Prison population: substance use and wider support needs
Research into the substance use support needs of people in prison. One of four studies on the health needs of Scotland's prison population.
Chapter 5: Healthcare data collection and analysis
- There are significant deficiencies in existing substance use and related health data collection, analysis, sharing and storage leading to significant variations across Scotland's prisons, resulting in no universal or meaningful body of data to give an accurate overview of substance use among Scotland's prison population.
- Only with a more accurate and consistent gathering of substance use and associated health data will the quantitative data produced by prisons be usable and valid.
This chapter addresses research objectives 4 and 5:
- Assess the scope for the improved collection of routine data that can be made available to analysts, managers, and service providers for continued monitoring and analysis of support needs relating to substance use.
- Offer insights for future data linkage and data collection priorities.
Data sources
Part of our methodology for this project included a high-level strategic review of how healthcare data is gathered and used within Scotland's prisons. It was, however, quickly identified and confirmed by the views of key data informants that there are significant deficiencies in existing substance use data collection, analysis, sharing and storage. This means that data varies greatly across Scotland's prisons and there was no universal or meaningful body of substance use and related health data to give an accurate overview of substance use within Scotland's prisons. Moreover, on account of Scottish Government Covid-19 restrictions on research, which prevented in-person/physical access to Scotland's prisons, this project was unable to conduct screening exercises typically associated with prison health needs assessment research and could only rely on existing prevalence data.
Table 2 below provides an overview of the available and relevant datasets, along with commentary on the limitations of the datasets that were highlighted by the expert data informants interviewed.
This chapter is an abridged version of a fuller paper included in Appendix D.
| System | Description | Limitations |
|---|---|---|
| DAISy (Drug and Alcohol Information System) | DAISy was rolled out across Scotland from April 2021 and should include information from prisons. | The reporting functions of the system are very limited. |
| PR2 (SPS Prisoner Records Database) | This is the "go to" source of information on health concerns for frontline SPS staff. PR2 uses a 'Conditions' and 'Risks' matrix where individual profiles can contain information on health issues. | The 'Conditions' are broad and the descriptions lack detail. There is no universal approach to recording information and no systematic auditing of the data. There is also no context given to the health issues noted. The data held on PR2 is maintained without any engagement with prison healthcare. |
| Vision | The core healthcare database system used by NHS providers in prison settings. Vision is where intake health data is logged. | Concerns have been raised about the quality of the coding on Vision. As a result, this system makes it difficult to find, collate and analyse data. |
| Paper-based records | Opioid Substitution Treatment prescribing is recorded using a paper-based systems. | OST data is not held on the Vision system, is not shared, and therefore is not accessible at the point of need. |
| Public Health Information Dashboard | Published by Public Heath Scotland. This covers eight data sets with a particular focus on substance use data. | Repackaging of historic data with limited day-to-day value. Unlinked datasets mean that patterns and trends are not accessible. Concerns about accuracy of data. |
| The Scottish Prisons Survey | This is a voluntary survey for those who live in Scotland's prisons to complete. It was last published in 2019. | Voluntary nature means that some individuals are potentially less likely to disclose illicit activity. |
| NHS healthcare data | This is held by the NHS and is not routinely shared with SPS. |
Results
The illicit nature of drug taking means that it is very difficult to collect accurate data on the prevalence and types of drug taking within Scotland's prison populations, without forced, compulsory drug testing and a universal and standardised way of conducting these tests.
| Condition type | No. Studies[30] | Prevalence (%) |
|---|---|---|
| Drug use disorder | 3 | 35 - 67 |
| Alcohol use disorder | 8 | 33 - 81 |
Published substance use and related healthcare data for Scottish prisons is deficient and a number of issues require to be addressed if this is to provide valuable real-time insights. Data is often outdated meaning that its usefulness is severely limited when it comes to identifying and understanding drug use needs as these trends change quickly. There was a general view from respondents that data systems, reporting, and analysis could all be substantially improved.
Collectively the data systems we reviewed for this research are fragmented and fail to fulfil important data principles. Inputting is conducted by individual staff and we were told of concerns that there were significant variations in this. Information on OST prescribing is recorded on paper and is not kept within the general healthcare system (Vision). Individual datasets are not linked and so any patterns and trends cannot be identified.
The Drug and Alcohol Information System (DAISy) was rolled out across Scotland from April 2021 and all prisons should now be inputting information into it. However, at the time of writing, the reporting function of the system is heavily constrained. Due to the lack of current reporting and data available for analysis, we are unable to comment on the future role and value of the system.
At worst, current systems may provide false assurance regarding healthcare needs, thereby heightening risks. This is amplified by the challenges posed by SPS's Prisoner Records system, PR2, which remains the 'go to' source of information for frontline SPS staff despite it having no link to prison healthcare systems. Health assessment systems at reception are reported as adequate for providing a provisional understanding of someone's healthcare needs. However, there is no aggregated intake data. There is scope to increase data sharing on cohorts of the prison population, without compromising patient confidentiality.
A lack of analysis of existing substance use and related health data, as well as a lack of sharing of any such data at individual prison and national level, means that significant changes in the healthcare needs of those who use substances whilst living in a Scotland's prison could potentially go undetected.
Current systems are not capable of confirming that prison Health and Wellbeing Standards are being met, and to date inspection arrangements have focused on individual prisons without evidencing national fulfilment. What's more, the data principles[31],[32] of timeliness and relevance are not being met by current systems.
Summary
Regardless of context, and because of the behaviours involved, the collection of reliable and accurate data on substance use is challenging. However, there are steps that could be taken to ensure that the best data possible can be collected. The current haphazard and variable nature of all substance use and health related data collection should be addressed and potential options for data sharing reviewed. Whilst the illicit nature of some substances may make it much harder to gather accurate data, key stakeholders believe it is more likely that self-reporting will increase when punishment is no longer given for disclosure.
Contact
Email: social.research@gov.scot
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