Excerpt

In April 2013 NHS England became responsible for commissioning all health services for people in prison in England. Healthcare in prison has a very important role in identifying significant health needs, maintaining health and detecting chronic conditions. This guideline supports equivalence of healthcare in prisons, a principle whereby health services for people in prisons are provided to the same standard, quality and to the same specification as for patients in the wider NHS. Providing equivalence of care will aim to address health need, reduce health inequalities, prevent deterioration, reduce deaths due to natural causes and subsequently assist rehabilitation and reduce re offending. This approach takes into account the differences in client groups to support improved take up of services and contribute to health improvement of people in prison.

• For women, these include women-specific services and national screening programmes being available. For those women who are pregnant, maternity and social care services are provided in line with the wider community.
• For young people aged 18-21 in young offender institutions, services are geared to take into account age appropriateness and the opportunity to have access to catch-up services (for example, vaccinations) that they may have missed in mainstream services during childhood.
• For males, this includes a range of services to support healthier lives and better understanding of health issues as well as access to adult male screening programmes available to the wider population.

Contents

• Guideline Development Group members
• NCGC technical team members
• Co-optees
• Acknowledgements
• 1. Guideline summary
  • 1.1. Algorithms
  • 1.2. Full list of recommendations
  • 1.3. Key research recommendations
• 2. Introduction
• 3. Development of the guideline
  • 3.1. What is a NICE guideline?
  • 3.2. Remit
  • 3.3. Who developed this guideline?
• 4. Methods
  • 4.1. Developing the review questions and outcomes
  • 4.2. Searching for evidence
  • 4.3. Identifying and analysing evidence of effectiveness
  • 4.4. Identifying and analysing evidence of cost-effectiveness
  • 4.5. Developing recommendations
• 5. Health assessment
  • 5.1. Introduction
  • 5.2. Review question: What physical health assessment needs to be done at reception into prison?
  • 5.3. Review question: What are the most appropriate tools for the recognition of mental health problems, or what modifications are needed to recognition tools recommended in existing NICE guidance, for adults: • in contact with the police? • in police custody? • for the court process? • at reception into prison? • at subsequent time points in prison? • in the community (serving a community sentence, released from prison on licence or released from prison and in contact with a community rehabilitation company [CRC] or the probation service)?
  • 5.4. Review question: What are the most appropriate tools to support or assist in the assessment of mental health problems, or what modifications are needed to assessment tools recommended in existing NICE guidance, for adults: • in contact with the police? • in police custody? • for the court process? • at reception into prison? • at subsequent time points in prison? • in the community (serving a community sentence, released from prison on licence or released from prison and in contact with a community rehabilitation company [CRC] or the probation service)?
  • 5.5. Review question: What subsequent health assessment(s) are clinically and cost-effective in prisons?
  • 5.6. Review question: When should subsequent health assessments be done in prisons?
  • 5.7. Review question: what are the most effective and cost-effective assessment tools to determine the health promotion needs of prisoners?
  • 5.8. Recommendations and link to evidence
  • 5.8.3. Mental health assessment (see sections 5.3 and 5.4)
  • 5.8.4. Other health assessments (see section 5.5)
• 6. Coordination and communication
  • 6.1. Introduction
  • 6.2. Review question: What are the barriers and facilitators to coordination, case management and communication between healthcare professionals involved in primary care, mental healthcare, substance misuse and secondary care?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Promoting health and wellbeing
  • 7.1. Introduction
  • 7.2. Review question: What are the most clinically and cost-effective interventions that can be implemented to promote health and wellbeing in prisons?
  • 7.3. Review question: What are the most clinically and cost-effective methods of delivering health promotion activities in prison?
  • 7.4. Review question: Who should deliver health promotion activities in prison?
  • 7.5. Review question: What are the barriers and facilitators to information provision, support and mentoring for prisoners to promote health and wellbeing?
  • 7.6. Recommendations and link to evidence
• 8. Medication management
  • 8.1. Introduction
  • 8.2. Review question: What are the most clinically and cost-effective methods for people to access medicines in prisons to maximise adherence and good health outcomes and reduce inappropriate use?
  • 8.3. Review question: What are the most clinically and cost-effective methods for continuity of care for people to access medicines to maximise adherence and good health outcomes and reduce inappropriate use when: • coming into prison? • being transferred between prisons? • discharged from prison?
  • 8.4. Review question: What are the barriers and facilitators to ensuring access to medicines to maximise adherence and good health outcomes and reduce inappropriate use when: • coming into prison? • in prison? • being transferred between prisons? • discharged from prison?
  • 8.5. Recommendations and link to evidence
• 9. Monitoring chronic conditions
  • 9.1. Introduction
  • 9.2. Review question: How should chronic conditions be monitored in prison? – review of NICE guidance
  • 9.3. Clinical evidence
  • 9.4. Economic evidence
  • 9.5. Evidence statements
  • 9.6. Recommendations and link to evidence
• 10. Deteriorating health and emergency management
  • 10.1. Introduction
  • 10.2. Review question: What are the barriers and facilitators to prison staff, healthcare workers and prisoners for recognising deteriorating health?
  • 10.3. Review question: What are the barriers and facilitators for prison staff, healthcare workers and prisoners in managing emergency situations including first person on the scene?
  • 10.4. Recommendations and link to evidence
• 11. Continuity of healthcare
  • 11.1. Introduction
  • 11.2. Review question: What are the barriers and facilitators to ensuring continuity of healthcare, including management of patient records, of people moving from: • community to prison? • prison to prison? • prison to court? • court to prison? • prison to hospital? • hospital to prison? • prison to community? • transport to or from other detention centres?
  • 11.3. Review question: What are the most clinically and cost-effective systems to manage patient records, to ensure continuity of healthcare of people moving from one prison to another, or between prison and the community or hospital?
  • 11.4. Recommendations and link to evidence
• 12. Reference list
• 13. Acronyms and abbreviations
• 14. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Clinical review protocols
  • Appendix D. Health economic review protocol
  • Appendix E. Clinical study selection
  • Appendix F. Health economic study selection
  • Appendix G. Literature search strategies
  • Appendix H. Clinical evidence tables
  • Appendix I. Health economic evidence tables
  • Appendix J. GRADE tables
  • Appendix K. Forest plots
  • Appendix L. Excluded clinical studies
  • Appendix M. Excluded health economic studies
  • Appendix N. Cost analysis: First-stage health assessment
  • Appendix O. Unit costs
  • Appendix P. Research recommendations
  • Appendix Q. Full recommendations from published NICE guidance on monitoring of chronic conditions
  • Appendix R. Mental health of adults in contact with the criminal justice system appendices
  • Appendix S. NICE technical team
  • Appendix T. Summary of evidence submitted for call for evidence: Physical Health in Prison
  • Appendix U. References
  • Appendix V. Service Users’ Experiences Concerning Their Physical Health Needs in Prison in relation to Clinical Guidelines

Developed by the National Guideline Centre, hosted by the Royal College of Physicians

Disclaimer: Healthcare professionals are expected to take NICE guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and, where appropriate, their guardian or carer.