Post written by Wendy Dyer and Paul Biddle

Improvements in offender healthcare are key to the current UK Government’s reform of the criminal justice system and the aims of reducing reoffending and protecting the public. Current approaches to offender health care emphasise the importance of ‘continuity of care’. Reference to the ‘offender health pathway’ suggests the existence of seamless delivery and experience of care; however, evidence suggests these remain some way off.

This research published in Social Policy and Society explores prison health discharge planning in four North East prisons and uncovers elements of good practice, but also a number of challenges the prisons continue to face in their attempts to improve clinical pathways for prisoners being released or transferred including institutional, staffing and prisoner issues.

Prison regimes by their very nature are rigidly structured and focused on security which means that the creation of effective clinical pathways can lose out to other institutional priorities. Providing medical and nursing care within an environment focused on control leaves some staff feeling unsupported, isolated and lacking focus. Finally prisoners can be difficult to engage, lacking interest or motivation to address their health issues, a problem often compounded by the environment into which they are released.

Despite these problems prison healthcare staff remained motivated to provide the best possible care they could in a very challenging environment. There is evidence of good practice supported by the introduction of Prison Service Order 3050 ‘Continuity of Healthcare for Prisoners’ and ‘SystmOne Prison’, a patient data software package. However in order to achieve continuity of care at the end of the offender health pathway these two often competing health and criminal justice systems must find improved ways of working together. Suggestions based on the findings from this project include implementation of a ‘whole prison’ approach so that the development of a transfer or discharge care-plan becomes the responsibility of criminal justice and health staff within the prison and community, prisoners and their families; and the development of a ‘Care Management’ role for Criminal Justice Mental Health Teams, who would become responsible for ensuring continuity of care for individuals across the whole offender health pathway.

In this article we argue that challenges need to be acknowledged and addressed if robust discharge planning and continuity of care at the end of the offender health pathway is to be achieved, ensuring that people do not return to the community with health problems equal to, or greater than, those that they faced when they first entered the criminal justice system, and consequently potentially impact on the risk of re-offending.

Read the entire article ‘Prison Health Discharge Planning – Evidence of an Integrated Care Pathway or the End of the Road? without charge until the end of January 2014.