Health and justice services are seeing an increase in prisoners in custody with very complex health needs which is resulting in an increase in referrals for NHS continuing healthcare (CHC) and end of life care. However, prison healthcare teams often have a high staff turnover and a limited understanding of the processes involved.
Arden & GEM’s clinical support team was engaged to design and deliver a specialist training programme to provide staff with a clearer understanding of health and social care service requirements and increased knowledge of the decision-making processes.
The aim was to improve the appropriateness and completeness of referrals so that prisoners have the right care for their needs, whether they be health or social care needs.
The challenge
Health and justice services are seeing an increasing number of prisoners with very complex physical health and/or social care needs. Referrals for NHS CHC and end of life care for prisoners in custody are increasing yet prison healthcare teams often have a limited understanding of the processes involved, sometimes leading to inappropriate or incomplete referrals.
The prison environment is very different to other settings in which clinical care takes place. Providing the best possible complex and end of life care in prison is challenging, with significant variation across the country linked to the setting, skills and experience available.
Consequently, some prisoners end up staying in hospital because there aren’t the facilities to support them within the prison setting, causing delayed discharges in hospital. Particularly for those who are deteriorating quickly and are at the end of life.
Some prisoners want to return to prison when they are coming to the end of their life as the surroundings and people – both staff and fellow prisoners – are familiar and comfortable to them.
Our approach
Arden & GEM is commissioned to receive and process referrals on behalf of NHS England Health and Justice for NHS CHC and fast-track referrals from prisons in the East of England and Midlands regions.
In April 2023, the team was asked to use their experience in complex case management in the prison environment and understanding of the National Framework for NHS CHC, Funded Nursing Care (FNC) and fast-track pathways to develop and deliver a training package for prison healthcare staff.
Developing a training package
Working closely with NHS England, Arden & GEM gathered details of all prison healthcare teams within the secure estate across the East of England and Midlands regions.
An online survey was then sent out to these teams to better understand current feeling, knowledge and practice around CHC and end of life care. These responses were then used to devise a training package that would provide a broad range of participants with:
- a clear understanding of the 2022 National Framework for NHS CHC and FNC
- a full appreciation of the importance of consent
- the knowledge to complete robust referrals.
Delivering training sessions
Once the programme content had been devised, prison healthcare teams were invited to monthly online training sessions, along with other key stakeholders including:
- NHS England health and justice commissioners
- NHS England nursing and quality leads
- Prison heads of healthcare
- HMPPS Prison Group Directors, Governors and Controllers
- Social care providers.
Following the training sessions, information packs were sent to attendees and their teams covering the basics of CHC, and how and where to make a referral, as a reference point and to share with new starters. A similar pack of information was developed and distributed to health and justice commissioners to provide clarity on the services and packages available.
Outcomes
Six training sessions were delivered in 2023 to 50 staff members working within 12 prisons, NHS England and prison social care teams.
Feedback on the sessions has been positive with all participant evaluation forms stating that their knowledge of CHC and fast-track processes has improved as a result of the training.
What was particularly helpful about the training?
“Reading material provided prior to training, and further slides / information provided afterwards. Multiple opportunities for questions.”
“A good insight into CHC and the relevant forms.”
“Overview and understanding of the process, and how to apply this in a prison setting. It was pitched at the right level and depth for the wide-ranging audience in attendance.”
The training team is available to hold ad hoc sessions as required to new staff or those who were unable to attend the initial series.