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The Care Quality Commission (CQC) and Her Majesty’s Inspectorate of Prisons (HMIP) are calling for improvements in NHS healthcare provided for adults in the prison system in a joint report.

The findings of the 2008/09 report are based on a sample of 21 PCTs that commission healthcare for prisons.  It indicates progress has been made in embedding management and clinical governance systems and also in the way IT systems are used to record and analyse information on the quality of care.

But CQC and HMIP say clear improvements must be made in broader arrangements to monitor the quality of care and to ensure care is centred on patients’ needs.  The review flags up particular concerns over arrangements for continuity of healthcare around prisoners’ transfer and release.  The report describes it as inadequate and says it appears to be getting worse.

There has also been no improvement in the provision of drug treatment systems, a potentially critical resource within a prison environment.

CQC programme manager, Alex Baylis, said: ‘We are encouraged to see some improvement in the standards of healthcare provided to adults in the prison system over the last year, but significant improvements still must be made.

‘CQC particularly wants to see improvements around arrangements for adults’ transfer and release, which appears to be getting worse. People in prison are often not registered with a doctor and have a high prevalence of chaotic lifestyles, which can involve – for example – substance misuse and mental health issues. Expecting them to make their own arrangements can mean they may end up without access to healthcare.’

Alex Baylis explained that healthcare in prisons was now covered by CQC’s new system of registration: ‘It is now a legal requirement for the NHS to meet essential standards of quality and safety and the independent sector will be subject to the same law from October.

‘This means we will be monitoring these services on an ongoing basis to ensure both are compliant with the regulations set out in the new system of registration.

‘If providers breach standards they will be committing an offence. If this happens, we will use our wide range of enforcement powers to prompt action. These escalate from warning notices to fines to cancellation of registration and the closure of services.’

The review assesses care provided and commissioned by a sample of primary care trusts (PCTs) over 2008/09 and compares them to the 2007/08 results.

Recommendations include:

• PCTs must develop the information they collect on the quality of service provision and on health promotion so they can better detect and correct unsatisfactory practice and better demonstrate that individual services they commission achieve their objectives for quality of care.
• PCTs must be able to show information systems are used for regular review of clinical standards and that these reviews are followed up with action where needed.
• PCTs must prioritise continuity of care at transfer and release and show that services for each prison in their area join-up effectively with other services.
• PCTs should be able to show they act on complaints in how they commission and monitor services.

This year providers of healthcare in prisons are subject to a new tougher system of statutory registration and must apply to CQC for a licence to provide services, declaring they meet legal essential standards.  This system of registration gives CQC new powers to carry out enforcement action against providers if the quality of services falls below required levels.  Providers of healthcare in prisons are subject to fines or legal proceedings if they fail to meet the required standards.

Although the registration system applies to providers and not to the commissioners of services, commissioners should play a major role in helping services improve and ensure they are giving top priority to monitoring quality of care, according to the report.

Notes to editors

• Read the report on healthcare in prisons

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of all health and adult social care in England. We inspect all health and adult social care services in England, whether they're provided by the NHS, local authorities, private companies or voluntary organisations.  We also seek to protect the interests of people whose rights are restricted under the Mental Health Act. We make sure that essential common standards of quality are met everywhere care is provided, from hospitals to private care homes, and we work towards their improvement. We promote the rights and interests of people who use services and we have a wide range of enforcement powers to take action on their behalf if services are unacceptably poor.

Our work brings together (for the first time) independent regulation of health, mental health and adult social care. Before 1 April 2009, this work was carried out by the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.

Our aim is to make sure that better care is provided for everyone, whether it is in hospital, in care homes, in people’s own homes, or anywhere else that care is provided.

Registration: The Health and Social Care Act 2008 introduced a new, single registration system that applies to both health and adult social care. The new system will make sure that people can expect services to meet new essential standards of quality and safety that respect their dignity and protect their rights.  The new system is focused on outcomes, rather than systems and processes, and places the views and experiences of people who use services at its centre.

From April 2010, all health and adult social care providers will be required by law to be registered with CQC and must show that they are meeting the essential standards. Registration isn’t just about initial application for registration.  We will continuously monitor compliance with the essential standards as part of a new, more dynamic, responsive and robust system of regulation.