1

Framework for the Delivery of Stop Smoking Services in Prisons

‘The basic principle underpinning health provision within prisons is that services are based upon need and offered to an

equivalent standard to those in the wider Community’

(DH, 2003)

2

ContentsIntroduction 1

Complexities of the Setting 4

Best Practice Checklist 6

Framework for the Delivery of Stop Smoking Services in Prison 7

Conclusions 14

References 15

Useful links 17

Contact Details 18

Acknowledgements

Stephen Woods North West Tobacco Control Co-ordinator Prisons and Criminal Justice Settings

Michelle Baybutt Intervention Manager UCLan

Susan MacAskill Senior Researcher Institute for Social Marketing University of Stirling

Douglas Eadie Senior Researcher Institute for Social Marketing University of Stirling

Jennifer McKell Research Assistant Institute for Social Marketing University of Stirling

The project would also like to thank all those involved in developing this document

The project is part of a portfolio funded by the Department of Health and led by the UK Centre for Tobacco Control Studies (UKCTCS www.ukctcs.org): a UK Public Health Research Centre of Excellence and a strategic partnership of nine universities involved in tobacco research in the UK.

November 2011

3

INTRODUCTION

This document will outline the opportunities identified within North West prisons to enhance the effective delivery of stop smoking services. It will outline the public health opportunities and benefits of delivering targeted services within a prison setting. The document will draw on examples of good practice from HMP services across the North West region and present how creative and innovative approaches can support the delivery of stop smoking services. It will focus primarily on opportunities to enhance service delivery within existing resources and will reflect on how creative use of staff across the system can increase capacity and reduce waiting lists. It is widely recognised that prison healthcare services can provide access to an ‘at risk’ group often deemed hard to reach where innovative approaches can improve health and address health inequalities in areas of multiple deprivation. In addition the document will draw on other examples of practice that challenge the perceptions of offenders being a hard to reach group and present how the prison setting presents an ideal opportunity to deliver stop smoking initiatives.

Background

This document is an output of the delivery of a Department of Health funded Public Health Inequalities Demonstration project, one of 6 such programmes nationally. This project focuses on the role of a Regional Tobacco Control Coordinator: Prisons and Criminal Justice Settings which was established to look toward the organisational/systems perspectives across prisons, probation services, and police custody in relation to tobacco control and stop smoking support and treatment in the North West1. The project is part of a portfolio funded by the Department of Health and led by the UK Centre for Tobacco Control Studies (UKCTCS www.ukctcs.org): a UK Public Health Research Centre of Excellence and a strategic partnership of nine universities involved in tobacco research in the UK. The overall findings and recommendations being used to focus on ‘what works’, recognising complexities such as the constraints within systems for practitioners; challenges of working across organisational boundaries; and the needs of differing audiences, such as commissioners and providers.

Prisons as a Healthy Setting and Public Health Opportunity

The Healthy Settings approach was derived from the WHO strategy of ‘Health for All’ in 1980, followed by the 1986 Ottawa Charter for Health Promotion (WHO, 1980 – WHO, 1986). Both these documents were important steps towards establishing the holistic, multifaceted and multidisciplinary approach embodied by Healthy Settings programmes, as well as towards the integration of health promotion and sustainable development.

"Health is created and lived by people within the settings of their everyday life; where they learn, work, play, and love."

(WHO, 1986)

1 UCLan http://www.healthysettings.org.uk/

1

WHO have defined ‘settings for health’ as “the place or social context in which people engage in daily activities in which environmental, organisational and personal factors interact to affect health and wellbeing” (Dooris, 2006).

In 2000 the responsibility for health policy development and standards passed from HM Prison Service to the Department of Health, Primary Care Trusts becoming fully responsible for commissioning prison healthcare in 2006. This helped change the perceptions of wider offender healthcare presenting opportunities to widen the previous medical model focus and acknowledge the opportunities for addressing the wider inequalities and public health agenda (Baybutt, et al 2006).

