Improving prison healthcare

New draft NICE guidelines set out seven key areas to ensure that prisoners receive same standard of care for their physical health as people in the community.

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The Physical health of people in prison

The National Institute for Health and Clinical Excellence is the independent government body responsible for providing national guidance and advice to improve health and social care.

Health (and social care) commissioners and providers are expected to follow this guidance which makes their publication earlier this month (17 May 2016) of draft guidelines on the Physical health of people in prison an important document. The document is published in the context of the expectation that:

People in prison should receive the same level of care as those outside

The short version of the guideline covers assessing, diagnosing and managing physical health problems of people in prison and contains the recommendations, context and recommendations for research.

Recommendations

NICE’s draft recommendations focus on seven key areas which are very briefly summarised below.

Assessing health

A healthcare professional (or trained healthcare assistant under the supervision of a registered nurse) should carry out a health assessment for every person on their first reception into prison. This should be done before the person is allocated to their cell. It should include identifying:

any issues that may affect the person’s immediate health and safety before the second-stage health assessment
priority health needs to be addressed at the next clinical opportunity.

The NICE guideline provides a detailed framework for this assessment and for subsequent assessments.

Communication and coordination

There are three primary recommendations in this section:

Ensure that every person in prison has a named healthcare coordinator who is responsible for managing their care. Ensure that the person and all healthcare and prison staff know who this is.
Ensure that the different teams that manage a person’s care in prison communicate with one another to coordinate care.
Share relevant information about people with complex needs with prison staff using prison record systems in line with legislation and national guidance.

Promoting health and wellbeing

The NICE guidelines promote the use of peer support and mentoring to help promote a healthy lifestyle in prison with an emphasis on exercise, diet, stopping smoking, sexual health and personal hygiene.

Managing medicines

The sale and unauthorised use of prescribed medicines in prison has always been a thorny problem which appears to have gotten worse in recent years although less discussed in the last year as concerns have been focused on the use of legal highs/New Psychoactive Substances. NICE’s primary recommendation is that prison healthcare departments should:

Carry out an individual risk assessment to determine if the person can hold their medicines in-possession. Allow people in prison to hold all medicine in-possession unless the person does not pass the risk assessment.

Monitoring chronic conditions

NICE recommends that prisoners with chronic conditions should get exactly the same service as they would in the community; having their condition monitored in line with established NICE guidelines for those conditions. It should be remembered that there is a significant evidence base that prisoners are likely to suffer from higher levels of ill-health for a broad range of conditions compared to the general population.

Managing deteriorating health and health emergencies

The legal high problem has meant that prisons are having to deal with a much greater number of health emergencies. NICE recommends the development of local protocols for managing health emergencies which includes such key issues as:

essential training for front-line prison staff, including the first person likely to be on the scene in an emergency;
processes to enable healthcare staff to reach a person in prison quickly, such as how to gain access to their cell;
processes to ensure a person can be quickly seen by a healthcare professional if their health deteriorates quickly;
availability of emergency equipment, such as emergency ‘grab bags’;
recording the actions and observations taken by prison and healthcare staff when assessing people with rapidly deteriorating health or in an emergency situation, such as updating a person’s care plan or recommendations for immediate follow-up;
a clear care plan for supporting people with rapidly deteriorating health and
guidance on sharing information between prison staff and healthcare staff, such as details on standardised clinical handovers and follow-up.

Continuity of healthcare

The final area on which the NICE guidance focuses is continuity of healthcare, another issue which has caused considerable concern over the years. The guidance concentrates on ensuring good access to prisoner health information on reception, transfer between prisons and on release. It recommends that prisoners should receive a pre-release health assessment one month prior to release.