Healthcare provision in prisons

Summary of the investigations

HSSIB is undertaking a series of investigations that examine the following topics related to healthcare provision in prisons:

emergency care
continuity of care
data sharing and IT.

Our investigation team will visit prisons across the country. We will account for all categories of prison, age of buildings, geographical location and look at both male and female prisons.

An investigation report will be produced for each topic, followed by a final thematic report which will cover any cross-cutting themes identified by the investigations.

So far, two of the four reports have been published:

Background

Prison healthcare is commissioned by the NHS and delivered by a combination of NHS and private healthcare providers. Prisons have several health services that are provided to patients on-site, including dentistry, opticians and physiotherapy. They also rely on access to services in the local community, for example acute hospitals or screening programmes (such as breast cancer and bowel cancer screening).

HSSIB has spoken to over 20 national organisations, from the healthcare and justice systems, who have highlighted issues within prison healthcare that are regularly raised as patient safety concerns. We have analysed these in a thematic way to form the basis of these investigations.

We also have evidence from a previous investigation – ‘Management of chronic health conditions in prisons’ – which is relevant to this theme. We have been told by multiple organisations that our investigations are timely and that prison healthcare is often under-studied.

Intelligence review

We have multiple evidence sources including:

interviews with 26 national organisations from across the healthcare and justice systems
national incident reporting systems
academic literature
national publications
stories from patient advocacy groups
our previous investigation into prison healthcare.

As part of these investigations we have heard from over 120 patients about their experience of healthcare in prisons, through a patient engagement group.

Safety recommendations

HM Prison and Probation Service

HSSIB recommends that HM Prison and Probation Service, in collaboration with the Association of Ambulance Chief Executives, reviews and amends the design of the medical emergency response card, to better support staff in identifying emergency situations and providing the situational information required by ambulance service call handlers. In scenarios where direct communication between staff at the scene and the ambulance service emergency centre call handlers is not possible, this will ensure that the control room receives and can provide sufficient information to the call handlers to triage the situation.

HM Prison and Probation Service

HSSIB recommends that HM Prison and Probation Service enhances the existing training delivered to prison officers, to increase their ability to identify medical emergencies that require 999 calls to be made by prisons, thereby reducing the number of calls and diverted ambulances and easing the burden on the emergency care system. The training should be delivered on a recurrent basis.

HM Prison and Probation Service

HSSIB recommends that HM Prison and Probation Service reviews and implements changes to current communication methods between staff at the scene of an incident and the ambulance service call centre. This is to ensure that situational information about the patient is passed directly from the scene to the call handlers, meaning faster and more accurate triage and categorisation of the emergency response.

Association of Ambulance Chief Executives

HSSIB recommends that the Association of Ambulance Chief Executives, in collaboration with HM Prison and Probation Service, sets up formal communication routes, at both national and regional levels, between prison and ambulance services to escalate concerns, review risks and improve systems for emergency care response and ensure continuous improvement of the service.

HM Prison and Probation Service

HSSIB recommends that HM Prison and Probation Service updates Prison Service Order 3050, ‘Continuity of healthcare for prisoners’, including guidance on communication of information about prison patients when transferring between prisons, and on the process when prison patients are released from court. This will reduce variation and ensure better continuity of care for patients when being transferred or on their release.

HM Prison and Probation Service

HSSIB recommends that HM Prison and Probation Service standardises the approach to the provision of prison officer escorts for outpatient appointments to protect the dignity of patients and reduce variability of escort slots. This will assist in reducing the likelihood of patients refusing to attend healthcare appointments, while balancing appointment availability, thus improving the continuity and equality of care.

NHS England

HSSIB recommends that NHS England, via regional commissioning teams, works with HM Prison and Probation Service to identify barriers to using telemedicine for outpatient appointments, and then implements local solutions to promote and enhance the capability and usability of telemedicine. This aims to reduce the burden on prisons of providing escorts and the likelihood of patients not attending appointments.

Safety observations

Healthcare provision in prisons: continuity of care

Prison healthcare departments and operational staff in prisons can improve patient safety by working together to develop internal policies in relation to clinical holds, to include a requirement for communication with any receiving healthcare team about a patient’s health needs. This is to ensure patients’ healthcare needs are met and that their treatment is not delayed due to the transfer.
Prison healthcare departments can improve patient safety by increasing awareness and education for prisoners in terms of health, hygiene and the importance of engaging in their own healthcare. This will help patients to make informed decisions about whether to attend appointments and the impact on their health if they do not.
Prison officers can improve patient safety by encouraging patients to engage with the healthcare team to discuss the reasons why they do not want to attend appointments. This will help to increase the appointment attendance rate.
Prisons and NHS trusts can improve patient safety by working together to ensure outpatient escort availability and that the timing of hospital appointments is aligned to fit with the prisons’ and the trusts’ regimes. This will reduce the administrative burden and the number of appointments being made and cancelled because of different regimes.

Healthcare provision in prisons

Jump to:

Summary of the investigations

Background

Intelligence review

Safety recommendations

HM Prison and Probation Service

HM Prison and Probation Service

HM Prison and Probation Service

Association of Ambulance Chief Executives

HM Prison and Probation Service

HM Prison and Probation Service

NHS England

Safety observations

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