A community within four walls

An innovative integrated care system for patients in the prison service

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Introduction

Northamptonshire Healthcare NHS Foundation Trust (NHFT) provides mental health and community services to the population of Northamptonshire and is a long-term partner of iWantGreatCare (iWGC).

NHFT uses iWGC across all its mental health and community services to listen to what service users are saying and use this insight to make quality improvements and build a ‘patient first’ culture within the organisation.

NHFT also provides healthcare services in prisons, specifically the following three secure settings:

●     Whitemoor: (run by HMPS), a high security(Category A) prison with an average of 450 residents with a negligible turnover of inmates. With the majority of patients being over 50, exhibiting many of the typical medical conditions associated with that age grouping, and being the most sceptical of all the prisons.

●     Littlehey: (run by HMPS), a Category C prison with approximately 1,200 residents, including sex offenders, the largest prison of its kind in Europe, with a regular turnover of residents.

●      Peterborough: (run privately), a Category B prison, with approximately 840 residents in a relatively high security environment with separated male and female residents and a very high turnover.

“We have used the values established within the Trust and put them to work in a prison setting”

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The challenges

Initial challenges of working in the prison environment included:

• Most prisons are non-digital environments. A lack of evidence from residents and staff that feedback made any difference.
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• Feedback for staff, was deemed equally important as feedback for patients.

• Needed to overcome residents’ initial mistrust of the support being provided.

• Residents’ fatigue from repetitious form filing was a notable irritation.

‍Discovering a workable operational model

NHFT with an ‘outstanding’ CQC rating, brought many of their proven core working practices and experience of using iWantGreatCare in engaging with patients to the Prison settings, believing care for the individual’s health needs is just as important in a secure environment as elsewhere.

“It’s about the 3 P’s: Person, Patient, Prisoner - in that order.”

Treating residents as a person first, patient second and prisoner third, this was the foundation for the workable ‘Trust’ model.

The team then brought their own innovations to the operational model including the removal of the term ‘Managers’, replacing only with ‘Leaders’, closely followed by establishing regular Patient Experience Groups (PEGs) each with Healthcare Representatives, gaining buy-in from the Prison Governors with each revision of process and practice.
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Actions from early feedback

To address form filling fatigue, administrators went through every clinic attendance each week to select 2 patients at random to send the patient form to; thereby ensuring a rotational freshness of feedback.

To address the concern of evidential feedback, a system was developed of ‘You said – We did’:

Example 1

·       You said: We can only access basic medication at certain times.

·       We did: Provided easy and timely access to certain over-the-counter medications without the need for additional restrictions.

Example 2

·       You said: Accompanied trips to hospital in highly-visible prison outfits make us stand out and are a difficult experience for residents. These also require a lot of staff resources.

·       We did: Organised a visiting Mobile‘MRI’ unit to attend Whitemoor Prison, capable of 20 scans per visit, rather than individual external appointments. More on premise clinical sessions are planned; very important to the patients.

Staff began receiving regular feedback, making it clear they were being listened to, which in turn helped to build the framework of trust, both throughout the command chain and across the patient community.
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“It is disrespectful to deny the opportunity for healthcare to anyone.”

Underpinning the early changes, was the adoption, application and where necessary adaptation of the core principles and values learned within the parent Trust (NHFT); equally,the reverse was true, with clear successes being fed back to the Trust as learning and development opportunities.

Benefits and outcomes over time

Consistent across the life of the project has been the delivery of services by a caring and compassionate staff, helping to overcome ‘the fear of coming to healthcare’ in the early days, and cementing the trust going forward.

Feedback has facilitated the continuous shaping of services, albeit within the constraints of each of the prison profiles.

Notably, the Care QualityCommission have both applauded the work and sought insight as to the processes and procedures deployed, resulting in frequent and ongoing dialogue withCQC and the staff being the norm.

Taking all contributing factors into account, there has been a major positive morale boost for staff, with key benefits seen as:

Stable staffing levels reflected in:

-       Minimal agency staff

-       Extremely low turnover of staff

-       Minimal loss of staff over Covid period

In turn, that generated positive relationships between the staff and residents, with one of the major upsides being a marked reduction in disruptive events, especially given the additional pressures from Covid constraints.

‍“I have been very impressed with the ‘iWantGreatCare’ initiative at HMP Whitemoor. The collaboration between Northamptonshire Healthcare and the prison has improved directly as a result and directly impacted on the quality of care provided to residents. The approach taken between us on two very complex residents who had been long-term gated-cell occupants was particularly useful and, in the case of one of them resulted in breaking an extremely self-destructive cycle of behaviour and getting him back onto normal location where he is being managed appropriately and sympathetically.“ 

       Craig Nethercott, Deputy Governing Governor, HMP Whitemoor

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Conclusions

Prison life is a micro model of an integrated care system, with patient pathways covering the early first stage interactions, through the treatment phase and into the daily management of an enduring condition, as with care provided in non-secure environments.

Given the full spectrum of prison categories with their individual behaviours and challenges, the application of consistent principles of care, mean that this is an entirely replicable process.

The Trust, in partnership with iWantGreatCare has been able to evidence the following findings for its innovative approach:

·       There are no insurmountable barriers to introducing this approach as the principles are entirely transferable from providing similar care in non-secure settings.

·       The approach delivers a Return On Investment (ROI) model where independently evidencing the quality of care has successfully impacted the winning of tenders.

·       There has been a significantly beneficial effect on the wellbeing of staff – both those delivering the care and the broader prison staff not directly involved in healthcare delivery.

·       The successes experienced have resulted in the Trust’s dementia pathway work being accepted into the Royal College of Psychiatry’s “What good looks like” programme.

·      The processes applied have made it easier to measure and report against the 138 Health & Justice Indicators of Performance that the service is required to adhere to (effectively the KPIs for the industry).

“People think it’s too hard to engage with patients in prisons - it’s not.”

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Further information

This case study has been co-authored by iWantGreatCare and Katie Bates, Head of Specialist and Secured Services - Cambridgeshire, Northamptonshire Healthcare NHS Foundation Trust. Please get in touch via the enquiry form on this website if you'd like more information or to speak to Katie or the iWGC team.

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