The Choosing Health White Paper (DH, 2004) identified the need for greater focus on preventative services, fairer access to health information, resources and care, and greater emphasis on healthier lifestyles, particularly amongst disadvantaged groups. The World Class Commissioning agenda and the work of Sir Michael Marmot (Marmot, 2010) provided the context for the development of cost effective, quality services that are delivered in partnership. The report by Sir Michael Marmot stresses the importance of addressing inequality through joint work between the NHS, Local Authorities and individual communities. The report estimates the cost of inequality as £5.5 billion to the NHS and £31-33 billion to the economy. It is indicated that we currently spend an estimated £2.7 billion a year on treating smoking related illness, but less than £150 million on encouraging smoking cessation (DH, 2011). Prisons and probation present an ideal opportunity to access an otherwise hard to reach and at risk group.

It is clear that prisons can be seen in this holistic way - they are indeed both a place and a social context, albeit in a captive or controlled environment. The opportunities for health promotion are evident in that the majority of the prison population are from deprived backgrounds and in many instances engaged in a variety of risk taking behaviours. The headline findings and the best practice outlined in the 2007 document Stop Smoking Support in HM Prisons: The impact of Nicotine replacement therapy (MacAskill and Hayton, 2007) identifies that substantial quit rates can be achieved in the prison setting acknowledging that in addition to this there is prisoner interest in participation. This paper will build on these finding and the” Acquitted”: Best Practice Guidance document (DH, 2003) using the North West mapping work to present a delivery framework and a checklist for effective delivery of stop smoking services. Certainly the Prison Service Order PSO 3200 (HMPS, 2003) provides an additional lever and tool to consider prisons as healthy settings, supporting health promotion interventions and approaches that acknowledge the holistic ethos set out in the Ottawa Charter (WHO, 1986). It also provides the mechanism to consider how tobacco control activities link to other initiatives and how they fit into the wider strategic level.

In addition to this there are high levels of smoking amongst prisoners (80%). It is reasonable to consider that those in the probation system have an equally high rate, coupled with contributory factors such as high levels of mental health conditions, substance use and educational limitations. It is important that attention is given to the prisoner pathway on release, particularly those released on licence, to help prevent successful quitters relapse. This is supported by evidence from a number of studies across the wider Criminal Justice System. For example, a 2007 survey of offenders on the probation caseloads in Nottinghamshire and Derbyshire revealed that 83% of probationers were smokers compared to only 22% of the general population. (Brooker, et al 2009). In addition to this

2

63% of detainees in police custody in London reported dependence on cigarettes in a 2007 survey (Payne-James, et al 2010).

‘Improving Health, Supporting Justice’ : The National Delivery Plan of the Health and Criminal Justice Programme Board (DH, 2007) proposes a whole system approach and outlines that research has also shown that offenders generally do not access the health services they need outside of prison (DH, 2007). The criminal justice system offers a range of settings and opportunities that, when properly used, would allow health services to engage better the perceived ‘hard-to-reach’ sections of the population. It provides a prime opportunity to address health inequalities, through engagement with NHS health services and specific health promotion, treatment and prevention interventions.

The basic principle underpinning health provision within prisons is that services are based upon need and offered to an equivalent standard to those in the wider Community

(DH, 2003;DH, 2002; DH, 1999)

This is supported in HMP service order PSO 3050 which states that the aim of the partnership between HMP and health ‘is to provide prisoners with access to the same range and quality of services as everyone else’ (HMP, 2006; DH, 1999).

3

COMPLEXITIES OF THE SETTING

‘Acquitted’: Best practice guidance for developing smoking cessation services in prisons (DH, 2003) acknowledges the importance of understanding the role smoking has in the lives of prisoners, in particular relief from both boredom and stress and this is supported from the mapping work to date. This is perhaps further compounded by increased stress points and the lack of variety in diversionary activities in prison;

