Opportunities for HCAs to work prison health care increasing

The most rewarding work can happen in the most challenging of settings and working in prisons more than proves that point.

Nursing staff who work in prisons have to think and act in a different way from those in hospitals or primary care practices, but that does not mean they enjoy their job any less.

Most prisons in the UK are likely to employ at least one healthcare assistant as part of a healthcare team providing a considerable range of care that can include asthma, diabetes and epilepsy clinics, GP sessions, triage clinics, health screening, phlebotomy, mental health assessments, vaccinations, smoking cessation, sexual health and substance misuse help.

Kevin Maguire, HCA at HM Prison Liverpool, has worked at the prison for a year, and has enjoyed his time at its well-reviewed and praised healthcare facility.

Mr Maguire, who previously worked in a children’s home, says: ‘I came into prison work because of the caring aspect of it. There were good opportunities to progress and scope for courses to develop your skills. It is a unique place and a good environment to work in.

‘It’s quite a different job from what most HCAs would be doing. Every day is different and that is part of the appeal. It’s an enjoyable job because you can make a difference. You see people coming in with alcohol and drug problems for detox and you start to see them coming off of those. It’s really rewarding.’

Any problems are tackled by asking for help from the ‘strong senior staff chain’ there.

‘What I like most about my job is the interaction. I have had patients leaving here giving me a hug to say thanks for what I’ve done for them. You see lots of different things here - schizophrenia, bipolar, paranoia, for example - and it’s good because we get to understand their medical conditions when they are coming off drugs,’ he says.

This area of care is often under the spotlight and not always in a positive way, as shown by the recent joint report from the Healthcare Commission and Her Majesty’s Inspectorate of Prisons (HMIP) published in February.

Commissioning Healthcare in Prisons called on the NHS to provide better health care for adults in the prison system, saying it was variable and did not always meet individuals’ health needs.

The report pointed to a lack of planning and poor assessment of prisoners’ health needs, which meant that PCTs were not always able to provide the right services or ensure the right number or mix of staff.

Liverpool Prison, which has around 1,250 inmates, is a good example of how to get it right. All its clinical services are commissioned through Liverpool PCT, and a new all-purpose 28-bed inpatient/primary care service opened in July 2007. It has a nursing station, outpatients department, dental facility, GP surgeries, education rooms, therapy rooms, the psychologists’ team, and other primary care teams.

In the main jail, each wing has a surgery with a primary care team administering medications and treatments. Altogether, there are around 50 dedicated healthcare staff with more people coming in to provide specific services.

The healthcare facility follows a multi-agency approach, working closely with the prison service, Mersey Care NHS Trust, probation services, Jobcentre Plus and others.

Liverpool’s approach seems to be working as it has a comprehensive service for long-term conditions and has multidisciplinary case reviews for offenders with very complex needs, which has led to a notable reduction in self-harm and suicide. There has also been an 80% plus uptake of hepatitis B vaccinations. In 2007 HMIP described the service as ‘excellent’ and it was a finalist in last year’s Nursing Times Awards team of the year category.

Debbie Pudge, clinical head of health care at the prison, has worked there for seven years.

‘I came into this because I wanted a challenge, starting from scratch, something we could build up and have something at the end of it,’ she says. ‘As prison health was often recognised as being poor, I wanted to get involved and take the service forward.’

When Ms Pudge joined the prison, it had no HCAs, something she was keen to change.

‘HCAs are an invaluable part of the healthcare team,’ she says. ‘We had trained nurses who needed to develop the service but were being caught up in the hands-on work, so we brought the HCAs in to help with the hands-on running of the service.

‘HCAs are important because you have to have a skill mix of all different capabilities. They are your starting point, your day-to-day running of the establishment and, without them, you can’t do it.’

One of the nurses at the prison, Steve Trwoga, who is deputy inpatient manager, joined the prison service in 1991.

‘I went into it because it’s consistent and there were good opportunities for training and development. It crosses all barriers of nursing and you don’t know what you are going to be using your nursing capacity for on any day.
‘You don’t always have patients that are mentally or physically unwell, they can fall between two stools. It’s less clear sometimes what is wrong with the patient, so you have to be a little bit more investigative.

‘It is very multidisciplinary and it’s dynamic work. Five years ago, when it was organised by the prison service, it was more that we didn’t have the facility, leadership or communication to function at a higher level.’

Mr Trwoga likens the role of the prison’s 11 HCAs to ‘the cog in the mechanism that helps the place keep moving during the day’.

‘They assist in most activities within the area. They are the backbone of the place. It’s a fantastic job for HCAs, interesting and with lots of training prospects and opportunities.’

Gail Adams, head of nursing at UNISON, says: ‘HCAs working in prisons have a really rich, diverse work environment despite it being within a custodial environment. They play an extraordinarily vital role in introducing what we would take for granted as access to health care in a very different environment.

‘I have visited Liverpool Prison and what has struck me about it was the multidisciplinary team which provides for an extraordinarily complex range of healthcare needs and treats the widest possible range of medical conditions.

‘Although they provide a fabulous service, they are still slightly restricted because they work within prison timetables. For example, medication is given at very specific times and they have a short time in which to dispense it.’

The team sees prisoners with the full range of health needs, but particular conditions such as mental health problems and drug and alcohol addiction have a high prevalence.

‘It’s an environment that gives challenges and it means they have to think and act slightly differently but it is one where you will get the same development opportunity, in fact slightly more, than elsewhere. It’s an environment that people should be encouraged to work in.’

Since PCTs took over prison health care it has improved, she believes.

‘It is more inclusive now and staff have greater access to training and more ability to use innovative practice,’ she says.

Tom Robson, national vice-chair of the Prison Officers’ Association and chair of its healthcare committee, says he ‘worries about the safety of nursing staff’ in prisons.

HCA Mr Maguire, disagrees, saying: ‘I’d say it’s a safe environment with senior staff to look after us. Security is paramount. I’d recommend this job without a shadow of a doubt.’

Click here for Commissioning Healthcare in Prisons

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