Clinical update

Physical health of people in prison

Read our guide on a new resource from the National Institute for Health and Care Excellence (NICE) that urges nurses to ensure patients in prison receive the same standard of care as the general population.
Prison_Nurse-Alamy.jpg

Read our guide on a new resource from the National Institute for Health and Care Excellence (NICE) that urges nurses to ensure patients in prison receive the same standard of care as the general population

Essential facts

Since 2013, NHS England has been responsible for commissioning health services for those in prison in England. According to NICE, healthcare in prison plays an important role in identifying health needs, including chronic conditions.

Whats new

In November, NICE published new guidance on the physical health of people in prison. It includes recommendations on assessing someones health when they come in to prison, managing and supervising medicines, promoting health and well-being in prison and how to manage health emergencies and support those with rapidly

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Read our guide on a new resource from the National Institute for Health and Care Excellence (NICE) that urges nurses to ensure patients in prison receive the same standard of care as the general population


Every prisoner should have a health assessment before they are allocated a cell, says NICE. Picture: Alamy

Essential facts

Since 2013, NHS England has been responsible for commissioning health services for those in prison in England. According to NICE, healthcare in prison plays an important role in identifying health needs, including chronic conditions.

What’s new

In November, NICE published new guidance on the physical health of people in prison. It includes recommendations on assessing someone’s health when they come in to prison, managing and supervising medicines, promoting health and well-being in prison and how to manage health emergencies and support those with rapidly deteriorating health. The guidelines support the principle that healthcare should be provided to the same standard, quality and specification as for patients in the wider NHS. New guidance on the mental health of adults in the criminal justice system is due to be published in February 2017. 

Profile

At the end of March 2016, there were 85,400 people in prison in England and Wales, with a further 7,700 in Scotland and 1,800 in Northern Ireland. According to the Prison Reform Trust, people aged 60 and over are the fastest growing age group in the prison estate. The Prison Reform Trust also estimates 36% of prisoners have a physical or mental disability. This compares with 19% of the general population.

Risk factors

The prison population includes highly vulnerable groups such as those with learning disabilities, older people, those serving longer sentences whose physical health deteriorates, and those with particular healthcare needs, including physical disabilities or a history of substance misuse. According to the government’s website, offenders are more likely to smoke, misuse drugs or alcohol, suffer mental health problems, report having a disability, self-harm, attempt suicide and die prematurely in comparison with the general population. Public Health England reports that in a typical week there are almost 600 incidents of self-harm and at least one suicide.  

How you can help your patient

Every prisoner should have a health assessment before they are allocated a cell, says NICE. This should cover physical and mental health, alcohol and substance misuse and their self-harm and suicide risk. Practitioners should prioritise safety, both of the patient and themselves.   

Expert comment

RCN adviser in criminal justice and learning disability nursing Ann Norman:

‘The guidance is welcome, showing us what good practice should look like. But I’m also realistic about the current picture in prisoner healthcare across the UK. There are some significant and well-reported challenges – for example, both self-harm and suicide rates are rising. We also have a real challenge on our hands to make sure we’re developing the workforce to enable them to realise these guidelines. 

‘Nurses are critical. Without the nursing workforce we don’t have anything. I urge nursing staff to try to work towards these guidelines, but I acknowledge that the current situation is difficult. It’s work in progress, and this gives a sense of where we need to head. 

‘Practitioners also need to be vocal about what needs to change now to realise these guidelines. That’s about investing in safe staffing levels, making sure there is good leadership and time for practitioners to undertake research and gather evidence about best practice. But the biggest priority is to maintain at least a safe service – everything else is aspirational. Let’s get the fundamentals right first.’ 


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