Offenders as a high risk group Both educational and health literacy issues Lifestyle experiences and risk taking behaviour Isolation – lack of , or a need for, support from partners and family members Boredom and including unemployment;– access to diversionary activities and incentives Culture and masculinity issues relating to men’s health and access to health services Tobacco and its role as currency in prisons including issues of illicit trade Mental health and well-being – depression, anxiety ; confidence self-worth ; emotional

wellbeing; stress and appropriate coping mechanisms Bullying – the social context, relationships and cultures of violence Identity and the need to ‘fit in’ Control over the frequency, ability and affordability of smoking; impact on offenders of staff

smoking – in prison and probation

Barriers / Facilitators

As has been previously outlined, smoking prevalence in prison has been estimated to be around 80%, with similar figures suggested for the probation setting. However smoking habits do change in prison and this can be both positive and negative. The feedback from the mapping exercise indicates that smokers in prison smoke a reduced amount largely due to the reduced supply and in some instances, in a reduction in the frequency of smoking. This is supported by findings from the project rapid literature review (Mac Leod, et al 2010) which cites evidence from a number of sources. The review also identifies a US study from a female prison that indicates an increase in smoking behaviour among inmates showing that 14% of prisoners started smoking for the first time when entering the prison 50% having increased their consumption (Cropsey, et al 2008 cited in Mac Leod, 2010).

From the project mapping exercise it is possible to identify a number of keys issues in the delivery of stop smoking services. The variety of delivery models is in some ways to be applauded, as there have been creative solutions to providing access to stop smoking services. However there are also a number of barriers to delivery. The key area of concern is that of capacity, an issue despite how or who delivers the service. All the prisons have waiting lists which range from 2/3 weeks to potentially 12 weeks, although drop in style services have in some instances resolved this. The number of DNA’s (did not attend) in some establishments is a problem due in many instances to regime issues and difficulties escorting prisoners to sessions or appointments.

4

There are positives and negatives to the mode of delivery. In establishments where the community teams deliver the sessions, the benefits are dedicated time by staff whose core role is delivery of stop smoking services. The negative to this is that staff are less familiar with the complexities of the prison system and the internal nuances, offering greater opportunities for prisoners to abuse the system and use of NRT. Where prison health care staff or gym staff deliver the sessions, the positive is that they understand the internal systems and day to day issues and are perhaps more aware of potential abuse etc. The downside is that the time is not always dedicated or prioritised to the delivery of stop smoking sessions so they are more prone to being cancelled. In some prisons, particularly local remand and female establishments, the turn round of the population presents a challenge to delivery of a structured stop smoking programme and as a result it is understandable to see lower numbers accessing services.

The abuse of NRT is an issue although most prisons have mechanisms in place to monitor the distribution and use of patches in most instances this is on a patch for patch return basis. This coupled with regular/random CO monitoring helps alleviate some of the issues. However in larger prisons, the distribution and monitoring through pharmacy is more complicated and weekly supplies are more frequent. Some prisons use compacts ( a contract) with prisoners commencing stop smoking programmes. These explain the prisoner’s commitment to the programme, outlining the use of CO validation, monitoring the use of patches and in some instances, informing prisoners of potential random cell checks. These measures are useful in terms of controlling abuse of NRT, reducing the opportunity to use it as currency. Both tobacco and NRT are used as currency and there is the potential for bullying to take place as a result. This is an important factor in understanding the role of tobacco in the prison environment.

The use of random CO monitoring is utilised in some establishments to varying success but it certainly provides an additional level of control. It should be feasible in prison to achieve the target of 85% CO validated 4 week quits and there is definitely potential to have 100% CO validation. The only barrier would be prisoners lost to follow up due to release or transfer.

Access to NRT is limited to patches in many establishments although some do actively provide access to Micro tablets, nasal sprays, inhalators and in a small number Champix. However access to Champix is not good and is often only considered in instances where a prisoner has already started on a programme on the outside or has been transferred part way through a course of treatment. Some prisons do not provide access due to the indicated additional suicide and mental health risks. Patches are generally accepted as the preferred treatment option as they are proven to be effective, easily administered and cost effective and this is reflected across the prison system. There is clearly a need to provide some consistency to the wider products available across the system as some prisons have cleared items through security whilst others have not; again these are issues that need to be considered in the training of staff.

