Transcript Slide 1

Sue Cobbold
Diabetic Eye Screening Service – NHS Suffolk
PSI – Prison Service Instruction, Feb 2002 -
In line with the overarching Health Services for
Prisoners Standard to provide prisoners with
access to the same range and quality of
services that the general public receives
from the National Health Service.
National Service Framework for Diabetes: Standards
PSI – Prison Service Instruction, Feb 2002 Diabetes does not affect everyone equally.
Significant inequalities exist in the risk of
developing diabetes, in accessing health services
and in health outcomes. The burden of disease
falls disproportionately on people from minority
ethnic and socially excluded groups.
National Service Framework for Diabetes: Standards
‘NSF - Who gets diabetes –
Health Inequalities, paragraph 9’
Less affluent and socially excluded communities
High risk, hard to reach groups are
overrepresented in the prison population. People
with diabetes living in custodial settings should be
managed in line with the standards set out in this
NSF. Close partnership working between the prison
health care team and local NHS diabetes services is
essential.
PSI – Prison Service Instruction, Feb 2002 There are no additional staff or
non-staff resources required to
implement this PSI.
April 2006 – responsibility for prison healthcare
is transferred from HMPS to NHS. PCT’s
responsible for delivery of care.
Engagement of screening programmes with
prison healthcare departments becomes
compulsory.
What is the scale of the task?
We screen:
Pop
DESS
%
Cat A
Whitemoor
450
11
2.4
Cat B
Littlehey
716
26
3.6
Cat B/C
Highpoint
920
23
All prisons
3154
80
2.5
2.5
QOF data 2008, national average = 3.9%
Diabetic Eye Screening Service
o
Make contact with PCT prison DSN.
o
Determine number prisons within your area
and establish a named contact in each one.
o
Arrange to visit the healthcare department.
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Organise screening.
Visit to Prison Healthcare.
o
Rapport with healthcare staff
o
Security/ID requirements
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Familiarise yourself with prison layout
o
View screening room to establish needs
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Discuss timetable for day
Organise screening:
Good communication is vital.
o
Ask for list of prisoners – use nhs.net
email.
•
May have no unique identifier.
•
Alias commonly used.
Send an inventory of equipment and summary:
Screening in prison......
o
Really isn’t too bad or scary!
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Only take bare essentials, clear clutter
from van and kit.
o
Be prepared to be searched
o
Keep NHS ID card with you
o
o
You will not be left alone with patients
You will hear some stories!
Admin
o
All correspondence is sent to Prison
Healthcare.
o
Referrals too.
Breakdown of screening outcomes
5
DNA
4
R3/M1
Referral rate = 16%
0
R3
3
R2/M1
2
R2
7
R1/M1
23
R1
57
R0
0
10
20
30
40
50
60
Challenge: Are we doing enough?
We know:
Prisoners are amongst high risk groups.
Referable retinopathy is more prevalent.
Prison population is very fluid.
Most sentences are approx six months duration.
Lack of continuity in medical records.
Good news!
SystmOne rolled out to 60 prisons in the
North, Midlands and East of England from
6th July, 2009.
Approval now gained to extend this to
London and the South where 8 prisons are
already online.
In conclusion:
A different approach?
Annual visits don’t guarantee
annual screening for eligible
patients.
More frequent visits are impractical.
Impossible for prisoners to attend
venues outside prison.
Slit lamp biomicroscopy
performed by a trained,
accredited screener (SLE)
who visits each prison
more frequently –
perhaps quarterly.