Lancashire Police Force by 6fZpX3Vk

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									Lancashire Police
     Force

  Offender Health
Needs Assessment
 - Police Custody

      2012
Contents
                                                                     Page
Executive Summary                                                             3

Background                                                                    3

Current Position                                                              4

The Health Needs Assessment                                                   5

Custodial Environments in Lancashire                                          5

Juvenile Establishments in the North West                                     8

Female Establishments in the North West                                       9

Probation / Youth Offending Services in Lancashire                          10

Overview                                                                    11

Local Demography                                                            11

Current Healthcare Provision in:           Police Custody                   13

Crime in Lancashire                                                         21

Current Health Provision in Lancashire: Prison                              22
                                        Probation
                                        Youth Offending Services

Current Health Provision in the Lancashire Area                             25

Overview of Lancashire Custody HMIC Report                                  25

ROHT Recommendations                                                        26

Scope and Limitations for the Report                                        27

References                                                                  27

Who was involved in the process                                             28

Gap Analysis                                                                28

Appendices                                                                  29




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Executive Summary

This Health Needs Assessment presents an overview of the health needs of offenders
primarily within the custody suites of Lancashire Constabulary. It also explores the needs of
offenders who are in contact with community criminal justice agencies, namely the National
Probation Service, Youth Offending Teams and Integrated Offender Management (IOM)
across Lancashire.

Data has been gathered to inform this document via Lancashire Police, Medacs, Lancashire
Care Foundation Trust, Lancashire DAT Teams, local Primary Care Trusts and Local
Authorities. A range of issues have been identified in this document and five
recommendations have been made for service improvement and development.

The benefits of completing a robust health needs assessment will; enable improved
partnership working between the police and NHS, more informed and improved identification
of the clinical need of individuals coming into contact with criminal justice services including
detention in police custody suites, improved and integrated pathways between the Criminal
Justice System and the wider health and social care agencies and the opportunity for more
appropriate staff training and understanding of the needs of offenders, particularly those with
mental health problems and those with a learning disability.

Background

In 2009 Lord Bradley published a review into how the Criminal Justice System (CJS)
interacted with those suffering with mental ill health problems and those with a Learning
Disability, the Healthy Children, Safer Communities report also published in December of
2009 identified the needs of children and young people in contact with CJS. The needs of
women had been identified in the 2007 Baroness Corston review of women with particular
vulnerabilities in the CJS and were again referenced in the Bradley Report. The
recommendations made in these reports were accepted by the previous government under
the “Improving Health, Supporting Justice” delivery plan and have now been adopted by the
coalition government.

Nationally governance of the deliverables is now via the National Health and Criminal Justice
Board which has cross government representation from the Department of Health (DH),
Ministry of Justice (MoJ), Home Office (HO), National Offender Management Service
(NOMS) and Association of Chief Police Officers (ACPO).

On the basis of Lord Bradley’s recommendations, the Board currently manages two
deliverables that affect the way that the NHS interacts with policing, namely:
     The transfer of commissioning, budgetary responsibility and accountability for police
        detainee healthcare, forensic provision and Sexual Assault Referral Centres (SARC)
        to the NHS by April 2013.
     The development of mental health criminal justice liaison and diversion schemes.

Both the Minister for Social Care, (DH) and the Policing Minister, (HO) have now signed off a
joint submission detailing the benefits and trajectory of the transfer, which is inclusive of an
Early Adopter programme, for which Lancashire Police has been accepted.

It is important to point out that this is a transfer of commissioning, as opposed to a transfer of
provision. A commissioner in conjunction with the police partnership board will make an
assessment in the transfer process as to who the best provider may be, based upon cost,
quality and scope of provision. Such a decision would need sign off by both the NHS and the
police.



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Rationale for Change

All chief constables received a letter from Acting Commissioner; Tim Godwin, ACPO Criminal
Justice Business Area inviting expressions of interest to become early adopters to a
commissioning transfer during 2011/12. This letter outlines some of the organisational
benefits to the services for change including:
     The transfer of the organisational risk of health provision in police custody and
        SARCS to the NHS.
     The development of improved care pathways for detainees in need of immediate
        access to Accident and Emergency.
     The eventual transfer of any clinical and financial liabilities to the NHS commissioner.
     Improved engagement with health colleagues to signpost and manage the healthcare
        of offenders upon their return to the community to reduce their re-offending.
     A reduction in re-offending based upon better engagement with health services
        particularly around drug, alcohol and mental health provision.

In turn, the NHS anticipate that they will improve the quality of service delivery to disengaged
groups who fail to register with healthcare services in the community, thus reducing the
likelihood of such groups presenting to NHS services at a point of crisis, by better and earlier
identification and management of their clinical needs and improve public health outcomes.

The transfer of commissioning responsibility from the police to the NHS will provide an
opportunity to develop and deliver services that are aligned and integrated with the wider
health and social care services. Contribute to the reducing re-offending objectives of all CJS,
by providing increased support to vulnerable individuals, easier access to services and better
understanding of the needs of offenders with improved training and joint working.

In the meantime, the current NHS reorganisation will lead to the development of an NHS
National Commissioning Board that will eventually have responsibility for commissioning all
healthcare services in secure settings. It is likely that regulations will be introduced in the next
spending review of March 2015 that would include police custody suites in these provisions.

Current Position

Early Adopter sites have been selected against set national criteria including size, NHS
commissioning experience and the flexibility of current commercial contracts within the early
adopter project timeframe. Twenty forces applied to be Early Adopters, of which ten have
been accepted. (See Appendix A for the list of successful forces)

Lancashire Police have been awarded £80k annually for two years, with the option to opt out
after one year, to engage with an NHS Commissioner to establish a partnership board to
undertake this process.

Lancashire Police currently have a commercial contract with Medacs for the provision of
forensic health services for police detainees. However, at the end of 2011, a tendering
process was completed in conjunction with the NHS Commissioner, a decision has yet to be
made regarding who has been awarded as the new contract provider. It is expected the new
contract will commence in April 2012.

An integral element of the Early Adopter work is to complete a Health Needs Assessment
(HNA) within the custody suites within each Constabulary. This information will better inform
the DH and NHS Commissioners with regard to the health needs and services required both
within custody and community services, to ensure the safe detention and handling of
detainees, reduce reoffending and improve public health outcomes. The two year pilot



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allows the NHS and HO time to develop arrangements to work in partnership, share learning
and establish robust working relationships prior to the expected legislation change in 2015,
which will transfer accountability for commissioning all Police health provision to the NHS
from the HO.

The Health Needs Assessment (HNA)

    Aim of the Health Needs Assessment

This Health Needs Assessment will examine the health needs of those detained within the
custody suites across Lancashire. This data will be compared to national, regional and local
trends wherever possible. This comparison will allow us to ascertain if offenders have a
disproportionate need, examine current provision and identify unmet needs. Thus, informing
the commissioning process nationally and locally. Where improved access to services is
developed, it is hoped there will be a reduction in reoffending, increased community safety
and improved public health outcomes.

    Area to be Needs Assessed

This Health Needs Assessment will look at police custody primarily, with additional data from
Prisons, Probation and Youth Offending Teams, where available, to support a better
understanding of the health requirements of the overall population, specifically offenders
involved with police custody and the impact on current health service provision across
Lancashire.

    Data Required to complete the HNA

Collating the data shown as Appendix C will provide information to identify what the current
health needs of the specified population are in comparison with regional and national trends.
This will allow a better understanding of the health and associated services required to meet
these needs in the Lancashire area. Improved and regularly updated information will also
allow the partnership to assess changes in current service needs, manage potential future
need and plan accordingly.

The final HNA report will be signed off by the Lancashire Police / NHS partnership Board and
shared with local partners and the Department of Health as part of the Early Adopter Pilot as
detailed above.

Custodial Environments in Lancashire

Police Custody;
There are six police divisions with seven regularly used custody suites, the seven custody
suites (highlighted in bold) located within the six divisions are detailed below;




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       Central Division               Pennine Division         Western Division
       Fulwood                        Bacup                    Blackpool
       Lea                            Barnoldswick             Bispham
       Preston                        Burnley                  Kirkham
                                      Colne                    Lytham St Annes
       Eastern Division               Haslingden
       Accrington                     Nelson
       Blackburn                      Padiham
       Clitheroe                      Rawtenstall
       Darwen
       Great Harwood                   Southern Division
       Longridge                      Bamber Bridge
                                      Burscough
        Northern Division             Chorley
       Carnforth                      Coppull
       Cleveleys                      Leyland
       Fleetwood                      Ormskirk
       Garstang                       Penwortham
       Heysham                        Skelmersdale
       Lancaster                      Wheelton
       Morecambe
       Poulton le Fylde

The seven custody suites have a throughput of 64,192 offenders annually (see below);

                               Total No. through Lancashire Police Custody
Oct  Nov Dec Jan Feb Mar Apr May Jun Jul          Aug Sep Total
6051 5762 5128 5667 5009 5113 5096 5343 5293 5378 5116 5236 64,192
(Data received from Lancashire Police Dec 2011)


As can be seen from the data above there are monthly fluctuations to the numbers through
custody, which may be explained as follows;

Predictable calendar events: There are times when custody will experience increases due
to bank holidays, New Years Eve, Good Friday, Easter weekend, most of the bank holidays.
There may also be peaks during festivals and other events such as the end of Ramadan.