The following checklist provides an excellent framework to support the delivery of prison specific stop smoking services. This along with the service delivery framework, will provide a comprehensive tool kit to assess current stop smoking services, outlining a set of minimum standards and identifying best practice to support enhanced delivery.

5

6

BEST PRACTICE CHECKLIST: KEY LEARNING TO MAXIMISE SUCCESS WITH QUITTERS IN PRISON SETTING

Effective partnership development between the PCT and the prison is an underpinning essential -both in health care and the wider prison organisational structures - building relationships through on-going planning and feedback mechanisms for cessation and wider tobacco control issues.

A range of cessation delivery models, both group and one-to-one support, should be available offering flexible support to meet individual needs. Services can be offered through a range of prison staff, i.e. not just health care staff but others such as physical education instructors or Prison Officers. Stop smoking external specialists may run group sessions and staff quit support, but involvement of internal prison staff remains vital.

Protected staff time and role development for those delivering the service needs to be secured, not just for core interaction with quitters, but for administration and record keeping activities which may be more demanding than in community settings. This is important for both prison staff and stop smoking specialists and will also enable advance planning of programme sessions. Sufficient staff should be recruited and supported to provide a sustainable service. An enthusiastic ‘champion’ who promotes the service, co-ordinates activities and liaises across organisations is extremely valuable and should be supported, making cessation part of core work.

Clear record keeping will enable promotion of the service – telling people what is happening and ‘selling’ the successes. This is important for providing rewarding feedback to those delivering the service and making a case for future developments.

Assessing and exploiting the expressed desire to quit among prisoners, as well as interest from staff, will contribute to building the service. Needs assessments and keeping track of waiting lists will help.

Ring-fenced or clearly identified NRT budgets for prisoners and on-going funding commitment continue to be needed. Efficient and economical ordering procedures and effective supply mechanisms should be developed across localities, in conjunction with prison pharmacies and pharmaceutical companies.

Straightforward NRT prescribing and dispensing should be developed within the context of safety issues. Experience shows that weekly dispensing of NRT with return of used patches achieves a balance between empowering prisoners and minimising misuse of NRT as currency. Consistent guidance is needed, for example in use of alternative forms such as lozenges.

Staff training and on-going support by stop smoking specialist services will contribute to high standards and increase confidence among those delivering the service. Network meetings are valuable.

Additional support approaches should be explored and developed, such as peer support, previous quitters joining a session, and access to exercise and healthier food options. Wider involvement of prison staff will contribute to a supportive environment, for example, through Brief Intervention training. Recruitment of prisoners from one wing at a time facilitates mutual support, or at least involving a few quitters at a time from each wing to minimise isolation. Appropriate visual aids and support literature are needed.

Care Pathways should be developed with mechanisms to cope with prisoners being transferred from one prison to another or released during a course of treatment (PSO 3050).

Wider tobacco control interventions, which are being addressed nationally by the Prison Service, should be on the agenda in each prison, considering for example smoke-free cells for non-smokers and quitters and making all ‘public areas’ outside of cells smoke free. This will support cessation attempts and contribute to de-normalising smoking. Staff cessation support should be considered, within the prison or through links to community settings.

Awareness and anticipation of relevant legislation and guidance in relation to prisoner health promotion and workplace issues will enable and support planning and preparation and increase effectiveness – be ahead of the game. This includes the 2006 Health Act and the forthcoming PSO, current PSO 3200 and the requirement for Local Delivery Plans.

(MacAskill and Hayton, 2007)

FRAMEWORK FOR THE DELIVERY OF STOP SMOKING SERVICES IN PRISON

Assessment area Anticipated service delivery

Best Practice

Health Needs Assessment (HNA)completed and up to date

HNA completed and action plan in place.

HNA reviewed and updated on an annual basis.

HNA completed and action plan produced reviewed and updated on an annual basis.

HNA used to develop a wider strategy for prison health care incorporating health promotion and addressing inequalities.

Smoking Policy Present

Smoking policy in place in line with the current PSI.

