Overall they found that progress is being made but there are still areas that require improvement. They recommend that PCTs move beyond ensuring management systems are in place to making sure they are effectively monitoring the quality of the care that they commission. One area they highlighted as a concern is the continuity of care that prisoners receive when they are either transferred or released, which they suggest “seems to be getting worse rather than better”. Detailed below is an overview of progress made, areas that require more focus and their four key recommendations.
Progress made since 2007/08:
- Management systems – all of the PCTs surveyed could now describe the formal service level agreements they have in place. They also all showed improvement in their governance arrangements by holding regular partnership board meetings.
- Clinical governance – the survey showed that all of the 21 PCTs now have systems in place to investigate and review serious untoward incidents and all but one involved clinical advisors in their commissioning process. They found that there was still a high turnover of staff and difficulties in recruitment but staffing arrangements and training were continuing to improve every year. Although progress has been made in improving the quality of information available to PCTs there remains more to be done (see recommendation 1).
- Service plans and frameworks – although there has been progress they emphasise that PCTs were starting from a low base line in this area. However, in 2008/09 all but one of those surveyed had developed a prison health delivery plan.
What still needs to improve:
- Performance monitoring – all of those surveyed were now systematically collecting performance data but they indicated that this is a developmental area (see recommendation 2).
- Personalised care – they report that there is no real evidence from their sample that prisoner involvement has improved and there is a lack of vision “of how to ensure personalised care through commissioning”. They also found that not all commissioners are making sure services are responding to complaints (see recommendation 3).
- Continuity of care – of their sample only one PCT had a continuity of care policy in place with most instead reporting a number of issues that were not working, for example the difficulties in monitoring continuity (see recommendation 4).
Recommendations - their expectations of PCTs in 2010/11include:
- Showing that they are using information systems to review clinical standards and are following up issues with the necessary actions.
- Improving the “sophistication” of the information they gather on the quality of services so that they are better able to “detect and correct unsatisfactory practice”.
- Sharing knowledge of what works in improving prisoner involvement and personalisation of services and demonstrating that they are acting on complaints (or absence of).
- Sharing knowledge of what works well in improving continuity of care and demonstrating that prisons in their area are effectively joined up with other services.