Weather: During hot weather custody notes an increase due to alcohol yet last year during
the heavy snows there was a decrease attributed to people staying at home in the
abnormally cold weather.

Demonstrations & pre-planned events: Although pre-planned they can have an effect
especially if it’s a football match that’s a derby. Last year the Lancashire area experienced 3
demonstrations by EDL, which did not have any impact on custody numbers.

Some of those offenders require medical treatment when in custody, a breakdown of the
volume of calls to Medacs for the period October 2010 - September 2011 is below. See
Appendix B for an overview of the Lancashire area with current healthcare call out data.




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                                Total No. of Calls to Medacs for health input
                                   Volume of              No of             % of
                                       calls           attendees        attendances
                     Oct-10            2030               1913              94.24
                     Nov-10            2093               1925              91.97
                     Dec-10            1426               1377              96.56
                     Jan-11            1877               1750              93.23
                     Feb-11            1668               1577              94.54
                     Mar-11            1907               1770              92.82
                     Apr-11            1675               1649              98.45
                     May-11            1793               1755              97.88
                     Jun-11            1571               1543              98.22
                      Jul-11           1674               1643              98.15
                     Aug-11            1898               1581              83.30
                     Sep-11            1967               1589              80.78
                    Total             21579              20072              93.02
                                    (Data received from Lancashire Police Dec 2011)


Prisons;
There are five prisons in the Lancashire Area, which contribute towards the population
residing in the Lancashire as detailed below;

Prison Name          Prison            Operational               % of                   Area in      NHS Lead
                    Category             Capacity              Offender               Lancashire    Provider for
                                      (ie maximum             Population                Prison     Health in 2009
                                        number of                from                  occupies
                                     detainees held           Lancashire
                                          in the                 area
                                     establishment)
HMP Garth                 B                847                     13%                 Leyland          Central
                                                                                                   Lancashire PCT
HMP Kirkham               D                  592                  19.6%                Kirkham     North Lancashire
                                                                                                         PCT
HMYOI                    C                   517                   24%                Lancaster    North Lancashire
Lancaster              (YOI                                                                              PCT
Farms                Training)
HMP Preston              B                   842                  80.5%                Preston         Central
                                                                                                   Lancashire PCT
HMP Wymott                C                 1176                  37.8%                Leyland         Central
                                                                                                   Lancashire PCT
                           Total 3974 (max) prisoners residing in Lancashire Prisons
(Data sourced from www.hmprisonservice.gov.uk)


HMCIP Inspection Reports of 2009 have described the prisons as follows;
HMP Garth – is a category B training prison holding men who have committed serious and
violence offences and are serving long or indeterminate sentences.

HMP Kirkham – an impressive open prison, it manages its risks well, focusing on safety,
setting appropriate boundaries and confronting poor behaviour.

HMYOI Lancaster Farms – “Lancaster Farms has made significant progress since our last
visit. It is now a safer place, although the continuing levels of violence mean that there is no
scope for complacency.” (it should be noted this quote was taken from the HMCIP Report of 2011).


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HMP Preston – is an inner city prison with a transient population of needy and sometimes
challenging prisoners. (NB: it should be noted that HMP Preston is a local prison receiving both
remand and sentenced prisoners from local crown and magistrate courts, which will explain why HMP
Preston has such a high % of local people on the table above)

HMP Wymott – a prison that has managed to progress despite a considerably increased and
very varied population.
(the full reports can be found at www.justice.gov.uk/inspectorates/hmi-prisons)


It should be noted that since the HMIC reports were written, the Lead Provider from the 1st
April 2011 for all five prisons is Lancashire Care Foundation Trust.

A snapshot of people in prison by the Prison Reform Trust Bromley Briefings Factfile of
December 2010 (www.prisonreformtrust.org.uk/portals/0/Documents/FactfileDec10small.pdf) found that;
    The average age of those sentenced to custody in 2006 was 27, a quarter was aged
      21 or under.
    The number of sentenced prisoners aged 60 and over rose by 119% between 1999 –
      2009.
    At the end of September 2010 there were 11,062 foreign national prisoners (defined
      as non-UK passport holders), 13% of the overall prison population.
    23% of young offenders have learning difficulties (IQ below 70) and 36% borderline
      learning difficulties (IQ 70-80).
    In HM Inspectorate of Prison Surveys, 15% of people in prison reported a disability.

HMCIP have reported that 19% of prisoners surveyed by HM Inspectorate of Prisons
reported having an alcohol problem when they entered prison, it was even higher among
young adults at 30% and women at 29%. (HM Chief Inspectorate of Prisons for England and Wales (2010)
Alcohol Services in Prisons: an unmet need, London: HMCIP).


The UK Drug Policy Commission (2008) Reducing Drug Use; Reducing Re-offending,
London: UKDPC reported between a third and a half of new receptions into prison are
estimated to be problem drug users (equivalent to 45,000 – 65,000 prisoners in England and
Wales.

However, a recent study completed in a Scottish prison on the use of the AUDIT screening
tool, showed a higher prevalence of alcohol problems with 73% of sentenced prisoner scores
indicating an alcohol use disorder. (Assessment of alcohol problems using AUDIT in a prison setting: more than
an 'aye or no' question, Susan MacAskill, Tessa Parkes, Oona Brooks, Lesley Graham, Andrew McAuley and Abraham Brown)


Juvenile Establishments in the North West

Whilst there is not a Juvenile prison within the area of Lancashire, HMYOI Hindley is the only
Juvenile establishment for the North West area and as such will house juvenile offenders
from the Lancashire area.

HMYOI Hindley caters solely for male offenders aged between 15 and 18 years and has an
operational capacity of 440. The average sentence length for the whole population is
approximately 20 months however, 41% of Hindley’s population serve less than a 12 month
Detention and Training Order sentence.

There is a full range of healthcare services available to the young men at HMYOI Hindley
however demand for the Dentist and the Vaccination Clinics is high. It is also noted that
many young men coming into the establishment exceed the safe guidelines for alcohol



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consumption prior to detention with almost half of the juvenile population drinking either
harmfully (22-50 units weekly) or hazardously (over 50 units weekly).

Substance misuse is a problem for young people with 65% of adolescents experimenting
with illegal drugs. 69% of juveniles arriving at Hindley have used drugs in the week prior to
custody, with Cannabis being the main drug of choice, followed by Cocaine, Methadone and
Amphetamines.

HMYOI Hindley is a no-smoking establishment, however 96% of offenders entering Hindley
are smokers and therefore a comprehensive smoking cessation package is available.

All young people entering the establishment undergo a comprehensive mental health
assessment by an RMN, any young person identified as needing further input is then referred
to the appropriate service. (Data sourced from HMYOI Hindley HNA 2010)

Female Establishments in the North West

On 12 June 2009 the number of women in prison in England and Wales stood at 4,269, 236
fewer than a year before(1). In the last decade the national women’s prison population has
gone up by 60%. In 1997 the mid-year female prison population was 2,672. In 2000 it stood
at 3,355 and in 2007 it was 4,283. A total of 11,847 women were received into prison in UK
during 2007(2).
HMP YOI Styal is one of the largest women’s prisons in the UK prison estate and is the only
female prison in the North West, it should be noted that HMP Styal is also a local prison
receiving both remand and sentenced prisoners from local crown and magistrate courts.
Like all women’s prisons, following the shrinkage of the female estate, it needs to multi-task:
holding second stage lifers as well as young adults and short-sentenced and remanded
women coming directly from court. Prisoners entering HMP YOI Styal have complex
healthcare needs as well as a range of learning disabilities that are not often recognised.

The healthcare contract at HMP YOI Styal is run by Cheshire East Community Health
(CECH) and Greater Manchester West as a collaboration. The current contract became
operational in April 2009. There is a doctor on site covering routine GP services Monday to
Friday, limited access on Saturdays for receptions and no service on a Sunday.

Clinic sessions cover genito-urinary health and family planning, Nurse Triage, stop smoking,
bloods, independent drug treatment services, midwifery and sonography services. Once a
month, there is a specialist podiatry service which is arranged by referral only. There is a
fortnightly optometrist service. In addition, there is a family support worker who works with
women with children who have drug and alcohol issues. The Healthcare Centre (which is in
need of modernisation) does not provide in-patient care. Consultant psychiatrist clinics and
visiting counsellors are facilitated by the Mental Health In-Reach Team and a day care centre
deals specifically with prisoners with primary mental health problems.

