Prisons and special hospitals - key issues
The prison environment can be detrimental to both physical and mental health. In addition, movement of prisoners between prisons may result in poor continuity of care. The overriding theme identified by a study of prisoners' views of health services in prison was that of imprisonment being a journey from prison entry to release. At all stages of this journey the extent to which a prisoner can exercise autonomy is likely to affect a prisoner's access to healthcare and how they manage their health (Condon et al 2007a).
Diabetes UK points to a number of problem areas that impact on self-management. Concerns raised by prisoners have been about procedures for obtaining medication, lack of self-monitoring facilities and difficulties around diet and timing of meals and whether this corresponds with insulin doses (Diabetes UK 2006). A review of the primary health care needs of prisoners in England and Wales highlights studies reporting variations in quality of services and lack of protocols for care of diabetic prisoners (Condon et al 2007b).
There are also issues around lack of education about diabetes among staff and prisoners to the point where hypoglycaemia may be misinterpreted by prison staff as difficult behaviour (Diabetes UK 2006).
In response to these issues, Diabetes UK has made a series of recommendations (Diabetes UK 2006; Diabetes UK 2005a).
The standards set by the National Service Framework combined with the reorganisation of prison health care as part of NHS primary care services in England and Wales has major implications for the improvement of services. This may require development of a primary care infrastructure within prisons. Many prisons are now developing chronic disease management services.
The qualitative research study by Condon et al (2007a) highlights the importance of the initial health screening process for prisoners on entry to prisons. Prisoners with long-term conditions interviewed for the study in general felt that their transition to the prison health services was well-managed.
The impact of the National Service Framework and reorganisation also have important implications for the role of health care practitioners in delivering primary care services in prisons and, in particular, the role of nurses in assessing health needs and promoting health.
The Department of Health highlights examples of good practice in the delivery of health care services in prisons. Examples relating to diabetes include the partnership between HMP New Hall and Pinderfields and Pontefract NHS Trust which aimed to provide screening for diabetes equitable to that offered in primary care, and to develop links with local mainstream services. Through a diabetes care scheme delivered by Leeds PCT in partnership with HMP Leeds, the number of prisoners needing hospital treatment for diabetes related illnesses has been significantly reduced (Department of Health 2007b, pages 37,48).
The RCN Diabetes Forum has conducted an audit of diabetes care and management in prisons which is to be published. As a result of this audit the Forum is now working with the National Patient Safety Agency on guidance on insulin safety in prisons and primary care - See Diabetes care and management in prisons.
References
Full details of the bracketed citations in the text above and, in many cases, links to the actual documents are available in the reference list within this resource. Go to the reference list.
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