How JWPM has helped to integrate Substance Misuse Services (SMS) patient data into the patient’s clinical record, reducing administration and enabling improved patient outcomes.

Identifying a Gap

While Substance Misuse Services (SMS) teams deliver essential services within prisons, they have rarely been a part of the single patient healthcare record, hosted within the current electronic medical record system. In addition, in many instances primary healthcare providers are not commissioned to provide Psychosocial SMS Services. This leads to gap in joined up care and consequently an increased safety risk: a potentially critical aspect of a patient’s health and wellbeing is absent from their record means primary healthcare providers are less able to provide support to the patient or to the SMS Teams.

The recent Prevention of Future Deaths report into the case of Finlay Finlayson (25 March 2024) provided a case study. It highlighted the difficulty in sharing information between different case management systems:

“During the course of the Inquest the jury heard evidence about the difficulty in information being transferred over from Mr Finlayson’s GP surgery system, which uses SystmOne to the prison system (also SystmOne). The evidence was that information was not able to be freely shared between the two and it meant that there was a delay in healthcare staff in the prison accessing relevant information about Mr Finlayson’s long term health issues as well as contact with his GP as recent as a week before going into prison.”

Discussions with a number of SMS teams indicated a willingness and a preference to record their interventions in the patient’s medical record, and to cease recording clinical data in the HMPPS PNOMIS system.  

As a first of type project, it has shone light on the SMS teams indicating the lack of integration with primary care practices within the secure sites and how getting sites in an ‘IT ready’ state took longer than expected.

Bridging the Gap

The Commissioner requested JWPM to investigate potential solutions to improve outcomes for patients and providers.

Relevant SMS providers were contacted and met with at several prisons to capture and map out the “as-is” processes.  This highlighted that all the prisons had slightly different ways of handling SMS patients. SMS templates were also reviewed with service providers. These were deemed to be overly complicated and did not mirror the real-world patient journey through the service. It became clear that all current processes and practices needed to be revised.

Using the national NDTMS templates as a baseline, key stakeholders from the SMS teams reviewed the new SMS Toolkit templates built by JWPM. They were built to capture the national requirements, and more, to help ensure best practice and the real world flow a SMS patient, which follows:

• Reception

• Referral

• Dual diagnosis

• Risk assessment

• Caseload assignment

• Brief intervention (if required)

• Treatment Outcome Profiles (TOP’s)

• 5-day review

• 28-day review

• 13-week review

• Care plan

• Recalls

• Clinical reports

Joining the Shared Care Record

The JWPM designed toolkit, bespoke to SMS services, has achieved its purpose, making it easier for the SMS Teams to access the information required within a medical record and add to the record if needed. This also helped the patient’s experience, as less information was requested in duplicate.

To support the staff in using the SMS Toolkit, reports were built to support two primary areas:

• Workforce Planning (workforce planning was supported by caseload reporting and monitoring upcoming patient reviews)

• Patient Outcomes (patient outcomes were reportable using the referral outcomes and certain key CTV3/SNOMED codes to capture referral to key services, or the end to an intervention)

Benefits and Outcomes

SMS teams across all 13 prisons in the East of England now have greater access to healthcare information available within the patient’s record. We are incredibly grateful to all SMS providers that supported JWPM and took part in modelling the flows and the prisons that are benefitting from improved patient care. Enhanced access helps to facilitate integrated working with the Health and Wellbeing services within the secure site. Specific benefits noted by SMS and healthcare providers have been that it is easier to share information, and there is a reduction in time spent requesting or searching for specific information. Also, patients are identified as being referred to the SMS service a lot quicker.

Conclusion

The SMS Toolkit project has been beneficial. At the same time, it highlighted that the SMS teams, especially the Psychosocial provision, have been historically more embedded with the HMP service, using the HMP PC’s and uploading to PNOMIS.

Now that the SMS teams are on the single patient record, the next steps are to support the team in their continuing use of the SMS toolkit. If appropriate we will conduct a business review of the changes implemented and we will make any further changes required to improve the SMS service.

John White

Founder & CEO

SONAR – Supporting Partnerships such as Right Care Right Person

One of the core motivations of SONAR is to enable more agencies across healthcare, social care, and criminal justice to work together effectively. SONAR will achieve this by enabling real-time sharing of accurate health information between different settings so that the Right Information will enable the Right Person to deliver Better Care.

Our goal is to provide up-to-date health information from a wide range of sources in an accessible format for healthcare professionals to determine appropriate courses of action.  Success will be measured by reductions in preventable deaths and serious harm significantly, and improvements in treatment quality, rates and outcomes for detained populations.   Capturing and presenting patient data in suitable formats to enable better treatment and more informed decision-making to reduce recidivism, with fewer crimes and victims of crime.

Right Care Right Person

This is relevant to a key current initiative, Right Care Right Person (RCRP), first developed by Humberside Police in 2019. The Chief Constable and the Humberside PCC described the programme at a hearing of the Health and Social Care Select Committee in September 2023.

The Chief Constable said that the impetus for a new approach came from his officers. They were conscious that they were attending a greater number of people suffering from poor mental health – but felt that they did not have the skills or experience to help them effectively:

“Day in, day out our officers and staff were saying to us that they were dealing with an increased demand from mental health, but they felt they did not have the skills or ability to help the people. The question is, who is better to deal with a patient going through crisis? In many of these circumstances, and in many of the daily incidents we were attending, someone with training—a mental health doctor or nurse—has to be a better person for someone going through trauma than a police officer.”