The age distribution of prisoners at HMP YOI Styal can be broken down as follows;




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                                    Age                  Number of          Percentage
                                                          Women                 (%)
                         18-20 years                        42                   9
                         21-29 years                       127                   31
                         30-39 years                       157                   37
                         40-49 years                        87                   20
                         50-59 years                        13                   3
                         60-69 years                        3                    1
                         70 years plus                      0                    0
                         Maximum age                        0                    0
                         Total                             429                 100
                        (Table – Age distribution of prisoners at HMP YOI Styal 01/05 Sept 2008)

It has been noted that prisoners are increasingly coming into HMP YOI Styal with multiple
healthcare needs. Since the HNA took place in 2005 those entering prison with alcohol
problems have risen to 40%. (Taken from the HM Inspection Report 2008)

The average age of the prison population within HMP YOI Styal has begun to shift from an
average of 22 years old to 28 years old. This age shift means that more people are coming
into HMP YOI Styal with chronic diseases.

There has also been an increase in the number of wheelchair users.

There is still a mixture of both long and short periods of remand and sentences for women at
HMP YOI Styal, but the average length of stay is 6-7 weeks. This relatively short time period
can have an impact on healthcare, for example smoking cessation programmes last for 12
weeks, appointments for specialist clinics and services may not be achieved and women
requiring counselling services to support identified psychological needs are more difficult to
access due to the high turnover of the female prison population. If a prisoners’ stay is
shorter then data is either incomplete or lost.
(Data sourced from HMP Styal Health Needs Assessment 2009)


Probation / Youth Offending Services;

There are 14 Probation Offices in Lancashire and 8 Youth Offending Service offices, detailed
below;

Probation Centres in Lancashire;                                Accrington
                                                                Blackburn x 2
                                                                Blackpool x 2
                                                                Burnley
                                                                Chorley
                                                                Fleetwood
                                                                Lancaster
                                                                Morecombe
                                                                Preston x 2
                                                                Nelson
                                                                Skelmersdale




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Youth Offending Service Offices in Lancashire;                    Blackburn
                                                                  Blackpool
                                                                  Lancashire with offices in: Burnley /
                                                                  Chorley / Hyndburn / Lancaster / Preston /
                                                                  Wyre & Fylde

Overview

The link between crime and ill health is long established, these client groups include children,
young people and women who are often amongst the most vulnerable in our society.
(McManus, J (2000a) Health & crime: some issues from the literature, London: Nacro, Robinson, F, Keithley, J, Robinson, S
and Childs, S (1998) Exploring the Impacts of Crime on Health and Health Services: A Feasibility Study, Durham: University of
Durham)


Offenders lifestyles are often chaotic and lack stability, many who go through custody have
been in care or involved with Social Services. Mental Health needs, issues with substance
misuse and alcohol abuse are prevalent. In the majority of cases offenders have been
excluded from formal educational settings from an early age and therefore lack the skills
required to access many support systems available to them. It is also known that many
people in the criminal justice system face multiple disadvantages, have complex needs and
often face numerous barriers to engaging in education, training and employment.

The criminal justice system can act as a gateway to health services for vulnerable people
who find it hard to access mainstream health and social care services and indeed significant
health gain can be made in this way while a person is in custody. The challenge is to not
only affect this move towards health improvement whilst in custody but to maintain this on
discharge with community services. It is also imperative to ensure the safe detention and
handling of detainees whilst in custody.

Local Demography

The population breakdown for the 12 County Districts and 2 Unitary Authorities in the
Lancashire area is shown as Appendix D. (Data collected from the Office of National
Statistics 2009.)

The population of Lancashire is estimated at 1,166,000 with 90.9% of the population from a
white ethnic background which is higher than the national average of 87.5%, however the
areas of Preston, Blackburn and Pendle show a notable percentage of residents in the BME
group greater than the England average of 12.5%(1).

A breakdown of the age of the Lancashire population is shown below (1 Figures supplied via Office of
National Statistics 2010);


             Age Ranges            Percentage             Females                  Males
                                     for all
                                     people
                  0-14                17.6                   16.3                   18.4
                  15-24               13.6                   13.0                   14.1
                  25-44               24.6                   24.1                   25.0
                  45-64               26.6                   26.7                   26.7
                   65+                17.6                   19.4                   15.8




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   30
   25
                                                                             0-14
   20                                                                        15-24
   15                                                                        25-44
   10                                                                        45-64
                                                                             65+
    5

    0
         Percentage for all people         Females          Males


Overall the health of people in Lancashire is mixed compared to the England average.
2
 Deprivation is high, with more than 45,000 children living in poverty, with the areas of
Blackburn, Blackpool and Burnley the most deprived in the area.

Children in the county of Lancashire achieved 56.7% of GCSE grade’s A-C marginally higher
than the national average of 55.3% but Blackburn, Blackpool and Burnley results are worse
than the England average with Burnley attaining 38.8% which is as low as England’s worst
area.

Generally the level of violent crime in the county is lower than the national average of 15.8
per 1000 population though the areas of Preston and Blackpool show higher rates of violent
crime, Blackpool is the highest in Lancashire at 30.2.

Long term unemployment is at its highest in the area of Blackpool at 7.1 per 1000 population
but this is only marginally worse than the England average of 6.2.

The level of teenage pregnancy in the county is higher than the national average of 40.2 per
1000 population at 41.7 with the highest number in Blackpool, Preston and Burnley.

Life expectancy for both men and women is lower than the England average of 78.3 at birth
2007-09 and 82.3 respectively. Whilst early death rates from cancer 119 per 100,000
population under 75 and heart disease and stroke 76.4 have fallen in the last ten years they
remain worse than the England averages of 112.1 and 70.5 respectively and hospital stays
for alcohol related harm 2193 per 100,000 population are higher than average.

Obesity is prevalent in the Lancashire area with 22.5% of adults classed as clinically obese
against the national average of 24.2%.

The percentage of smokers in the county is 22.3% slightly higher than the national average
of 21.2% however the number of smoking related deaths is significantly worse than the
national average with approximately 2297 per 100,00 population aged 35+ deaths each year.
Whilst all areas in the county contribute towards this the highest number is recorded in
Blackpool.

Increasing and higher risk drinking is not significantly worse than the national average of
23.6% at 29.3% for the county it is at it’s worst in the South Ribble area with 33% however,
hospital stays for alcohol related harm are significantly worse than the national average with
30,637 per 100,000 population people admitted to hospital every year with the areas of
Blackpool and Blackburn the most affected for this.

Drug misuse in the county is lower than the national average of 9.4 per 1000 population aged
16-34 years at 9.1 although Blackpool at 23.8 and Burnley at 19.5 are the most affected
areas.



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Hospital stays for self harm in the county are higher than national figures with Blackpool and
Blackburn yearly figures significantly higher at 480 per 100,000 population and 499 hospital
stays for self harm per year.

The Table and Graph detailing the above is shown as Appendix E                      (2Data sourced from the Public
Health Observatory Health Profile of Lancashire 2011).


23% of young people aged 15 to 23 years have been tested for Chlamydia, with a positive
results rate of 6.8%. The test and positive results rates vary across PCT, with 26% of young
people tested in Central Lancashire and 21.2% in East Lancashire, but with positive test
rates of 8.7% in Blackpool and 6% in North Lancs. (NI113 - http://www.chlamydiascreening.nhs.uk)

Rates of selected STI & acute STI diagnoses per 100,000 population, by patient PCT: 2009
(Health Protection Agency).

                                                          Rates per 100,000 population: 2009
                                 Chlamydia (by           Gonorrhoea Syphilis Herpes          Warts         Acute
                                   age group)                                                              STIs
                                 15-24     25+
 Blackburn with Darwen           2395.4      92.0           13.5         2.8       44.1      151.4        824.6
 Blackpool                       4357.7      176.2          57.1        17.6       84.6      235.4        1328.3
 Central Lancashire              2662.1      98.1           18.1         2.2       55.4      174.9        874.7
 East Lancashire                 2531.9      75.4           19.8         4.2       44.2      159.7        789.6
 North Lancashire                2193.3      75.5            8.8         2.7       58.6      160.4        752.4
 North West Average              2639.4      103.1          26.8         5.7       55.1      170.0         848.9

The Place Survey asked people to assess their overall health and wellbeing. This is used as
a proxy indicator for mental health. There is a stronger association with deprivation in
Lancashire than England and Blackpool and Pendle have poorer health than would be
predicted by deprivation level.

Mental health related emergency admissions to hospital are high in Lancashire and in
2007/08 there were almost as many as there were for chronic heart disease and more than
the numbers for asthma and diabetes combined.

