An audit of hepatitis C services in a representative sample of English prisons, May, 2013

Abstract Background This audit follows a survey of hepatitis C services in prisons in England published in 2012 by the Health Protection Agency (HPA) and the Department of Health (DoH). This survey revealed variation in the quality of hepatitis C services delivered in prisons, which required further examination. An audit instrument was developed in December, 2012, on the basis of the best practice guidance in the survey as well as existing national guidance to examine key areas of service provision. The aim of the audit was to identify best practice guidance that was being followed and provide evidence and intelligence for commissioners and service providers as a driver to improve the care received by patients. Methods The audit was done before April, 2013, by the DoH as well as the HPA (a predecessor organisation of Public Health England [PHE] that was formed in April, 2013). A sampling frame based on those adult prisons covered by the HPA's sentinel surveillance study for hepatitis C was used to select 21 prisons for audit. Prisons were then selected to ensure representation of the institutions identified in the whole estate by security category, population size, and geographical distribution in England. The sampling strategy was as follows: four category B (at least one of each size); seven category C or D (at least two of each size); one female (any size); one high security (any size); and eight local prisons (only large and medium in sample frame). A letter was sent by the National Offender Management Service, the HPA, and DoH to prison governors and health-care managers. Completion of the audit was not mandatory. Findings Only one prison did not respond (95% response rate) and we used another prison from the same region and of the same category to replace it. Six (29%) of 21 prisons had a steering group to oversee the testing, treatment, and care strategy in prisons. 13 (62%) had a written hepatitis C policy or equivalent document. 11 (52%) had blood-borne virus information available in the induction programme for new prisoners. Disinfectant tablets were available in 17 prisons (81%). 13 prisons (62%) stated that blood samples were automatically tested by PCR. 16 (76%) had documented guidelines requiring a pretest discussion and 15 (71%) a post-test discussion. The most common service delivery model was hospital outpatient (11 of 21 [52%]), followed by hospital in-reach (nine of 21 [43%]) and general practitioner led (one of 21 [5%]). 18 prisons (86%) reported that they always or sometimes place prisoners on medical hold. 17 prisons (81%) had training in blood-borne viruses for health-care staff; ten (48%) had training for prison officers; and 12 (57%) had training for drug workers. There are limitations to the audit because it is based on self-reporting from the prison. Also, the audit represents 17% of the total number of adult prisons in England. Interpretation The audit highlighted areas of good practice as well as areas of concern; the findings are now being used to drive an improvement in the commissioning and service delivery of hepatitis C services nationally. The audit showed a scarcity of provision for in-reach hospital services. A set of 12 recommendations were made, which included the need for PHE and National Health Service England to coproduce a high-level service specification in relation to hepatitis C to ensure that all prisons and detention centres are consistently delivering good quality and accessible care in line with the good practice described in the audit. This recommendation has already started to be addressed nationally. Funding None.