Wider deployment of new and different health roles in prisons, such as nurse prescribers, would help ensure services meet inmates’ needs as well as reduce costs, according to a new review.
The review of evidence on NHS-commissioned services, carried out by Public Health England, found “significant improvements in the quality of healthcare in prison settings”.
“The composition of healthcare teams, particularly in prison, was raised many times”
Strengths included the development of specific professional training and resources by bodies like the Royal College of Nursing, alongside other efforts to boost clinical standards.
However, the review – titled Health outcomes in prisons in England: a rapid review – also found areas for improvement including the need for more funding and the need for a greater emphasis on early intervention.
More than 80 research papers were scrutinised as part of the review, which also involved 40 one-to-one interviews with clinicians and other experts from NHS England, the National Offender Management Service and charities working with prisoners and their families.
One of the key issues identified was the need to develop new models of care with the right skill mix to meet prisoners’ needs, which could mean greater reliance on nurse prescribers.
“The composition of healthcare teams, particularly in prison but also in liaison and diversion services, was raised many times,” said the report.
“This covered the need to develop the appropriate skill mix to meet the identified need and the use of new and different practitioners such as nurse prescribers, pharmacy assistants and social care support workers,” it stated.
Interviewees said Health Education England should be an “active partner” and help “inform training, education and recruitment and retention of staff”.
“Challenges were identified around the inadequacy of commissioning budgets”
According to the review, the development of new care models could help improve the cost-effectiveness of prison health services – an area that needs work, it said.
This should be informed by workforce mapping exercises as well as “an understanding of the ratio of staff required to meet needs”.
The report, which will help pinpoint priorities for future work, also called for more preventative care to identify health conditions before they get worse and cost more to treat.
For example, it cited wider use of screening and immunisation programmes and more work to detect mental health problems early on to prevent self-harm and suicide.
Another area for development was getting prisoners themselves actively involved in health initiatives.
The report cited a scheme in Ireland that was first introduced to Wheatfield Prison in Dublin by the healthcare and nursing manager. It has seen volunteer prisoners do basic qualifications in community-based health and first aid.
The programme has now been adopted by the Irish Prison Service, Irish Red Cross and Educational Training Boards of Ireland and now runs in all 14 prisons in the country.
Meanwhile, lack of funding was also identified by the review as an issue in prison healthcare.
“Challenges were identified around the inadequacy of commissioning budgets to meet the high needs of the population and/or cope with in-year or new demands not associated with specific resources,” said the report.
There was also a need to strengthen monitoring of contract and gathering of performance data, concluded the report.
It highlighted that some areas had been using “performance dashboards”, while others had carried out reviews with NHS England’s nursing and quality teams.
“However, this area was clearly stated by interviewees as being under-developed and there is a need for more robust contract monitoring and performance reporting,” stated the report.
A new system of Health and Justice Indicators of Performance is currently being developed by NHS England.