Mental health related emergency admissions are most common in the most deprived areas
and were 70% higher than expected given national patterns.

It is estimated that 28,750 people across the Lancashire area have learning disabilities. This
is approximately 3% of the population. Of these, 5,383 have moderate to severe disabilities.
(Emerson, E et al (2001) Learning Disabilities the Fundamental Facts London The foundation
for People with Learning Disabilities)

Current Healthcare Provision in Police Custody

Lancashire Police Constabulary currently employ Medacs to comply with Safer Detention
and Handling of Prisoners (SDHP) and Police and Criminal Evidence Act (PACE) guidance
regarding detainees in police custody (documents attached as Appendix F). Across the
seven custody suites 15 nurses and 5 Forensic Medical Examiners (FME’s) work with the
police dealing with approximately 21,500 health related call outs per year.




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For the month of September 5,981 persons were detained within Lancashire’s custody
suites, with 16% female offenders. The breakdown of people in the Lancashire area
detained by Lancashire Police for the month of September 2011 is below;

                           No. of persons detained in the period 1st – 30th September 2011
Custody Suite
                          Total Number         Number of Females             Number of Males
Blackburn                     1105                      141                        964
Blackpool                     1392                      241                       1151
Burnley                       1062                      153                        909
Lancaster                      784                      166                        618
Leyland                        343                       53                        290
Preston                        918                      152                        766
Skelmersdale                   377                       63                        314
Total                         5981                      969                       5012
(Data collected October / November 2011)


Out of the 5,981 detainees, 1,928 (32%) required medical intervention by Medacs, with 19%
of those seen being female. The number of people detained in Lancashire Police custody
and seen by Medacs for treatment is detailed below;

                             No. of persons detained and seen by Medacs in the period
                                             1st – 30th September 2011
Custody Suite            Total No. of    No. seen by      % of Detainees   No. of Custody
                          Detainees        Medacs         seen by Medacs records reviewed
                                                                              by ROHT
Blackburn                   1105             326              29.5%               29
Blackpool                   1392             398               29%                35
Burnley                     1062             307               29%                41
Lancaster                    784             276               35%              28 *
Leyland                      343             124               36%                12
Preston                      918             403               44%              35 **
Skelmersdale                 377              94               25%                12
Total                       5981            1928               32%               188
(* Although 28 records were reviewed one detainee appeared three times in the period, therefore data for 26 detainees was
collected.) (** Although 35 records were reviewed one detainee was released from custody before they were seen by Medacs
and one detainee appeared twice in the period.)


                             No. of persons detained and seen by Medacs in the period
Custody Suite                                1st – 30th September 2011
                          Total Number         Number of Females        Number of Males
Blackburn                      326                        36                    290
Blackpool                      398                        90                    308
Burnley                        307                        52                    255
Lancaster                      276                        61                    215
Leyland                        124                        14                    110
Preston                        403                        86                    317
Skelmersdale                    94                        25                    69
Total                         1928                       364                   1564
(Data collected October / November 2011)


The ROHT reviewed approximately 10% of custody records of those detained persons who
required medical treatment from Medacs, the results of this data collection is outlined below.




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Methodology

In order to complete this report comprehensively the following methods were used;

         Review of current healthcare provision within Lancashire Custody Suites.
         Analysis of number of detainees through custody and those seen by healthcare
          providers for the period 1st – 30th September 2011.
         Audit of 10% of custody records for the period 1st – 30th September 2011 to establish
          reasons for detainee health assessment and if further treatment is required ie via
          A&E, Mental Health Services, Drugs and Alcohol Teams etc.
         Review of all Lancashire Prison Health Needs Assessments (ie HMP Preston, HMP
          Garth, HMP Wymott, HMYOI Lancaster Farms and HMP Kirkham) 2011.
         Review of Lancashire County Council, North West Wellbeing Dataset Lancashire
          Analysis Report 2009.
         Blackpool Council Joint Strategic Needs Assessment 2007.
         Review of Probation and YOT data – see Appendix G for templates used.

Detainees Age

The predominant age range for the population of Lancashire is 45-64 years closely followed
by 25-44 years.

The office of national statistics shows the areas of Blackpool and Fylde have the highest
number of people in the 45-64 years category which is reflected in the custody data collected
showing Blackpool has the higher number of offenders in this age range.

Whilst the custody data collected shows that Burnley has the higher number of offenders in
the 25-44 years age range, this is not the case for Lancashire as a whole which shows
Preston has the highest percentage of the population in this age range. This age range is
shown to be the predominant age range of the offenders whose data was reviewed.

The breakdown of detained persons ages can be seen below;

                           Age Range of persons detained and seen by Medacs in the period
   Custody
                                             1st – 30th September 2011
    Suite
                            0-14       15-24         25-44           45-64          65+
Blackburn                    0           9             17              3             0
Blackpool                    0          12             15              8             0
Burnley                      0          16             21              4             0
Lancaster                    0          11             10              5             0
Leyland                      0           4              6              1             1
Preston *                    0           9             19              2             1
Skelmersdale                 0           2              7              3             0
Total                        0          63             95              26            2
(2 records reviewed did not have the detainees age / date of birth within).


Detainees Gender

The population of Lancashire is almost evenly split between male and female, apart from the
over 65 years age range which shows more females in this category, as per the office of
national statistics. The areas of Lancaster, Blackpool and Blackburn with Darwen show the
highest number of both males and females.




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The custody data reviewed shows a higher number of arrested males in Blackburn, Burnley
and Preston, whereas Lancaster and Blackpool show the highest number of arrested
females. Overall, the data collected shows there are more male offenders than female in the
Lancashire area.

The breakdown of the sex of detained persons at each custody suite can be seen below;

                           Sex of persons detained and seen by Medacs in the period
   Custody
                                           1st – 30th September 2011
    Suite
                                   Male                              Female
Blackburn                           26                                 3
Blackpool                           24                                 11
Burnley                             32                                 9
Lancaster                           15                                 11
Leyland                             10                                 2
Preston                             27                                 6
Skelmersdale                         7                                 5
Total                              141                                 47

Ethnicity of Detainees

The predominant ethnicity for detained persons in Lancashire custody suites is White /
British, however in the areas of Blackburn and Preston the number of detained persons in
the BME group is reflective of the Lancashire population based on the office of national
statistics data. The breakdown of ethnicity of detained persons at each custody suite can be
seen below;

                      Ethnicity of persons detained and seen by Medacs in the period
   Custody
                                          1st – 30th September 2011
    Suite
                   White / British   Asian / British      Black / British     Other
Blackburn                26                2                    0               1
Blackpool                34                0                    0               1
Burnley                  39                1                    0               1
Lancaster                26                0                    0               0
Leyland                  10                1                    0               1
Preston                  27                0                    2               4
Skelmersdale             12                0                    0               0
Total                   174                4                    2               8

Area of Residence of Detainees

The office of national statistics shows that within Lancashire, Lancaster, Preston, Blackpool
and Blackburn with Darwen have the highest population density. Custody data shows that
detained persons mainly reside in the areas of Blackburn, Blackpool and Preston, however
Lancaster and Burnley custody suites have the higher number of detained persons who
whilst arrested in these areas reside elsewhere in Lancashire. 6% of all the custody records
reviewed shows detained persons with no fixed abode and 6% from outside the Lancashire
area.

The breakdown of areas of residence of detained persons can be seen below;




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                                  Area of Residence of persons detained and seen by
                                    Medacs in the period 1st – 30th September 2011




                                                                                                                 Skelmersdale


                                                                                                                                Lancashire
                                     Blackburn



                                                   Blackpool




                                                                           Lancaster
Custody Suite




                                                                                        Leyland
                                                                Burnley




                                                                                                   Preston




                                                                                                                                  Out of
                                                                                                                                   Area
                           NFA
Blackburn               1         24              1             2          0            0          1         0                      0
Blackpool               1         0              28             0          0            0          0         0                      6
Burnley                 2         18              1            18          0            0          0         0                      1
Lancaster               1         0              13             0         11            0          0         0                      1
Leyland                 1         0               0             0          0            9          1         0                      1
Preston                 5         0               1             0          0            3         22         0                      2
Skelmersdale            0         0               0             0          0            3          1         8                      0
Total                   11        42             44            20         11           15         25         8                     11

Smoking

The custody data collected shows that the number of detained persons who smoke is largely
not known, however Blackburn shows the higher number of detained persons who were
shown to have cigarettes within their property where it has been assumed they therefore
smoke. For this reason, one of the key recommendations will be around more informed data
collection when detainees enter custody.

