Case study - prison healthcare services

Customer

Lambeth Primary Care Trust

Challenge

To provide a comprehensive range of healthcare services to 800 prisoners within HMP Brixton

Result

There were many advantages to the PCT in awarding Care UK the contract for this service. The PCT now has one single accountable provider of a fully integrated healthcare service, able to maintain the services under a fixed cost contract over 3 years. Care UK as a national organisation has been able to share with the PCT our experience and knowledge in the provision of prison health across a number of facilities along with our ability to link into a wider range of primary health and social care services currently provided by the group. A big advantage for the PCT is that as a national provider we have a national infrastructure to support care pathways beyond the prison healthcare setting, which in turn provides better outcomes for patients when leaving prison.

The client

HMP Brixton is a category B local prison, accommodating adult male prisoners aged 21 and over. In April 2004 the commissioning responsibility for healthcare services at HMP Brixton was transferred to Lambeth Primary Care Trust. This transfer was part of a national initiative aimed at raising the quality of prison healthcare in line with wider NHS provision.

The need

The aim for the PCT and HMP Brixton is to establish a long term strategic partnering relationship with the provider of all healthcare services. It is expected that the provider will provide strong leadership and develop services, which are primary care led, focused on tangible outcomes for patients and aimed at establishing integrated pathways with community services.

The solution

Prior to the award of this contract, Care UK was already delivering healthcare services in six prisons with a total population of approximately 5,000 prisoners. Care UK is the prime contractor working in partnership with South London & Maudsley NHS Trust (SLaM) and Lambeth PCT Provider Services. The combined experience of Care UK in prison health and primary care, with the local knowledge and experience of SLaM and Lambeth PCT Provider Services, ensures that we are able to deliver class-leading services.

The model of care was developed through a steering group and six workshops prior to tender submission. All partners attended these workshops with a broad range of multidisciplinary skills and focus. The steering group produced a vision and a set of principles.

Our vision is to provide a high standard of healthcare to prisoners in HMP Brixton which is:

• equivalent to, or better than, that provided in the community
• targeted to the particular health needs of prisoners, taking account of their diversity
• integrated both within the prison and with community health services

Prisoners, as one of the most disadvantaged groups in society, often have one of the highest levels of health needs, particularly with mental health and substance misuse problems. Providing health care services for this group can provide substantial benefits to both the individuals concerned and society.

In summary, our objectives are:

• Improve health in its widest sense (including the root causes of ill health)
• Reduce health inequalities
• To have a person centred approach
• Enhance access to high quality services
• Develop all Healthcare services in HMP Brixton through partnership and underpinned by pathways
• Deliver service to prisoners at HMP Brixton which are equitable and in line with services delivered to the wider community
• Develop links between services in HMP Brixton and mainstream community services to improve health outcomes

Multidisciplinary Team

Care UK’s philosophy is to create a strong multi-disciplinary Healthcare team within HMP Brixton to deliver an enhanced range of services. An innovative approach focused on enhancing the skills and competencies of the Nursing Team will be core to the delivery of higher quality services not only in Primary Medical services but also to integrate with other services e.g. IDTS, Sexual Health and Mental Health.

Key features

All primary care services including:

• GP provision
• primary care nursing
• primary care mental health
• diagnostic services (using new digital of X-ray equipment)
• pharmacy services

All mental health services including:

• Prison Community Mental Health Team (PCMHT)
• management of a 25-bed inpatient wing

Substance misuse services

Sexual health services

Dental services

Podiatry

Physiotherapy

Other services including:

• optometry
• art, drama and yoga therapies

Our model will deliver:

• Prisoner Centred Care
• Care Pathways driven service
• Multi-skilled Staff
• Innovative Solutions
• Highly integrated service delivery
• Sophisticated Scheduling
• Robust Data Collection utilising an EMIS clinical system and clinical governance arrangements
• Clear lines of Accountability
• Improved Communication between Professionals and between Agencies
• Improved continuity of care for discharged prisoners, providing prisoners with a complete medical discharge pack.

Care UK is continuously innovating within the health services provided at six prisons, identifying best practice in one location and applying it across all its prison services.