Improving health in prisons – from evidence to policy to implementation – experiences from the UK

Abstract

Purpose The purpose of this paper is to understand the components of a high-quality prison healthcare system and the impact, ten-years on, of the transfer of accountability in England, from a justice ministry to a health ministry. Design/methodology/approach A rapid the evidence review was undertaken, which included a review of 82 papers and qualitative interviews with key informants. The concepts and themes identified were summarised and analysed through a framework analysis, designed to improve population outcomes and address health inequalities. The use of a rapid evidence assessment, rather than a systematic review methodology, the use of abstracts (rather than full-text articles) to extract the data, and limiting the search strategy to articles published in the English language only might mean that some relevant research papers and themes were not identified. The need for the evidence to be produced within a limited time frame and with limited resources determined these pragmatic approaches. Findings The review found that English prison healthcare has undergone "transformation" during this period, leading to increased quality of care through organisational engagement, professionalisation of the healthcare workforce, transparency, use of evidence-based guidance and responsiveness of services. The review also highlighted that there is still room for improvement, for example, relating to the prison regime and the lack of focus on early/preventive interventions, as well as specific challenges from limited resources. Research limitations/implications Time and resource constraints meant a rapid evidence review of papers in the English language was undertaken, rather than a systematic review. This might mean relevant papers have been missed. The review also only covered small number of countries, which may limit the transferability of findings. The lack of qualitative data necessitated the use of quantitative data gathered from key informants. However, this enabled a good understanding of current practice. Practical implications The review findings support the World Health Organisation position on the value of integrated prison and public health systems in improving quality of healthcare. It also recommends future policy needs to take account of the "whole prison approach" recognising that healthcare in prisons cannot operate in isolation from the prison regime or the community. Originality/value This is unique research which has great value in supporting prison reform in England. It will also be of interest internationally due to the paucity of data in the published peer-reviewed literature on the impact of commissioning models on healthcare or health outcomes.

Secondary care clinicians and staff have a key role in delivering equivalence of care for prisoners: A qualitative study of prisoners’ experiences

“…We identified five major themes that described prominent experiences in accessing secondary care, relevant to the principle of equivalence: [ 1 ] Security overriding healthcare need or experience [ 2 ]; Security creating public humiliation and fear [ 3 ]; Difficulties relating to the prison officer's role in medical consultations [ 4 ]; Delayed access due to prison regime and transport requirements; and [ 5 ] Patient autonomy restricted in management of their own healthcare. Quotation data to support the themes is provided in Table 2 , along with comparative summaries of the equivalent experience/process as a community patient.…”

“…substance misuse, blood-borne virus and mental health provisions), in order to address the most prevalent issues. Resulting benefits will be transmitted to the wider community on release [ 5 ] and contribute to a reduction in social inequalities in health. Investing in prison healthcare and striving for ‘equivalence’ therefore aims to both achieve equivalent health outcomes for prisoners and invest in the health of our society [ 6 , 7 ].…”

“…There is disagreement about whether equivalence relates to access, outcomes, or basic needs, and the closed, complex, resource-poor, prison environment is positioned as an insurmountable challenge [ 9 ]. A review of UK prison healthcare studies found there was a lack of evidence on how to improve health outcomes for prisoners by focussing on equivalence of care, and highlighted the importance of acknowledging the views of prisoners [ 5 ].…”

Clinical Pharmacists in Correctional Facilities: A Literature Review and Future Directions

“…A balance must be found between these objectives, which can prove quite difficult (Simpson & Shah, 2005). There may often be a disconnect regarding the placement of health care on the hierarchy of prison-related issues (Leaman, Richards, Emslie, & O’Moore, 2017; Thomas, Wang, Curry, & Chen, 2016). Ideally, corrections administrators and health professionals would reach an understanding regarding these issues and provide flexibility in developing cohesive plans for management of health care (Simpson & Shah, 2005).…”

“…Looking at the body of evidence supporting pharmacist involvement in primary care and the heavy burden of illness among incarcerated individuals, it is a logical inference that incarcerated individuals would benefit at least as much as the general public by having a pharmacist manage their medications. The health system benefits of appropriately managing patients with chronic disease are highlighted by several authors (Ahalt, Trestman, Rich, Greifinger, & Williams, 2013; Leaman et al, 2017; Thomas et al, 2016). Within the community, pharmacist disease management services are considered to have an estimated rate of return between $1.29 and $2.50 per dollar spent, and for patients requiring inpatient care, that number is even larger (Houle, Grindrod, Chatterley, & Tsuyuki, 2014).…”