The breakdown of this data is shown below;

                        Number of persons detained and seen by Medacs in the period
   Custody
                                   1st – 30th September 2011 who smoke
    Suite
                         Smoker             Non-Smoker              Not Known
Blackburn                  16                     0                      13
Blackpool                  13                     0                      22
Burnley                    0                      0                      41
Lancaster                  14                     0                      12
Leyland                    6                      0                       6
Preston                    14                     0                      19
Skelmersdale               8                      0                       4
Total                      71                     0                     117

Substance Misuse / Alcohol Issues

The data collected in September 2011 shows that it is largely not known if detained persons
have issues with drugs, although it is shown that Heroin and Cannabis use is high for those
detainees who admit to drug use. Burnley and Preston are worse affected for Heroin use
and Burnley and Lancaster worse affected for Cannabis use.

It is shown that those detained persons who admit to drug use do not appear to be in contact
with drug services to obtain support for their problem.

The breakdown of drug use data is below;




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                          No of persons detained and seen by Medacs in the period
                                   1st – 30th September 2011 with Drug issues
   Custody
                    Heroin Cannabis Cocaine Other             None       Not  In contact
    Suite
                                                                      Known   with Drug
                                                                               Services
Blackburn             5          2             0       1        1         20       0
Blackpool             4          5             1       4        0         21       0
Burnley               9          7             1       0        1         23       0
Lancaster             1          7             0       1        0         17       0
Leyland               3          1             1       0        0         7        0
Preston               6          4             1       1        0         21       0
Skelmersdale          0          0             0       2        0         10       0
Total                 28        26             4       9        2        119       0

40% of those detainees seen by Medacs for medical treatment in the month of September
2011 were under the influence of alcohol on arrest, which may have contributed to their
offence. Equally, it is not known of 40% of those seen by Medacs if an alcohol problem
existed, with only 10% admitting to having a problem. Again, the data collected largely
shows that it is not known if detainees are in contact with services for their alcohol issues.

Blackpool, Lancaster and Preston custody suites had the higher number of detainees who
were under the influence of alcohol on arrest.

The breakdown of alcohol use data is below;

                          No of persons detained and seen by Medacs in the period
                                1st – 30th September 2011 with Alcohol issues
   Custody          Alcoholic   Under the      Alcohol   None       Not     In contact with
    Suite                       Influence        Use              Known         Alcohol
                               of Alcohol                                      Services
                                on Arrest
Blackburn               2           13            0        1        13             0
Blackpool               6           15            0        0        14             1
Burnley                 4            6            11       0        20             2
Lancaster               1           14            3        0         8             4
Leyland                 1            5            0        0         6             0
Preston                 5           14            1        0        13             0
Skelmersdale            0            9            1        0         2             0
Total                  19           76            16       1        76             7

Data received from Lancashire DAT shown below details the number of arrest referrals their
providers received recorded as a referral into criminal justice services for the period 1 st
October 2010 to 30th September 2011 for each district;




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         District                          No of Referrals               Provider
          Burnley                                 61                      Inspire
         Chorley                                  31                     Discover
           Fylde                                  32                     Addaction
        Hyndburn                                  42                      Inspire
  Lancaster & Morecambe                           35                     Addaction
          Pendle                                  47                      Inspire
         Preston                                 103                     Discover
       Ribble Valley                              3                       Inspire
       Rossendale                                 19                      Inspire
       South Ribble                               16                     Discover
     West Lancashire                              7                      Discover
           Wyre                                   52                     Addaction

Based on the data shown above for drugs and alcohol, and also the number of referrals
made to services, one of the key recommendations to be made will be to ensure referrals are
made to services where this is warranted with more partnership working to be encouraged
between all agencies.

Mental Health Issues

From the records reviewed the number of detainees where it is not known if there are any
mental health issues is high. However, where mental health problems have been identified
the number of detainees who have a history of self harm is great, particularly in Preston and
Blackpool. At 445 and 480 hospital stays for self harm per 100,000 population, significantly
higher than the local and national averages Preston and Blackpool are problematic areas for
this issue.

Once again, the number of detainees who are in contact with mental health services for an
identified problem is low at just 23%.

The breakdown of mental health issues is below;

                           No of persons detained and seen by Medacs in the period
                              1st – 30th September 2011 with Mental Health issues
   Custody
                    Depression Anxiety Self          Other (ie       Not      In contact with
    Suite
                                           Harm     Psychosis,      Known      Mental Health
                                                  Schizophrenia)                 Services
Blackburn               4           1         7          1            16             2
Blackpool               4           3        10          7            11             5
Burnley                 5           0         8          0            28             1
Lancaster               2           0         7          2            15             4
Leyland                 0           0         4          0            8              1
Preston                 3           0        16          0            14             6
Skelmersdale            3           0         1          0            8              1
Total                   21          4        53         10           100            20

Lancashire Care Foundation Trust, the mental health provider, have provided data and
information on the number of referrals they received for mental health in the same period,
this is shown below;




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                                                 No of referrals to Lancashire
                                                  Care Foundation Trust for
                            Custody Suite
                                                     the period 1st – 30th
                                                       September 2011
                         Blackburn                             19
                         Blackpool                             16
                         Burnley                               52
                         Lancaster                             33
                         Leyland                               9
                         Preston                               26
                         Skelmersdale                          6
                         Total                                161

This is information gained from CJMHT Managers according to what is recorded on NCRS
(where all referrals / contacts etc should be recorded) therefore the accuracy of these figures
is dependent on Practitioners being up to date with recording.

The Leyland Custody Suite was also closed from 13th – 27th September 2010.

Consideration needs to be given to seasonal trends and annual leave (lone practitioner
sites), which may affect the accuracy. LCFT do not have the figures for out of hours and
weekends as these would go to the three EDT’s or local crisis teams.

One of the key recommendations will be to ensure referrals to the correct service for a
mental health assessment / ongoing intervention are made for those with an identified mental
health problem and to encourage more robust partnership working with agencies.

Health Interventions

The custody suites in Lancashire utilise the services of Medacs when medical treatment is
required for detainees. From the data collected 53% of the reasons for a Medacs call out
was to review minor injuries, treat where possible or refer to A&E if required.

On the whole the number of records reviewed where a more comprehensive health history
was collected was low at 13%.

                               Breakdown of Reason Medacs called out for detainees
   Custody                            in the period 1st – 30th September 2011
    Suite              Minor       Drug / Alcohol      Mental Health     Other     None
                      Injuries       Withdrawal
Blackburn                13               0                    4           9         3
Blackpool                21               0                    2           9         3
Burnley                  18               4                    2           8         9
Lancaster                11               0                    1          11         3
Leyland                   6               1                    1           4         0
Preston                  21               0                    0           6         6
Skelmersdale              9               0                    0           3         0
Total                    99               5                   10          50        24

One of the key recommendations would be to introduce a comprehensive health screening
tool to be completed by the custody nurse for all detainees, not just those who require
medical treatment, to ascertain what health needs there may be and to refer to the



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appropriate services if required. This is aspirational and will require contract negotiation with
the Healthcare Provider.

Crime in Lancashire

From the custody records reviewed most of the offences committed were Assaults, ranging
in severity, and ‘Other’ offences, including Breach of the Peace, Affray and Public Order
offences. As noted above, 40% of the detainees whose records were reviewed were under
the influence of alcohol on arrest, which may have contributed to their committing the offence
for which they were arrested.

The data collected is shown below;

                              Offences Committed by persons detained and seen by
                                  Medacs in the period 1st – 30th September 2011
   Custody
                     Drunk &      Criminal       Assault &          Theft             Other
    Suite                                                                   (ie Breach of Peace, Affray,
                    Disorderly    Damage        associated
                                                                               Public Order Offences)
                                                 Offences
Blackburn               4            3              10                2                 10
Blackpool               4            0              16                2                 13
Burnley                 5            1              11                8                 16
Lancaster               3            2               4                5                 12
Leyland                 2            0               4                2                  4
Preston                 5            4              13                1                 10
Skelmersdale            0            1               8                0                  3
Total                   23           11             66               20                 68

53% of detainees were charged for the offences they committed, with 12% having no further
action taken by the criminal justice system.

                                      Disposal of persons detained and seen by
   Custody                           Medacs in the period 1st – 30th September 2011
    Suite            Charged         Caution         Bailed            NFA          Other
                                                                                  (ie Remand, PND, Transfer
                                                                                         to court etc)
Blackburn                11                3                  3          5                   7
Blackpool                18                4                  2          2                   9
Burnley                  22                5                  0          4                  10
Lancaster                18                2                  0          3                   3
Leyland                  7                 1                  1          2                   1
Preston                  19                2                  2          5                   5
Skelmersdale             4                 2                  5          1                   0
Total                    99                19                13          22                 35

Data supplied by the Safer Lancashire Strategic Assessment of 2011 on crime in Lancashire;
    Anti Social Behaviour (ASB) is reducing in Lancashire with a reduction in complaints
       of ASB by 27% in the last 4 years. Lancashire has less ASB than the England and
       Wales average.
    All serious acquisitive crime eg burglary is reducing however, serious acquisitive
       crime is more widespread than other crime types affecting all areas of the county.
       52% of detected offenders were male aged 15-24 years.
    Total number of calls about domestic violence has increased by 9%.