All staff informed of the policy.

Policy reviewed bi-annually and compliance monitored quarterly.

Smoking cells designated in writing in line with the current PSI.

Non-smoking prisoners housed in smokefree cells.

Prisoners have access to smokefree landings if requested.

Staff smoking closely monitored to ensure compliance with policy.

Core Services delivered (see additional sections)

Applications and assessment process in place to outline motivation and readiness to quit.

Access to weekly support sessions and provision of pharmacotherapy (with regard to pharmacotherapy minimum treatment options being access to NRT patches).

Minimum duration of support 6 weeks. (12 week programme recommended) 4 week Quits CO validated.

Referral to healthcare for prisoners with additional health issues.

Applications and assessment process in place to outline motivation and readiness to quit.

12 week structured programme in place with access to both 1:1 and group support as appropriate.

Dedicated staff time allocated to stop smoking service delivery and all delivery staff trained in line with North West Prisons and Criminal Justice Settings - Stop Smoking Training Knowledge and Skills Competency Framework (UCLan, 2011) and to NCSCT accredited levels - other non- health care staff trained in brief intervention and all staff trained in Very Brief Intervention (VBA).

Health trainers and prisoners involved in supporting the delivery. Services supported by a variety of staff across the wider prison. Protocols in place to monitor and deal with those who do not attend (DNA’s) including where necessary waiting list initiatives.

Systems in place to ensure timely prisoner movement and mechanisms in place to provide speedy follow up when regime/security issues prevent attendance.

In line with regional and local NRT protocols access to patches for the majority of prisoners with additional NRT options including

7

Access to appropriate literature.

combination therapies as appropriate. Access to Varenicline (Champix) for selected

individuals supported by healthcare (it is anticipated numbers accessing will be very low).

Protocols and controls in place for provision and prescribing of NRT and Champix (see below).

All 4 week Quits CO validated (minimum 85%) with regular weekly CO checks in place. Prisoners sign a compact on commencement of treatment outlining their commitment to the programme.

Incentives and diversionary activities in place. Links to partners and visitor centres.

Programme specific literature available (consideration given to literacy and language needs).

Pharmacotherapy support

Routine access to support and NRT in the form of patches as a minimum for all prisoners signing up to a stop smoking programme.

Regular use of CO monitoring.

Access to additional healthcare support for prisoners with additional health needs.

In line with regional and local NRT protocols - Routine access to NRT in the form of patches for all prisoners signing up to a stop smoking programme.

Clear patches prescribed to aid security. Controls in place to monitor prescribing of NRT supplies distributed on a minimum weekly patch for patch return basis including routine/random CO validation/monitoring.

All prisoners achieving 4 quit status to be CO Validated. Prisoners agree a compact on sign up to stop smoking service programmes (including notification of potential random cell searches).

Access to other forms of NRT and combination therapies as appropriate in consultation with healthcare lead.

Varenicline (Champix) available to those meeting criteria.

Referral protocols in place for prisoners with additional health needs.

Priority targeting and access to support for prisoners with long term conditions for example those with COPD.

PCT formularies and protocols reflect access to NRT delivered in the community and delivered in line with regional and local protocols.

8

Funding Funding available for NRT to prisoners ordering arrangements and delivery mechanisms in place.

Monitoring of budget.

Funding available for NRT to prisoners ordering arrangements and delivery mechanisms in place.

Monitoring of budget to identify pressures. Additional allocations to support targeting of prisoners with long term conditions.

PCT payments to prisons achieving successful quits as an incentive to service developments. Consideration given to schemes to support staff in prison to access services.

Structured programme

Prisoners have access to weekly support sessions either on a 1:1 or group basis including monitoring of NRT and CO validation.

Prisoners have access to a 12 week structured programme of support delivered on a 1:1 or group basis or a combination.

Sessions include support, monitoring of NRT use and routine CO monitoring.

There is access to diversionary activities and there is a variety of incentives available to prisoners.

Programmes have clear links to opportunities for physical activity and discussion around diet and nutrition.

