Guidance

Continuity of care between prison and the community: self-assessment tool guidance

Published 12 June 2023

Applies to England

Introduction

For people leaving prison, the period immediately after release can be difficult because they are at high risk of overdose and reoffending.

The government’s drug strategy committed to providing a world class treatment and recovery system in England. Part of doing this will involve improving the continuity of care for people leaving prison with a substance misuse treatment need, so they are referred to and engage in community treatment after release. People leaving prison should get a priority appointment with a community treatment service to help them stay engaged. This appointment should be within 3 weeks of leaving prison for the person’s care to be classed as continuity of care. Treatment engagement and continuity of care is vital to reducing their risk of death and in supporting them from reoffending.

The tool

The Office for Health Improvement and Disparities (OHID), part of the Department of Health and Social Care, and HM Prison and Probation Service developed this continuity of care self-assessment tool. They were supported by an expert advisory group made up of internal and external stakeholders, including probation staff and drug and alcohol commissioners from local authorities.

You can use the tool alongside existing guidance and resources, which you can find in the resources section below.

Aim

The tool encourages a partnership approach to continuity of care, enabling local areas to bring relevant partners together to review and assess their local processes relating to:

• governance
• data management
• pathways
• factors that cause people to drop out of treatment

It will help partners to identify what is working well, and where things could work better. Once it’s complete, you can use the self-assessment results to inform a local action plan to improve outcomes for people leaving prison with a drug or alcohol treatment need.

Using the tool

Partners to include

The local partnership should identify someone to lead on completing the self-assessment tool. We recommend that this is a joint assessment and that it should be open to challenge.

The wider group involved in the self-assessment should include:

• local authority drug and alcohol commissioners
• commissioners of prison drug and alcohol treatment
• community and prison drug and alcohol treatment service providers
• local representatives from the Probation Service
• local representatives from HM Prison Service (this could be a lead from the prison or a regional lead)
• National Drug Treatment Monitoring System (NDTMS) teams (where possible)

Representatives should be at a suitable senior management level so they can address issues relating to staff resources and local agency practice.

Local partnerships may also decide to include representatives from:

• regional OHID drug and alcohol teams
• Job Centre Plus
• local authority homelessness teams
• community drug and alcohol recovery services
• voluntary sector organisations
• people with lived experience groups
• NHS integrated care boards

Areas to focus on

The self-assessment tool breaks down the delivery of continuity of care into 4 domains:

1. Governance and assurance
2. Data management
3. Pathways and professional relationships
4. Reducing attrition factors (things that cause people to drop out)

Each of the 4 domains looks at a different aspect of continuity of care, or how it is recorded. It is supported by several statements. Partnerships should consider and reach a consensus on how far they meet each of the statements and offer supporting evidence for their conclusion.

Priorities and actions

You should identify actions you need to take to address concerns and maintain strengths in the local system. You should make it clear who will lead on those actions. The actions should then inform resource allocation planning as part of a wider needs assessment process.

You can ask another local authority, a neighbouring probation area or another prison peer to assess your responses.

You should identify how often you will meet to review your actions. It may be helpful to set a timescale to re-evaluate when you can review whether your actions have achieved improvements in your local continuity of care.

What good continuity of care looks like

The Public Health Outcomes Framework (PHOF) provides the:

• overarching vision for public health
• outcomes to be achieved
• indicators that monitor how well local areas are improving and protecting health

The PHOF defines continuity of care as “Adults with substance misuse treatment need who successfully engage in community-based structured treatment following release from prison”.

Guidance for improving continuity of care between prison and the community and the findings from a 2022 OHID review of continuity of care in drug and alcohol treatment recommend that good continuity of care contains the following elements.

Partnerships

Partnerships where commissioners, community and prison treatment providers and the Probation Service work together regularly to develop, review and maintain pathways and protocols between prisons and the community.

Good communication between prisons and community services enables smooth transitions.

Community and prison treatment providers collect and record data from NDTMS and other local sources. The local partnership regularly reviews the data to:

• monitor activity
• identify and solve problems
• share good practice

Pathways

A joint protocol details the roles and responsibilities of prisons, probation and community services at each stage of the pathway. The protocol outlines the agreed process for sharing personal information securely.

There is a nominated single point of contact in each agency. Partners make use of the OHID single point of contact (SPOC) tool for out of area referrals (see the resources section below for more information about the SPOC).

Referrals to treatment

Referral forms between prison and community are fully and accurately completed in line with guidance for improving continuity of care between prison and the community.

Community treatment services have an effective process to track referrals at every stage. This includes recording people from their initial referral to their engagement in community treatment. This helps maximise opportunities for engagement and to enable services to follow up with people who do not attend the service as planned.

Outreach services contact people to re-engage them in treatment and provide harm reduction interventions, including interventions to help reduce drug and alcohol related deaths.

Early engagement with treatment

Community treatment services provide in-reach appointments in prisons (where possible) and remote interventions to engage early with people in prison who need alcohol or drug treatment. If these interventions are not available, good engagement on release is essential, linking with the person and probation staff.

The in-reach and remote interventions take the following steps.

1. Start the assessment process.
2. Collect information about other agencies involved in the person’s care and ask the person for consent to contact them.
3. Confirm arrangements for treatment and other appointments on release.
4. Provide information to the person about the range of services offered by community drug and alcohol treatment and recovery services, such as: prescribing options, psychosocial interventions, local recovery groups, housing welfare, family support and mutual aid.
5. Provide information to the person about post-release harm reduction support, including naloxone provision (to reverse a suspected opioid overdose) and how their prescribing needs in the immediate post-release period will be met.

Resources

Continuity of care for prisoners who need substance misuse treatment is an audit toolkit and guidance on data recording for prison and community treatment providers and commissioners. It contains a:

• summary of recommendations for local partnerships to improve continuity of care
• quick step by step guide to doing a continuity of care audit
• continuity of care audit checklist
• continuity of care audit template

Commissioning quality standard: alcohol and drug services supports local authorities to commission effective alcohol and drug treatment and recovery services in their areas.

Drugs strategy guidance for local delivery partners outlines the structures and processes through which local partners in England should work together to reduce drug-related harm.

Custody-community transitions report by the Advisory Council on the Misuse of Drugs provides advice on how to reduce drug-related harms that occur when people move between custody and the community.

NDTMS Adult drug and alcohol secure settings business definitions (PDF, 576KB) outlines the correct data processes for transferring people from treatment in secure settings to treatment in the community (in Appendix H).

The criminal justice SPOC directory supports continuity of care. It will help develop criminal justice pathways into treatment and achieve improved health and crime reduction outcomes.

The directory is available by email. You can sign up to receive it, or send updates and ask questions by emailing spoc-ohid@dhsc.gov.uk.