Mrs Anne Cowman
Leeds Community Healthcare NHS Trust
Utilising or developing shared-decision making tools for better patient decisions for use amongst disadvantaged or diverse groups.
Aim
The Patient Involvement within a Prison Healthcare Setting project was established to improve the quality and access to health care for prisoners, and for the prisoners themselves to actively take part in shaping, monitoring and improving the utilisation of health care services. The project also set out to engage the prisoners in decisions about their own health care, improve communications between the prison health care providers and prisoners, and be used as an example of best practice for other prisons.
The research
HM Prison Leeds is a category B remand prison that houses 1,154 male offenders who have a wide range of health care needs. Inmates are typically held on remand for one to five months.
Recently, the provision of health care services was brought in-house and it was recognised that the prisoners were not receiving health care equal to the community outside. A patient advisory service was established, in consultation with the prisoners, and a project was designed to measure the effectiveness of engaging prisoners to facilitate change to the provision of health care.
Prisoners were invited to apply for health care representative positions. Staff were delighted that 40 volunteers came forward. Once trained, the representatives made themselves available during social time in the prison. Their responsibilities included the development of a system that fed information from the prisoners to health care professionals, assisting prisoners with literacy problems, critiquing patient information, scheduling appointments and scoping out new services, such as those for prisoners with a long term condition.
The project was successful in several ways. There was a 380 percent increase of prisoner patients accessing health care, a 23 percent improvement in attendance to clinic appointments and the service reduced the waiting time for clinic appointments from four weeks to two days. There was also less confrontation between prisoners and staff around medication, appointments and provision of information.
More than 98 percent of the health care representatives reported that the experience was positive and that participation built their confidence, improved self-esteem and developed their communication skills.
In 2010, the service was rolled out to HM Prison Wealstun, a category C prison which holds 825 prisoners who stay for the duration of their sentence. The service was more effective because there was less need to constantly recruit health care representatives as in the remand prison.
Public benefit
The project highlighted the importance of engaging prisoners in the improvement and smooth delivery of health care services in a prison. The methodology used for this research could be used as an example of best practice for other prisons and may even be transferable to other services for disadvantaged or diverse groups.
