Involving patients or service users in any area of research can be challenging, but it’s particularly tricky in prisons. We are currently carrying out a literature review focused on prisoners’ physical health needs as part of our prisoner health project.
Difficulties for those outside the prison system in getting access to prisoners means it can be hard to involve them in research. A number of people have commented on the difficulties of conducting research within secure settings, with security constraints and having staff available to facilitate access being key issues.
Today’s sobering report from the Health Select Committee on prison health includes personal accounts from people in prison, which show there is a lot that can be learned from prisoners’ own experiences. We have been talking to professionals who work directly with prisoners to help understand how they feel about health care.
Frustration and worry
Trevor Urch, Inside Recovery and Service User Involvement Manager at HMP Birmingham and a member of the expert panel for the project, spoke to five male prisoners about their experiences of health care across a range of custodial settings. They talked to him about the prison regime and how decisions made by non-clinical staff (such as prison officers) can impact on health, with Trevor saying they feel that:
“You are at the mercy of organisational processes, staff shortages and their motivation to pick you up and escort you from A to B for an appointment. The inability of the regime to cater for every external hospital appointment undermines the faith in the service as a whole. It can lead to frustration and worry.”
Many of the health care worries that prisoners have, such as the uncertainty of waiting for a hospital referral date, are similar to those not in prison. But in prison it is complicated by having little or no control over external factors that may impact on physically attending the appointment on the day. This is relevant in the context of equity of care inside and outside of prison – a topic we will return to in future.
Trevor describes the prisoners saying that:
“You lose your liberty, you lose your identity and then you lose all control. This is especially in terms of access to prison health care services.”
The role of peers in prison
Prisoners can also play a direct role in telling other prisoners about health care, and setting expectations of how they will be treated.
Trevor highlighted the importance of peers in facilitating access to health care. Given the impact of staff shortages and newly joined staff, officers may not be fully aware of how health care works locally, and peers can play a vital role. As Trevor said:
“Prisoners who have first-hand knowledge of quality health care are essential as representatives to spread the positive vibe about the services to their peers. And the priority may not be for the individual but for the community, as some prisoners need encouragement to report illnesses that, if left untreated, may jeopardise the wellbeing of others they share the establishment with.”
How will our better understanding of prisoners’ experience shape our work?
It is important to think about prisoners’ access to health care when interpreting our research. Data is available that captures when they have left prison to visit A&E, outpatients or inpatients, but feedback from prisoners has highlighted the importance of recognising unmet need. That is, those prisoners who might have needed to go to hospital but no staff escorts were available, those who missed appointments as they clashed with a visit by a family member, or those who were not referred by the prison GP as they were due to be released shortly.
We are aware that differences between prisons in the use of hospital services may be the result of how health care is provided within a prison itself, or where particular schemes like peer support are in place. As we analyse the data that is available to show how prisoners have accessed health care, one of the things we will consider is whether differences between prisons might relate to such factors.
What we will do next
We will carry on visiting prisons to gain a range of perspectives – including from prisoners – so that we don’t lose sight of issues such as access that are important to prisoners themselves.
We will also continue to talk to a range of organisations working directly with prisoners, thinking about gaps in knowledge that our work can fill, and also how the information might be used to make improvements.
We want to consider the practical implications of what our research tells us about health care in prisons, including how prisoners’ experiences might shape practical recommendations for the future.
*The literature review will be completed in December.
*The project is funded by The Health Foundation, an independent charity committed to bringing about better health and health care for people in the UK.
Davies M (2018) "Understanding prisoners’ experience of health care to improve our research", Nuffield Trust comment. https://www.nuffieldtrust.org.uk/news-item/understanding-prisoners-experience-of-health-care-to-improve-our-research