Access to information sources – literacy /culturally sensitive

Prisoners have access to basic materials and or verbal support as appropriate there is provision to accommodate any language barriers for example Language Line.

Prisoners have access to a range of support materials as part of a structured programme including information on diet and nutrition to support quit attempts.

Use of a prisoner workbook structured over the length of the programme.

Information is available for partners and family members.

Induction sessions include information on accessing stop smoking services.

Promotional material outlining services are available in Healthcare, communal areas and landings.

Consideration given to literacy levels and language needs in workbooks and promotional materials.

Information included in welcome packs for all those requesting a smoking pack.

Wider Health Promotion Strategy/action plan in place

Prisons operate a Heath Improvement group in line with the PSO 3200. These are governor led and have dedicated

Prison Health Improvement Groups (PHIG’s) have structured action plans which make explicit links across other programmes.

Public health teams are key partners in these groups to support links with other initiatives.

There is good engagement of commissioners

9

action plans. as appropriate and robust links to the Prison Partnership Boards.

Prisoners are routinely represented on these groups.

Work towards removing tobacco welcome packs replacing these with a healthy alternative.

Prisoners involved in delivery of services

Prisoners routinely engaged in service developments and PHIG’s.

Prisoners routinely engaged in service developments and Prison Health Improvement Group PHIG’s.

Prisoners trained up to offer brief Intervention and or support – listeners trained up and allocated to wings.

Use of health trainers (HT’s) trained in additional brief intervention these should include prisoners.

Use Health trainers Prison supports the use of health trainers drawn from staff and prisoners.

Prisoners and staff trained as HT’s to act as champions for health.

HT’s trained in stop smoking brief intervention and potentially as stop smoking advisors.

Staff trained in delivery/support

Delivery teams trained to NCSCT level to deliver services.

Other disciplines trained to offer additional support as reflected in service delivery model.

Nominated prison lead for stop smoking services. Healthcare teams trained to provide advisor role and deliver services.

Multidisciplinary teams trained to provide greater capacity to service delivery. (consideration given to alternative structures including discipline staff, gym teams, and prisoners alongside healthcare).

Community Stop Smoking Teams (CSST’s) deliver training in line with National and Regional framework, CSST‘s key role in maintaining skills, knowledge and competency.

All staff trained in basic health awareness with designated staff trained brief intervention to improve knowledge base and provide greater capacity.

Access to incentives or diversionary activities

Prisoners have access to a range of diversionary activities.

Prisoners have access to a range of diversionary activities especially at daily pressure points when prisoners are in lock down and particularly in the evenings and at weekends.

10

Additional Incentives are in place to support prisoners –

- Extra gym sessions- Access to environmental projects. - Pumping Pad – cell based physical activity

routines- Yoga and Relaxation- Music /Meditation tapes and exercises- Replacements – study, reading , games,

mints, fruit and water- Structured programmes for the day - Sleep hygiene programmes - Puzzles/diary/writing and drawing - Access to additional dental cleaning and

polishing- Beauty/body care treatments

Consideration should be given to the provision of smokefree landings as incentives

Partners and visitors – links/information

Promotional Stop Smoking Service materials displayed in visitors centres.

Robust links in place to ensure partners and family members are aware of prison stop smoking services outlining what they can do to support prisoners.

Referral information is available in the visitor centres.

Visitor centre staff trained in brief intervention.

Certificates utilised for successful quitters that they can share with partners and family members.

Health days in prison take account of the opportunities with family/visitors.

Information on accessing community services available for visitors/family.

Data collection and submission

Data collected and submitted in line with the national guidance.

SystmOne in place to collect and collate stop smoking service data and links with local SSS data collection.

Data monitored on a monthly basis to performance manage delivery.

Dedicated time allocated to the collection, collation and submission of data.

Data reported to the Prison Health Improvement Group (PHIG) as part of the PSO 3200.

Target of 85% CO validation (100% for all completing in the same establishment).

