Recommendations

This toolkit is being produced at a time when systems change is either happening or likely to happen in both the health and justice arenas. For example, a number of attempts are underway to integrate health and social care systems. These include

• New care models, which introduced new models of working such as integrated primary and acute care systems (PACS) and multispecialty community providers (MCPs)
• The introduction of Sustainability and Transformation Partnerships (STPs), which bring together a variety of organisations such as CCGs, Mental Health Trusts and Local Authorities; and
• The continued roll out of Integrated Care Systems which evolved from STPs and involve the NHS working with local councils and others to collectively plan and run health and social care provision in their region. Here, budgets are pooled and the emphasis is on preventative work and avoiding hospitalisation. We recognise that in this toolkit we have focused on health needs, but increasingly health and social care are likely to be considered as one in the future

In addition, questions have been raised about the competency of Community Rehabilitation Companies, which were introduced as part of the structural reforms to probation created by Transforming Rehabilitation.The Ministry of Justice undertook a consultation called ‘Strengthening probation, building evidence’, the results of which are yet to be shared.

Within the context of this changing landscape, it appears that the key to improving healthcare provision for people in contact with probation lies in four main areas:

Commissioning

1. CCGs need to fundamentally recognise that healthcare commissioning for people in contact with probation is their responsibility not NHS England’s
2. CCGs in association with Public Health departments should be undertaking ‘gap’ analyses to examine the complex healthcare needs of people in contact with probation in their areas and the extent to which current service provision meets those needs. The new National Probation Service Health and Social Care Strategy 2019-2022 outlines ways in which routinely collected data in probation might be able to enable such gap analyses. Data on health needs from the research literature provided in this toolkit can also be shared with Health and Wellbeing Boards to inform commissioning
3. Those in contact with probation have high levels of mental health and substance misuse needs, CCGs and Public Health departments should examine the extent to which services are currently configured to meet these needs
4. Working with criminal justice agencies to address other obstacles to health service access such as GP registration
5. Including criminal justice agencies in commissioning processes to help improve understanding of the complex needs of people in contact with probation and ensure that services are capable of meeting them

Practice

1. Provision of cross-agency training, in particular around supporting people with mental health and substance misuse needs
2. All National Probation Service areas and Community Rehabilitation Companies having named health leads
3. Improved partnership working between health and justice agencies including
   • Developing mechanisms to support routine sharing of health data at transition points throughout the criminal justice pathway
   • Involvement of criminal justice agencies in Health and Wellbeing boards and other commissioning forums
   • Co-location of criminal justice and health staff
   • Developing clear pathways into services for those in contact with probation including for continuity of care from prison to probation Approved Premises and the community
   • Health agencies proactively sharing details of services available and how to access them with their local National Probation Service and Community Rehabilitation Company to support service access and use of community sentences with treatment requirements

Policy

1. Extension of current policy to create a national strategy for joint working between health and criminal justice agencies including co-commissioning of services
2. Development of shared cross-agency targets around the monitoring and improvement of health and access to healthcare

Research

1. Provision of up to date information on the prevalence of different health problems amongst people in contact with probation
2. Further development and evaluation of quality indicators for the health of people in contact with probation and the quality of the healthcare that they receive
3. Formally piloting, evaluating, and/or scaling up potential models of good practice identified in the literature and case studies

Extending the work undertaken to produce this toolkit to cover other areas of the country and/or social care needs