Prisoner Health: Insights from Hospital Data

1. RCGP’s 6th Health & Justice Summit: Safety through Continuity: Thursday 31st January 2019, 11:35 – 12:25. What can we learn from hospital data about prisoner health? Dr Miranda Davies, Senior Research Analyst, Nuffield Trust, @DaviesMiranda1

2. Workshop objectives • To give a taster of early findings from analysis of prisoners use of inpatient hospital services in 2017/18. 2. To provide an overview of the Nuffield Trust prisoner health research work in-progress. 3. To think about the potential uses of hospital data to better understand the healthcare needs of prisoners. Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

3. A question to start… What do you think were the top-5 reasons prisoners were admitted to hospital in 2017/18?

4. The data….. • Inpatient data, 1stApril 2017 – 31stMarch 2018 • Reasons based on primary admitting diagnosis • 11,908 inpatient admissions • 112 prisons • Mean age = 44 years (15 – 96 years) • 93% Male, 7% Female Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

5. What do inpatient hospital admissions tell us? • Areas of healthcare need? • Also need to think about: • How healthcare is organised in prison • Availability of escorts • Data reliability Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

6. Prisoner admissions to hospital: Top 5 primary diagnoses, 2017-18 Inpatient admissions n % Acute kidney failure and chronic kidney disease 709 6% 658 6% Malignant neoplasms ICD-10 Chapter block Injuries to the head 508 4% Diseases of oral cavity and salivary glands 450 4% Symptoms and signs involving the circulatory and respiratory systems 444 4%

7. Prisoners admissions to hospital: Top 10 primary diagnoses, 2017-18

8. Prisoner admissions to hospital for malignant neoplasms in 2017/18 Most common diagnoses Other and unspecified: skin 57 admissions Bronchus and lung 56 admissions Malignant neoplasms 658 admissions Bladder 52 admissions Prostate 42 admissions Colon 39 admissions Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

9. Prisoner admissions to hospital for injuries to the head in 2017/18 Most common diagnoses Fracture of skull and facial bones 308 admissions Injuries to the head 508 admissions Open wound of scalp 92 admissions Intracranial injury 39 admissions Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

10. Prisoners admissions to hospital: No. of admissions versus number of people

11. Prisoner admissions to hospital for chronic kidney disease in 2017/18 Chronic kidney disease 666 admissions Primary procedure: n = 645 Haemodialysis Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

12. Prisoners admissions to hospital: Elective versus emergency admissions

13. Prisoner admissions to hospital for dental caries in 2017/18 Primary procedures: n = 92 surgical removal of wisdom tooth. n = 50 Extraction of multiple teeth Dental caries 242 admissions Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

14. Top 10 primary diagnoses in England, 2017-18

15. Prisoner admissions to hospital: Top 10 primary diagnoses ICD-10 chapter level

16. Nuffield Trust prisoner health research work

17. Project aim To use routine healthcare data to better understand the healthcare needs of prisoners, their use of health services and how the quality of care for prisoners compares to the non-prisoner population. Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

18. Research questions • RQ1: What are the healthcare needs of prisoners, and how do they compare to the non-prisoner population? • RQ2: How accurate and complete is Hospital Episode Statistics (HES) data, as a record of prisoners’ use of secondary healthcare services? • RQ3: What secondary health care services do prisoners use, and how does the pattern of service use compare with the non-prison population? • RQ4: What are the existing measures of healthcare quality in prisons and other secure establishments and how does the quality of healthcare received by prisoners compare to the non-prisoner population? • RQ5: For people who enter the custodial system with a chronic condition, what can we learn about the subsequent management of their condition? Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

19. Project plan • Preparatory phase: Jan - June 2018 • Inviting members to join the expert panel  • Applying for data access permissions from NHS Digital  • Phase I: July - Dec 2018 • Literature review  • Phase II: Jan - June 2019 • Quantitative analysis & report write-up  In progress Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

20. Phase II: Hospital data analysis Episode(s) of care • HES inpatient data • Documents episodes/spells of care What is an episode/spell of care? Spell of care Discharge Admission T M W T F S S Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

21. Phase II: Hospital data analysis • Inpatient data • See online NHS HES data dictionary for full details of data fields • Examples of HES data fields Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

22. Question 2 How might we use hospital data to better understand the healthcare needs of prisoners?

23. Using HES to understand prisoners healthcare needs • Descriptive reporting • Readmissions and length of stay • Addressing specific questions: • How many prisoners gave birth in 2017/18? • Sub-group analysis: • Specific chronic conditions • What are the practical implications of this work? Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

24. What is happening next? • Formal reporting of the phase I literature review • Phase II analysis • Formal phase II data analysis reporting • Meeting / talking to people about the project • Developing future research / project ideas Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received

25. Thank you for listening Project webpage: www.nuffieldtrust.org.uk/project/prisoner-health Contact details: miranda.davies@nuffieldtrust.org.uk @DaviesMiranda1 Prisoner Health: Understanding prisoners’ healthcare needs, their use of healthcare services and quality of care received