Paper 02 - NHS Ayrshire and Arran.

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3. Proposal3.1 While it is clear that the legislative changes are designed to enable the prisonerpopulation to access a full range of healthcare services the advice and guidance fromthe National Programme Board for Prisoner Healthcare has been that the thereshould be continuity of service provision through a ‘business as usual’ approach inthe first instance.3.2 This is reflected in the advice being received from Scottish Government that thefinancial allocation to support the transfer of responsibility for Prison Healthcare toNHS Boards will not exceed the current level of expenditure. Work will thereforecontinue to deliver a range of services in line with that currently provided atKilmarnock Prison.3.3 Work will continue on the procurement of a Pharmacy contract in conjunction withNHS Lothian.3.4 Engagement and co-operation with Kilmarnock Prison will continue to ensure that arobust process for emergency care provision is developed and implemented ontransfer of healthcare services.4. Engagement and consultation on development of the proposal4.1 This paper is the culmination of planning processes developed by the localimplementation group whose membership includes;• NHS Primary Care• NHS Mental Health Services• Serco Health and Home Affairs• Prison Healthcare Staff• SPS Contracts and Transfer Teams• Local Authority Criminal Justice• Staff Partnership• Scottish Health CouncilDirectors have received regular updates throughout the process.5. Resource implications and identified source of funding5.1 Nationally SPS spends £20 million per annum on prison healthcare. £10.1 millionhas been transferred to NHS for the 5 months from November to March 2011/12.Agreement has been reached with directors of finance to allocate to boards for thisfinancial year on the basis of historic spends. An allocation of £1 million is to be heldby the health directorate to be used as a contingency fund that health boards canapply for assistance from should overspends be occurring.5.2 At the time of writing this report historic spend for private prisons is unknown and noformal notification of allocation has been made. It is anticipated however thatallocation for 2011/12 for NHS A&A will be in the region of £1.2 million and planninghas taken place on this basis.4 of 6
6. Risk assessment and mitigation6.1 There are a number of generic risks associated with transfer of prison healthservices;Firstly It should be noted that any real or perceived diminution of service provisioncould adversely affect order within the prison. This would be likely to jeopardiseimportant partnership arrangements with SERCO. To mitigate this risk, the principleof business as usual has been used as a basis for planning, representatives fromSERCO are involved in the current planning arrangement to ensure a smoothtransition to the new arrangements that should be imperceptible to the prisonerpopulation.The business as usual approach could be seen to be at odds with the legislationwhich entitles the prisoner population to the range of healthcare services offered bythe Health Board to its wider population. There may therefore be a risk that NHSAyrshire & Arran could be open to question and possibly litigation if a full service isnot available from 1 November 2011. To mitigate this an ongoing programme ofinvestment in prison healthcare services as funding becomes available, prioritisingthis against other cost pressures through the Clinical Resource Group.At the time of writing the allocation to NHS Ayrshire & Arran has not been finalised.There remains a risk that the financial allocation may not be as anticipated. Tomitigate this costed plans have been submitted to the national transfer group,discussions continue at national finance director meetings. Further action may beneeded to ensure delivery of service within the resource envelope if the allocation isnot as anticipated.Governance arrangements and culture across NHS, SPS and Serco health differ.There is a risk that the organisation will be open to complaint and litigation if any ofthe partners governance standards are breached. Local operational procedures arebeing agreed via the clinical governance group and nationally a memorandum ofunderstanding has been agreed between NHS and SPS to mitigate this risk.Given the time constraints identified with the process of tendering for a Pharmacycontract, procurement of a contract may not be completed prior to the 31 st of October2011. If this is the case other contingency options may have to be utilised such asobtaining a short-term contract with a local provider or using NHS Ayrshire & Arran’sin-house drugs supply until the procurement exercise is completed.7. Impact assessment and consequential changes proposed to mitigate adverseimpacts identified7.1 The final arrangements for the transfer of Prison Healthcare Services at HMPKilmarnock to NHS Ayrshire & Arran will only become clear when the work of all ofthe national workstreams has been completed and these findings have beenincorporated into local plans. The plans will therefore be subject to a full impactassessment when they have been concluded.8. Conclusion8.1 The Board are invited to review the challenges, financial implications and identifiedrisks associated with this transfer.5 of 6
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