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       Total number of serious sexual offences has increased by 24% following improved
        confidence in reporting. Lancashire is above average compared to similar areas for
        both domestic violence and serious sexual offences.
       The number of alcohol related crimes and alcohol related hospital admissions have
        increased by 2-3%. Preston and Blackpool are worst affected for this.
       All violent crime has reduced by 2%.
       All drugs offences have increased by 6.7% between December 2009 and November
        2010. Drug seizures have increased by 9% on the same periods.
       All areas are showing good reductions in repeat offending by prolific and priority
        offenders.

Current Healthcare Provision in Prison

The healthcare of prisoners is an integral part of the services provided within prison
establishments and the responsibility for this provision sits with the NHS. In the area of
Lancashire, Central Lancashire PCT and North Lancashire PCT are currently the lead
providers for health for the five prisons.

All prisoners are seen by a member of the healthcare team as part of their reception into the
prison and an assessment is undertaken of their existing health issues including mental
health and substance abuse. Any further primary care treatment / support required will be
available to the prisoner for the duration of their stay in the establishments. External health
provision may be sourced should the need arise.

The Department of Health in conjunction with the National Offender Management Service
publish Prison Health Performance Indicators on an annual basis for each individual prison.
These indicators are used to drive forward and improve the standards of all areas of prison
healthcare in order to improve quality – see Appendix H for the latest PHPQI Guidance.

All prisons are also under the scrutiny of Her Majesties Inspector of Prisons who conduct
regular audits and inspections of all areas of each prison in England and produce reports and
recommendations for service improvements.

Current Healthcare Provision in Probation

There are 14 Probation Offices in Lancashire and in quarter 2 of 2011 (1st July – 30th
September 2011), there were 2,342 convicted cases open to Probation. Probation use
OASYS to assess the following areas;

       Case Identification.
       Offending Information.
       Analysis of Offences.
       Accommodation.
       Education, training & employability.
       Financial management & income.
       Relationships.
       Lifestyle & associates.
       Drug misuse.
       Alcohol Misuse.
       Emotional health & wellbeing.
       Thinking & behaviour.
       Attitudes.
       Heath & other considerations e.g. general health, LD, communication problems,
        interpreter, phone line etc.



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The OASYS system scores as follows;
    Drug Misuse - 0 - 10 with a criminogenic need being assessed as those with scores
      of 2+.
    Alcohol - 0 - 8 with a criminogenic need being assessed as those with scores of 24+.
    Emotional Health and Wellbeing - 0 - 12 with no criminogenic need score.
    Health - No score at all but questions on general health are asked.

We have therefore interpreted the data supplied by Lancashire Probation as follows; an
OASYS score of 0 equals no issues and an OASYS score of 1 or more equals issues
identified.

The following table shows the OASYS scores of those open cases in the quarter 2 period;

                                                        Score 0   Score 1+
                Drug Misuse                               994       538
                Alcohol                                  1043       489
                Emotional Health & Wellbeing              751       781
                Health & Other Considerations             886       646

As can be seen from the data above, most of the cases through probation for quarter 2
scored 0 ie no issues identified, however it should be noted that Probation only score these
areas as an identified issue if it has impacted on criminal activity.

Current Healthcare Provision in Youth Offending Services

There are 3 main Youth Offending services in Lancashire; Blackburn (1 office), Blackpool (1
office) and Lancashire (5 individual offices).

Data was requested of the 3 main services in Lancashire around the number of convicted
cases in quarter 2 (1st July – 30th September 2011), along with the number of those cases
who scored 0 – 4 on ASSET and the number of cases who were referred to other agencies
for support.

The ASSET form reviews the following areas;
    Offending behaviour
    Living arrangements
    Family & personal relationships.
    Education, training & employment.
    Neighbourhood.
    Lifestyle
    Substance Misuse.
    Physical Health.
    Emotional & Mental Health.
    Perception of self & others.
    Thinking & behaviour.
    Attitudes to offending.
    Motivation to change.
    Positive factors.
    Indicators of vulnerability.
    Indicators of serious harm to others

The ASSET scores from 0 – 4, with 0 as no issues, 1 - 2 infrequent / minor issues identified
and a score of 3 – 4 shows moderate to severe problems identified.




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(Information from ASSET guidance: http://www.justice.gov.uk/downloads/guidance/youth-justice/assessment/asset-young-
offender-assessment-profile/2CoreProfileGuidance.pdf)

Data was only received from Lancashire and Blackpool. The breakdown of this data is
shown below;

                   Blackpool number of convicted cases in quarter 2: 133
                                Score 0 Score 1 Score 2 Score 3                                  Score 4
   Physical Health                 93          4          0           0                            0
   Emotional & Mental Health       51         23         21           2                            0
   Substance Misuse                44         13         33           7                            0

                  Lancashire number of convicted cases in quarter 2: 410
                                Score 0 Score 1 Score 2 Score 3                                  Score 4
   Physical Health                228         56         10           3                            1
   Emotional & Mental Health      110         65         85          37                            1
   Substance Misuse                87         75         72          48                            22

As can be seen from the data above, whilst most cases through the Youth Offending
Services for quarter 2 who completed the ASSET scored 0 ie no issues identified, 45% of
cases in Blackpool and 50% of cases in Lancashire scored 1 – 2 for Emotional and Mental
Health. 12% of cases in Lancashire scored 3 – 4 for Emotional and Mental Health.

In Blackpool 45% of cases who completed the ASSET scored 0 for Substance Misuse, with
47% scoring 1 – 2 and 7% scoring 3. In the Lancashire area, 29% of cases who completed
the ASSET scored 0 for substance misuse, with 48% scoring 1 – 2 and 23% scoring 3 – 4, a
score of 3+ as per the ASSET Guidance may show their offending behaviour was as a result
of their substance misuse issues.

Number of convicted CYP referrals made in quarter 2;

   Referrals to:                                                         Blackpool            Lancashire
   Generic YOT Health Workers                                               23                    0
   Substance Misuse Staff / Services                                        17                    50
   CAMHS YOT Health Workers / CAMHS Service                                 13                    61

Number of convicted CYP referrals made by Health staff to other health providers;

         Referrals to;                                   Blackpool                  Lancashire
         GUM                                                 2                          9
         Speech & Language Therapy                           0                          0
         Learning Disability Services                        0                          0
         Dental                                              0                          14
         Opticians                                           0                          1
         GP                                                  1                          25
         School Nurse                                        0                          5
         Stop Smoking Service                                0                          4
         Early Intervention Service                          0                          0
         Forensic Teams                                      0                          0
         Custodial Establishments                            0                          3
         FACTS Team                                          0                          0
         AMHS                                                0                          1
         Tier 4 Service                                      0                          1
         Healthy Lifestyles Team                             0                          1



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        A&E                                             1                3
        Young Carers                                    0                1
        CAMHS / MH Services                             0                4
        Midwife                                         1                0

The main reason for onward referral in Lancashire is for GP and Dental intervention.

Current Health Provision in the Lancashire area

Health Care;
Five Primary Care Trusts within the Lancashire area have clustered to become the Pan
Lancashire NHS Cluster. This cluster consists of the following Trusts;

Blackburn with Darwen Teaching Care Trust Plus; Blackpool PCT; Central Lancashire PCT;
East Lancashire Teaching PCT and North Lancashire PCT.

This Cluster is responsible for 384 GP Practices, 263 Dental Practices, 3 Minor Injury Units
and 2 Walk in Centres.