Systems in place to deal with those released or transferred that are potentially lost to follow-up. Routine collection of prisoner occupation categories in line with national

11

guidance. Community stop smoking teams support the collection and monitoring of data.

Pathways/protocols on transfer and release

Recorded information on smoking status and those on Stop Smoking programmes available on release or transfer.

Protocols in place to ensure recorded information on smoking status and progress of those on stop smoking programmes available on release or transfer.

Prisoners released receive a minimum of 2 weeks NRT to support them in the transition and prevent relapse.

All prisoners being released receive information on local stop smoking services and referral links in place for those needing continued support. Those released on licence have access to stop smoking information as part of their Probation induction.

Full assessment on smoking status completed on transfer.

Stop Smoking Service Information made available to all remand and short sentence prisoners.

Support links - mental health and wellbeing – emotional support

Support available for prisoners with additional needs.

Support available for prisoners with additional needs – integrated into initial assessment process.

Referral links in place for those suitable for Champix.

Mental health staff involved in the development of services and staff trained in Brief Intervention (BI). Additional support literature available.

Mental health and wellbeing including emotional support included in the 12 week programme. Staff across the prison system trained in awareness.

Administration of schemes – waiting lists/NRT/patches

Recording and data collection systems in place.

Recording and data collection systems in place.

Dedicated time available for the administration of schemes including protocols for dealing with those who do not attend (DNA’s) and monitoring use of NRT.

Support available from the Community Stop Smoking Teams (CSST’s).

PCT/CCG support Designated Designated Commissioning and Public Health

12

and contacts Commissioners and Public Health

Commissioning and Public Health Leads for Prisons and Offender Health.

Health leads represented on Prison Partnership boards.

Leads for prisons and offender health. Public Health Needs Assessments (PHNA)

regularly reviewed and partnership mechanisms in place between offender health and tobacco control leads – prisons included as part of a wider public health offender health strategy.

Commissioners and Public Health Leads working across PCT’s /CCG’s to design and commission services collaboratively.

Prisons and offender health feature in all PCT/CCG and HWB’s plans as appropriate. Designated public health representation at Prison Health Improvement Group (PHIG).

Staff Support available

All staff have access to local Stop Smoking Service information.

Staff have access to service information in the workplace stop smoking sessions available to and or voucher scheme operational.

Key staff trained in brief intervention to act as a support and referral route for staff wishing to stop smoking.

Ensure compliance with smoking policy and PSI 09/2007 (HMPS, 2007) to support and protect staff from exposure to the harm from second hand smoke (Staff only being allowed to smoke in designated areas at dedicated times).

Prisons working towards Smokefree environments for staff.

Additional observations

Development of a regional prison health strategy that includes both prisoners and staff. This could be supported by the PSO 3200 prison health promotion groups with support from the North West Health Promoting Prisons Network.

Potential for collaborative commissioning of offender health across a wider foot print rather than just on existing PCT areas for example on a county or North West basis.

Offender Health needs to be a key feature in the development of Health and Wellbeing Boards (HWB’s).

Widening access to smokefree areas in prisons, for example smokefree landings.

CONCLUSIONS

13

The provision of comprehensive stop smoking support in prisons can have marked successes with positive outcomes for staff, prisoners, their families, and the wider community and for public health goals.

It is clear from the mapping activity that there is scope to review and develop the delivery of stop smoking service provision in individual establishments within existing resources and without the need for additional investment. However in order to meet the best practice requirements in full individual establishments and commissioners may wish to consider investing in additional resources to increase capacity and support comprehensive delivery.

A number of the North West prisons have enhanced the delivery of services by a systematic review of internal delivery processes. Following a systematic process review it has been feasible to put in place a number of structural/system changes that have increased access, reduced waiting lists, enhanced attendance figures and improved the quality of the service provided. In many areas the Community Stop Smoking Teams have trained additional prison staff to increase workforce capacity and build a strong skills and knowledge base.

Attention has been given to the administration of schemes and mechanisms put in place to reduce the abuse of NRT and so reduce pharmacy costs.

