A dental services evaluation at seven prisons in the Midlands

Objectives: The objectives of this study were to evaluate the dental service provision at seven midlands prisons. Methods: Analysis of activity and costs data for 2002/3, telephone and direct interviews with dentists, nurses and prison healthcare staff. Results: The seven prisons included one Category C womens prison, three YOI/Juvenile and three male Category B/C training prisons with populations aged from 15 to over 70 years and sized from 140 to 860 places, mostly under sentence. One prison did not provide a routine dental service in 2002/3. The number of treatment sessions for the others ranged from 0.31 to 0.63 sessions per 100 inmates in a normal working week and actual provision across 2002/3 ranged from 0.31 to 0.48 sessions. Only one prison had an identifiable oral health promotion programme. Costs per actual session 2002/3 ranged from around 200 to 400 pounds, not including capital costs and a wide variety of pay arrangements were in place. Waiting times for routine care varied from one to three months in November 2003. Interviews revealed management concerns over lack of control over costs and quality, difficulty in understanding complex NHS fees arrangements, information problems and recruitment/retention issues. There was a strong desire for commissioning arrangements to be simplified. Waiting time for treatment was identified as a major source of complaint from inmates. Dentists identified the challenging nature of the clinical work and concerns over isolation. Dental Action Plans developed in 2003 identified considerable needs in order to develop a comprehensive service, including clinical governance and health promotion. Conclusion: Considerable development is required to improve services to prison inmates additional treatment sessions and development of supporting activities. Current NHS arrangements for general dental services are inappropriate for prisons. Funded by West Midlands Prisons Task Force Grant RHFS09672.