Acute Services:
4 Acute Trust;
    Blackpool, Fylde & Wyre Hospitals NHS Trust.
    East Lancashire Hospitals NHS Trust
    Lancashire Teaching Hospitals NHS Foundation Trust
    University Hospitals of Morecambe Bay NHS Foundation Trust

5 A&E Departments;
    Blackpool Victoria Hospital
    Chorley & South Ribble Hospital
    Royal Blackburn Hospital
    Royal Preston Hospital
    Royal Lancaster Infirmary

Drugs & Alcohol Teams (DATs):
Commissioners;
    Blackburn with Darwen DAT
    Blackpool DAT
    Lancashire DAT

Mental Health Services:
Provider;
Lancashire Care Foundation Trust

Overview of Lancashire Custody HMIC Inspection 2011

Her Majesties Inspector of Constabularies provided a rigorous inspection of Lancashire
Custody Suites in 2011. The report has been published and information on the area of
health and recommendations for service improvement in this area are detailed below;

Section 6 of the Report, Healthcare;
    6.2 - 29% of detainees seen by a health professional rated the quality of care as good
      or very good, which was similar to the comparator.
    6.7 - 39% of detainees previously on medications said that they were able to continue
      on them while in custody. Custody staff retrieved medications from detainees’ home if


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        necessary. There was no consistency for detainees who were on a programme of
        supervised consumption of methadone.
       6.21 - New arrivals were asked if they wanted to see a health services professional,
        or custody officers referred them to one if they presented any health-related
        concerns, and custody records indicated that 35% of detainees were seen.
       6.24 - In our survey, 61% of respondents said that they had a drug or alcohol
        problem. An analysis of custody records indicated that 54% of detainees had been
        said to be intoxicated when brought into custody. There was a large amount of multi-
        agency work to ensure that services were integrated across the force, so that
        substance users could readily access the relevant services for their need.
       6.28 - In our survey, 27% of detainees, similar to the comparator, said that they had
        mental health needs. There was exceptional multi-agency working with regard to
        mental health services, and partners complimented Lancashire constabulary about
        their contributions. Agencies had pooled budgets to employ a coordinator for criminal
        justice, health and social care. This post appeared to be pivotal in ensuring
        consistency of standards, improving the efficiency of mental health working across
        the force and monitoring and updating a comprehensive Bradley implementation plan.
        Operational policies and protocols for mental health working were sophisticated and
        up to date, including the Lancashire and Cumbria Information Sharing protocol and
        Multi-Agency Risk Assessment Conference (MARAC) protocol.
       6.30 - In each division, police officers had access to NHS places of safety, which
        were in emergency departments or in dedicated section 136 suites. There were local
        section 136 protocols for each division. The protocol included simple and helpful
        checklists for staff, such as the custody sergeant or receiving nurse, to ensure
        compliance with agreements. A relatively small number of section 136 detainees
        came into custody, with only 39 in 2009/10 and 25 in 2010/11. Data on the overall
        use of section 136 in Lancashire were said to be incomplete and unreliable. A new
        data recording and acquisition system had been introduced in January 2011 to
        replace this system. A police inspector scrutinised all section 136 cases using police
        custody as a place of safety and ensured that inappropriate use was kept to a
        minimum. Multi-agency training in the use of section 136 had started in Fleetwood
        and Morecombe. There was no regular mental health training for police or G4S
        custody staff.

HMIC recommendations;
   7.21 There should be robust infection control procedures for all the clinical rooms,
      which should be clean and be capable of being used for the taking of forensic
      samples. (6.9)
   7.22 If it is clinically indicated, methadone should be available to detainees, in line
      with national guidelines. (6.10)
   7.23 Custody staff should have access to a full range of appropriate first-aid and
      resuscitation equipment that is checked regularly, and records should be kept
      confirming this. (6.11)
   7.24 All clinical records should be compliant with professional standards and stored in
      accordance with the Data Protection Act and Caldicott principles, to ensure
      confidentiality of personal health information. (6.23)
   7.25 Custody staff should have appropriate training to recognise and take appropriate
      action when a detainee may have mental health problems, and should work
      effectively with health services staff. (6.31)




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ROHT Recommendations

The ROHT concur with the recommendations made by the HMIC however, based on the
data collected by the Team for the period 1st – 30th September 2011 the following additional
recommendations are made;

       Better record keeping and data collection for all detainees in custody and by all
        parties.
       Use of a health screening tool for all detainees, not just those seen by the healthcare
        provider for medical treatment, although as noted above this is aspirational.
       Appropriate referrals to relevant services for detainees with an identified health need
        ie drugs, alcohol, mental health.
       More robust partnership working.
       An annual refresh of the Health Needs Assessment with more concise data as per
        the recommendations above.

Scope and Limitations for the Report

The author was commissioned to undertake a review of healthcare provision within
Lancashire Custody Suites and to provide recommendations for service development within
Custody and the community. This report includes all areas of healthcare provision within
Lancashire Police Custody.

References

       Bradley Report 2009
       Healthy Children, Safer Communities 2009
       Improving Health Supporting Justice 2009
       HM Prison Service Data
       HMCIP Inspection Reports
       Prison Reform Trust Bromley Briefings Factfile December 2010
       Assessment of alcohol problems using AUDIT in a prison setting: more than an 'aye
        or no' question, Susan MacAskill, Tessa Parkes, Oona Brooks, Lesley Graham,
        Andrew McAuley and Abraham Brown (2011)
       HMYOI Hindley HNA 2010
       HMP Styal HNA 2009
       McManus, J (2000a) Health & crime: some issues from the literature, London: Nacro,
        Robinson, F, Keithley, J, Robinson, S and Childs, S (1998)
       Exploring the Impacts of Crime on Health and Health Services: A Feasibility Study,
        Durham: University of Durham
       Office of National Statistics 2010
       Public Health Observatory Health Profile of Lancashire 2011
       www.chlamydiascreening.nhs.uk
       Health Protection Agency
       Emerson, E et al (2001) Learning Disabilities the Fundamental Facts London The
        foundation for People with Learning Disabilities
       Safer Detention and Handling of Prisoners (SDHP)
       Police and Criminal Evidence Act (PACE)
       Lancashire Police Custody Suite Detainee Records Data
       Lancashire Prison Health Needs Assessment 2011
       Lancashire County Council, North West Wellbeing Dataset Lancashire Analysis
        Report 2009
       Blackpool Council JSNA 2009.



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       Data collected from Lancashire Probation Service for Quarter 2 (July – September
        2011)
       Data collected from Lancashire Youth Offending Services for Quarter 2 (July –
        September 2011)
       Safer Lancashire Strategic Assessment 2011.
       Prison Health Performance & Quality Indicator (PHPQI) Guidance 2011.
       OASYS Guidance
       ASSET Young Offender Assessment Guidance
       Lancashire Custody HMIC Inspection Report 2011

Who was involved in the process:
   Lancashire Police
   Medacs
   Rachel Watkin, Public Health Intelligence Specialist; NHS Bury
   Nicola Ellis, Primary Care Lead; NW ROHT
   Tracy Wilson, Business Administration Manager; NW ROHT

Gap analysis

Data currently available on the health status of detainees in custody is minimal as record
keeping needs to be more robust to allow for a more informed referral process to health
services for detainees.




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Appendix A

Sites Accepted for Early Adopters

       West Midlands
       Staffordshire
       West Yorkshire
       Greater Manchester
       Lancashire
       Cheshire
       Northumbria
       Devon and Cornwall
       Derbyshire
       Kent




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Appendix B

Map of the Lancashire area and current custody throughput




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Appendix C – Data required to complete the HNA

Custody Population:               Number through custody
(Data obtained via Lancs.         Ages of detained persons
Police)                           Sex of detained persons
                                  Offence committed / Disposal Category
                                  Area detained person resides
                                  Identified health need ie drugs, alcohol, mental
                                  health, physical health, sexual health
                                  Ethnicity of detained person

Local Area Population:            Total population number
(ie geographical area of          Breakdown of the population by age
Lancashire via Office of          Breakdown of the population by ethnicity
National Statistics)              Breakdown of population by sex
                                  Prevalent health needs in the area
                                  Deprivation status of the population

Regional Comparison:              Prevalent health needs in this area compared with overall
(ie North West area via           regional health needs and priorities.
Public Health Observatory
data 2011 for Lancashire)

National Comparison               Prevalent health needs nationally compared with regional (ie
England via Public Health         and local needs and priorities.
Observatory data 2011)




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 Appendix D

                                      All people                                     Females                                      Males
                                           Percentage aged:                                 Percentage aged:                          Percentage aged:
                        Population                                    Population                                    Population
                       (thousands)            15-   25-   45-        (thousands)             15-   25-   45-       (thousands)   0-    15-   25-   45-
                                       0-14                   65+                    0-14                    65+                                       65+
                                              24    44    64                                 24    44    64                      14    24    44    64