This document has drawn together the learning and best practice from the mapping activity and provides a framework to support the delivery of a comprehensive and integrated service. It outlines what can be put in place to ensure the delivery of a quality service. Individual establishments, service commissioners and public health teams would benefit from additional support in carrying out a stop smoking service review utilising this delivery framework.

14

REFERENCES

Baybutt M, Hayton P & Dooris M (2006). Prisons in England & Wales: An important public health opportunity? Chapter in Douglas S, Earle S, Handsley S, Lloyd C & Spurr S (eds), A Reader in Promoting Public Health: Challenge & Controversy. Milton Keynes: Open University Press, pp. 237-245.

Brooker C, Fox C, Barrett P & Syson-Nibbs L (2009). A Health Needs Assessment of Offenders on Probation Caseloads in Nottinghamshire & Derbyshire: Report of a Pilot Study. Lincoln: CCAWI University of Lincoln.

Department of Health (DH) (1999).The Future Organisation of Prison Healthcare. London: Department of Health.

Department of Health (DH) (2002). Health Promoting Prisons: A Shared Approach. London: Department of Health.

Department of Health (DH) (2003). Acquitted: Best Practice guidance for developing smoking cessation services in prisons. London: Department of Health.

Department of Health (DH) (2004). Choosing Health: Making Healthy Choices Easier. London: Department of Health.

Department of Health (DH) (2007). Improving Health, Supporting Justice. London: Department of Health.

Department of Health (DH) (2011). Healthy Lives, Healthy People: A Tobacco Control Plan for England. London: Department of Health.

Dooris M (2006). Healthy settings: challenges to generating evidence of effectiveness. Health Promotion International, 21(1): 55-65.

H.M. Prison Service (HMPS) (2003). Prison Service Order (PSO) 3200 on Health Promotion. London: HM Prison Service.

H.M. Prison Service (HMPS) (2006). Prison Service Order (PSO) 3050 Continuity of Healthcare for Prisoners. London: HM Prison Service.

H.M. Prison Service (HMPS) (2007). Prison Service Instruction 09/2007. Smoke free legislation: prison service application. London: H.M Prison Service.

MacAskill S & Hayton P (2007). Stop Smoking Support in HM Prisons: The Impact of Nicotine Replacement Therapy. Includes Best Practice Checklist. London: Department of Health. Online:http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_073032.pdf

Marmot M (2010). Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England Post 2010. UCL Institute for Health Equity.

15

Payne-James JJ, Green PG, Green N, McLachlan GMC, Munro MHWM & Moore TCB (2010). Healthcare issues of detainees in police custody in London UK. Journal of Forensic and Legal Medicine, 17(1): 11-17.

University of Central Lancashire (UCLan) (2011). Prisons and Criminal Justice Settings Stop Smoking Training: Knowledge and Skills Competency Framework .

World Health Organization (WHO) (1986). Ottawa Charter for Health Promotion. Geneva: WHO.

World Health Organization (WHO) (1980). Health for All. Geneva: WHO.

16

USEFUL LINKS

www.uclan.ac.uk/hsdu

www.healthysettings.org

Healthy Settings Unit

University of Central Lancashire

www.ctcr.stir.ac.uk

Centre for Tobacco Control Research University of Stirling

www.tobaccofreefutures.org

Tobacco Free Futures

(Formerly Smoke Free North West)

www.ukctcs.org

UK Centre for Tobacco Control Studies

www.ncsct.co.uk

NHS Centre for Smoking Cessation and Training

www.ash.org.uk

ASH Action on Smoking and Health

www.nosmokingday.org.uk

No Smoking Day 2012

www.roycastle.org

The Roy Castle Lung Cancer Foundation

17

CONTACT DETAILS

Stephen Woods

North West Tobacco Control Co-ordinator, Prisons & Criminal Justice Settings Demonstration Project, UCLan

smwoods2@uclan.ac.uk

01772 893651

07891 614692

Michelle Baybutt

Intervention Manager UCLan

mbaybutt@uclan.ac.uk

01772 8933764

www.healthysettings.org.uk

18