results in high hospital escort and bedwatch costs when prisoners are admitted to the local hospitals. This problem is further compounded by public safety issues when high security prisoners have to be taken to hospital.

A key benefit of the new delivery model for the Inpatients Service is that it will facilitate earlier planned discharge from hospital back to prison as the new Inpatients Service would have the capability and capacity to provide sub-acute / step-down / intermediate / rehabilitative care to bridge the gap between prison primary care and hospital acute secondary care. Inpatient prisoners will be clinically supervised and rehabilitated with the aim of returning to ordinary wing location as soon as possible.

The strategic case for change is made by two key reports: Clinical Quality Risk Assessment Report (Elliott, NHS Wakefield District 2011) and Independent Review of Inpatients (Russell, NHS Doncaster, 2011). Both reports highlight serious failings of service delivery at HMP Wakefield which include risks to patient care in terms of quality and poor clinical governance.

However, Andrew Russell’s independent report did recognise the unique benefit of retaining an inpatients service at the prison and recommended that the Inpatients Service be retained but substantially redesigned and provision by a suitable healthcare provider. The clear focus for the clinical health care provider would be to deliver professional clinical medical and nursing care and treatment within a framework of robust and professional clinical governance ensuring quality outcomes are achieved for this patient cohort.

As a consequence of these reports’ outputs the PCT/Prison Partnership initiated a project to take the recommendations forward with the redesign of the service delivery model and subsequent tender of the service being the key outputs.

The OBC was initially circulated to the Planned Care Clinical Commissioning Unit (CCU) for comment on 8th March and following this a report and the FBC went to the Wakefield CCE on 27th March that has made the recommendation to the Cluster Board to approve the FBC.