Burnley                          85.3 19.1 13.7 24.5 26.4 16.5                  43.7 18.1 13.3 24.5 26.3 18.1               41.6 20.2 14.7 24.0 26.0 14.9
Chorley                         105.4 16.8 11.5 26.3 28.6 16.8                  52.4 16.8 10.9 25.4 28.6 18.5               53.0 17.0 11.9 27.0 28.9 15.1
Fylde                            76.6 14.4 10.2 22.1 29.6 24.0                  38.9 13.6     9.3 20.8 29.3 27.0            37.7 14.9 10.9 23.1 30.0 21.5
Hyndburn                         81.1 19.7 13.4 25.3 25.6 15.9                  41.1 19.0 12.7 25.3 25.3 18.0               40.0 20.8 14.3 25.5 26.3 14.0
Lancaster                       141.1 15.5 17.6 24.4 24.7 17.9                  72.3 14.7 17.4 23.9 24.3 19.8               68.7 16.4 17.9 25.0 25.0 15.7
Pendle                           89.3 19.0 13.0 24.7 26.9 16.2                  45.3 18.3 12.8 24.5 26.3 17.9               44.0 19.8 13.6 25.0 27.3 14.1
Preston                         135.1 17.6 17.6 27.6 23.0 14.1                  67.0 17.3 17.6 26.4 23.0 15.7               68.1 18.1 17.8 28.6 23.1 12.6
Ribble Valley                    58.0 16.9 11.0 22.2 29.8 19.7                  29.6 15.9 10.1 22.3 29.4 21.3               28.4 18.3 11.6 22.2 30.6 17.6
Rossendale                       67.4 18.7 12.8 25.4 28.0 15.1                  34.4 17.7 12.2 25.9 27.6 16.3               33.0 19.4 13.3 25.2 28.8 13.9
South Ribble                    108.3 16.9 11.9 25.8 27.9 17.8                  55.2 16.1 11.4 25.4 27.7 19.4               53.2 17.7 12.6 26.1 27.6 16.0
West Lancashire                 110.3 17.1 13.4 22.4 28.3 18.7                  56.8 16.0 13.2 22.4 28.5 19.9               53.5 18.1 13.8 22.4 28.2 17.4
Wyre                            111.4 15.0 11.4 21.7 28.0 23.9                  57.4 13.9 10.5 21.3 28.0 26.3               54.0 16.1 12.2 22.2 28.1 21.3


Lancashire (12
                              1,169.3 17.1 13.5 24.5 26.9 18.0                594,0 16.3 13.0 24.1 26.7 19.8               575.3 17.9 14.1 24.9 27.1 16.1
districts)


Blackburn with
                                140.0 22.8 14.5 26.5 23.3 12.9                  70.1 22.1 13.8 26.2 23.4 14.6               70.0 23.4 15.0 26.6 23.3 11.4
Darwen
Blackpool                       140.0 17.1 12.9 23.9 26.7 19.4                  71.0 16.6 12.5 23.5 26.2 21.4               68.0 17.7 13.3 24.2 27.4 17.4


Lancashire (14
                              1,449.3 17.6 13.6 24.6 26.6 17.6                735.1 16.3 13.0 24.1 26.7 19.4               714.2 18.4 14.1 25.0 26.7 15.8
authorities)


 Data supplied via the Office of National Statistics – mid year population estimate 2010
The following population pyramids show the population of the 14 authorities in Lancashire against Lancashire as a whole;




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Appendix E – Public Health Observatory, Health Profile of Lancashire 2011 Data

Communities

               Indicator                     Local Value         England       England Worst
                                                 %               Value %             %
Deprivation                                     20.7               19.9             89.2
GCSE Achieved 5 A-C                             56.7               55.3             38.0
Violent Crime                                   13.3               15.8             35.9
Long Term Unemployment                           3.1                6.2             19.6
Teenage Pregnancy (under 18)                    41.7               40.2             69.4

  100

   80
                                                                     Deprivation
   60                                                                GCSE Achieved 5 A-C
                                                                     Violent Crime
   40                                                                Long Term Unemployment
                                                                     Teenage Pregnancy (under 18)
   20

    0
           Local Value       England Value       England Worst



Adult Health & Lifestyle

               Indicator                     Local Value         England       England Worst
                                                 %               Value %             %
Adults Smoking                                  22.3               21.2             34.7
Increasing & Higher Risk Drinking               29.3               23.6             39.4
Obese Adults                                    22.5               24.2             30.7


  45
  40
  35                                                                Adults Smoking
  30
  25                                                                Increasing & Higher Risk
  20                                                                Drinking
  15                                                                Obese Adults
  10
   5
   0
         Local Value %     England Value %    England Worst %
Disease & Poor Health

                  Indicator                       Local Value     England      England Worst
                                                                   Value
Hospital Stays for Self Harm                            263.7      198.3            497.5
Hospital Stays for Alcohol Related Harm                 2193       1743             3114
Drug Misuse                                              9.1         9.4            23.8
People diagnosed with Diabetes                          5.69        5.40            7.87

   3500
   3000                                                            Hospital Stays for Self
                                                                   Harm
   2500
                                                                   Hospital Stays for Alcohol
   2000                                                            Related Harm
   1500                                                            Drug Misuse
   1000
                                                                   People diagnosed with
    500                                                            Diabetes
         0
             Local Value        England Value England Worst

Life Expectancy & Causes of Deaths

                  Indicator                       Local Value     England      England Worst
                                                                   Value
Excess Winter Deaths                                    17.7        18.1            32.1
Life Expectancy – Male                                  77.1        78.3            73.7
Life Expectancy – Female                                81.2        82.3            79.1
Smoking related Deaths                                  250.2      216.0            361.5
Early Deaths: heart disease and stroke                  76.4        70.5            122.1
Early Deaths: Cancer                                    119.0      112.1            159.1

   400                                                             Excess Winter Deaths
   350
                                                                   Life Expectancy – Male
   300
   250                                                             Life Expectancy – Female
   200
   150                                                             Smoking related Deaths
   100
    50                                                             Early Deaths: heart disease
                                                                   and stroke
     0
                                                                   Early Deaths: Cancer
             Local Value        England Value     England Worst




17753a3c-7382-4357-832c-feb32ea61e92.doc   06/11/2012                               Page 38 of 44
Appendix F

SDHP



  Adobe Acrobat
    Document


PACE (code C)



  Adobe Acrobat
    Document




17753a3c-7382-4357-832c-feb32ea61e92.doc   06/11/2012   Page 39 of 44
Appendix G – Templates used to collate data from Probation / YOT Services

Request for Probation / Health information for the purposes of the Police Health Needs
                                    Assessments.

Probation Office______________________________________________________
Person completing the form_____________________________________________

Please could you complete the request for data below as fully as you can based upon
Quarter 2 (July, Aug & Sept 2011) Including PSR requests that do not go on to conviction.

Total number of all convicted cases open to Probation in Q2


Number of total convicted cases open to Probation in Q2 that have
scores of 0 on OASYS:
Drug Misuse
Alcohol
Emotional Health & Wellbeing
Health & other considerations

Number of total convicted cases open to in Q2 that have scores of 1 on
OASYS:
Drug Misuse
Alcohol
Emotional Health & Wellbeing
Health & other considerations

Number of referrals made by Probation staff to health providers::
GUM
SLT
LD
Dental
Opticians
GP
Other (please state)



Many thanks for completing this form, please could it be sent back by the 30th NOVEMBER
2011 to:

Nicola.Ellis@hmps.gsi.gov.uk Or Tracy.Wilson02@hmps.gsi.gov.uk




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   Request for YOT / Health information for the purposes of the Police Health Needs
                                    Assessments.

YOT Name__________________________________________________________
Person completing the form_____________________________________________

Please could you complete the request for data below as fully as you can based upon
Quarter 2 (July, Aug & Sept 2011)

Prevention (i.e. those CYP at risk of offending, but NOT on any orders to the YOT)

Total number of all prevention cases open to the YOT in Q2


Number of total prevention cases open to the YOT in Q2 that have
scores of 0 on ONSET / ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have
scores of 1 on ONSET / ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have
scores of 2 on ONSET / ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have
scores of 3 on ONSET / ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total prevention cases open to the YOT in Q2 that have
scores of 4 on ONSET / ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of prevention case referrals made in Q2 for:
Generic YOT Health Workers
Substance Misuse staff / services
CAMHS YOT Health Workers / CAMHS service




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Number of referrals made by Health staff to other health providers for
CYP on prevention interventions:
GUM
SLT
LD
Dental
Opticians
GP
Other (please state)



Convicted cases (i.e. those CYP who are on an order to the YOT including Final
Warnings but EXCLUDING those in custody at any period in Q2)

Total number of all convicted cases open to the YOT in Q2


Number of total convicted cases open to the YOT in Q2 that have scores
of 0 on ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores
of 1 on ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores
of 2 on ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores
of 3 on ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of total convicted cases open to the YOT in Q2 that have scores
of 4 on ASSET:
Physical Health
Emotional & Mental Health
Substance Misuse

Number of convicted CYP referrals made in Q2 for:
Generic YOT Health Workers
Substance Misuse staff / services
CAMHS YOT Health Workers / CAMHS service



17753a3c-7382-4357-832c-feb32ea61e92.doc   06/11/2012                      Page 42 of 44
Number of referrals made by Health staff to other health providers for
convicted CYP:
GUM
SLT
LD
Dental
Opticians
GP
Other (please state)



Many thanks for completing this form, please could it be sent back by the 30th NOVEMBER
2011 to:

Nicola.Ellis@hmps.gsi.gov.uk Or Tracy.Wilson02@hmps.gsi.gov.uk




17753a3c-7382-4357-832c-feb32ea61e92.doc   06/11/2012                         Page 43 of 44
Appendix H – Prison Health Performance & Quality Indicators 2011-12



 PHPQI Guidance
 2010-11final.doc




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