The police inspectorate in England had come to the same conclusion in 2018.

Humberside Police worked with health practitioners over three years to develop a new model. Police officers would attend scenes when a police presence was required – when there was an immediate risk to life, when a crime was being committed or when there was a possibility of degrading or inhumane treatment. Otherwise, local mental health services would respond. Adrian Elsworth, general manager of urgent and emergency mental health at Humber Teaching NHS Foundation Trust, told the Committee that genuine partnership between police and health services has meant that the needs of every person have been met:

“Mental health services are involved at every step of that. However, when we get higher up and when there are more concerns around risk to an individual, there is still a role for the police to play. It is very much around understanding whose role it is at what juncture and, more importantly, having routes of escalation to allow those conversations so that nobody falls through the net in regard to care needs.”

National Roll-out

The programme has received support from government. In July 2023, the Home Office and the Department of Health and Social Care (DHSC), the National Police Chiefs’ Council (NPCC), the Association of Police and Crime Commissioners (APCC) and NHS England supported the national implementation of the programme.

The guidance explains that it is appropriate for police to respond to calls “to investigate a crime that has occurred or is occurring; or to protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm”.

The guidance emphasised that partnership is essential, and that local partnerships must be in place before changes in police response take place:

“It is crucial that at the heart of planning and implementing RCRP for people with mental health needs, there is a focus on ensuring patient safety is maintained and people in mental health crisis are not left without support. This means the approach to RCRP implementation for people with mental health needs should be planned and developed jointly through cross-agency partnerships before changes to responses are introduced. While police forces will ultimately determine the timeframe for implementing the RCRP approach locally, it should be established following engagement with health, social care, and other relevant partners. Once implemented, locally developed arrangements should be monitored and reviewed over time.”

National mental health leaders have emphasised the need for evaluation of the impact on health services around the country and have called for extra resources for mental health services. Sean Duggan, chief of the NHS Confederation’s mental health network, has said:

“Health leaders are pleased that the DHSC has commissioned a short-term evaluation project into the impact on the NHS in five areas but now want to see this as an ongoing evaluation across the country. It must also include the views and experiences of people with mental health issues and have a focus on the most at-risk groups. The aims of Right Care Right Person are laudable. But it must be implemented at a pace that doesn’t risk the safety of some of the most vulnerable people in our society.”

SONAR – Supporting Partnership

SONAR is ideally placed to support partnership working of the kind embodied in Right Care Right Person. Through appropriate information governance, security of data, informed patient consent and role-based access controls, SONAR can record the medical and social care needs of the patient. 

Through appropriate and authorised data sharing agreements, SONAR can then share the patient record between:

• Healthcare Professionals

• Mental Health Practitioners

• Police officers and other emergency service professionals

• Social Care organisations and agencies

• Voluntary sector organisations – who have been a key part of delivery in Humberside.

The aim is to reduce the risk to the person, enable a safe intervention by the Police and enhance any vital sharing of medical and social care information by health and social care professionals. The Right Information will enable the Right Person to deliver Better Care, and enable more people to live the best life they can.

John White

Founder & CEO

One Year Follow Up to the HMICS Report

It has been over a year since the publication of a key report, “National baseline review of healthcare provision within police custody centres in Scotland”, by Healthcare Improvement Scotland (HIS) and His Majesty’s Inspectorate of Constabulary in Scotland (HMICS).

The review identified a great variation in access to healthcare between different custody locations and made a powerful case for improvements in the quality of healthcare provision. With great relevance to our work at SONAR, the review emphasised the importance of collection and sharing of data:

“There was a recognition that improvement is needed in how services capture and report on healthcare data and key performance indicators in the context of police custody. There was consensus across all NHS Scotland boards that the current electronic system for recording healthcare data (Adastra) is not fit for purpose and does not support the comparison of clinical data nor enable national reporting.”

It concluded by calling for a new electronic system to replace the current infrastructure:

“It is clear therefore, that Health boards require a suitable electronic system that supports them to appropriately record and monitor clinical data to ensure patient needs are met and enables the comparison and sharing of clinical data.”

One year later and these concerns remain current. In fact earlier this month, the report “Nothing to see here”, published by the Scottish Centre for Crime and Justice Research, presented very similar evidence. The study found that between 2015 and 2023, 26 people died in custody in Scotland with a further 198 deaths following police contact . Across all custodial settings, a repeated cause of death and harm were basic errors of information such as lost hospital letters, missed appointments or recommended tests:

“In previous reports we have noted a tendency in prison of homogenising the prison population as ‘unhealthy’, side lining scrutiny of healthcare quality and access within custody. Several cases raised questions about the possible impacts that incarceration can have on health outcomes, including poor communication between prisons and hospitals, missed health appointments and scans.”

It goes without saying that we at SONAR are still here and even more ready to help. Evidence from England also shows the importance of accurate collection and sharing of key data. We remain keen to work with all relevant authorities to progress the recommendations of the HIS / HMICS report, in particular recommendation #5:

“NHS National Services Scotland, NHS boards and HSCPs should work together to ensure clinical data is appropriately recorded and monitored to ensure patient needs are met and to support the comparison of clinical data and national reporting of outcomes.”

John White

Founder & CEO