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Innovation

Innovation

Care UK’s unique approach to healthcare provision for men and women in the justice system.

Care UK has dedicated healthcare teams working in prisons across the country who are passionate about helping the prison population – a socially excluded group with traditionally very poor outcomes – to develop lasting, positive health and wellbeing.

In a matter of a few years we have grown our offender health/health in justice service line from 2 to 21 prisons. Today we provide all forms of care, from primary and nursing care, to sexual health, mental health and substance misuse service, and on any one day we’re responsible for the healthcare of up to 9,000 prisoners.

We work across the offender pathway, from arrest to sentence and release, and we partner with organisations with credibility and presence in that pathway, including a number of mental health trusts.

Care UK’s health in justice services at a glance:

Primary care: We aim to provide at least the equivalent healthcare to what service users would be able to access in the community. In fact, in many cases, the services we deliver are enhanced, to answer the complex needs of the people we work with.

Substance misuse services: Our teams provide a full range of substance misuse services: independent, voluntary and NHS-based.

Mental health services: We also provide primary and secondary mental health services and are particularly proud of our in-depth and successful work with service users at HMP Grendon and HMP Frankland who have dangerous and severe personality disorders.

What makes Care UK innovative in this sector?

Making the most of technology

Our offender health services make full use of the latest technology to ensure that service users receive the best care within the shortest timescales, all while ensuring the safety and security of the prison and prisoner. Technology has proved of particular value in supporting service users in more remote prisons, such as HMP Isle of Wight.

Creating a holistic model

In traditional prisons there are three core pathways: primary care, substance misuse and mental health. A service user entering the prison will be referred into one, two or all three of these pathways, however, these strands of care will run alongside each other and be delivered by different teams, with little if any crossover.

During 2012 and 2013 Care UK developed a brand new, innovative recovery model that moves away from this disease-led model of the past to one based on a holistic approach that draws upon the key elements of a person’s health and wellbeing, namely:

  • Relationships
  • Substance use
  • Mental health and wellbeing
  • Physical wellbeing
  • Resettlement and re-offending

How does this new model work?

Care planning takes place across all five domains and involves the service user in their own recovery. We look at individual barriers to change – elements like anxiety, poor coping skills and poor social skills – as these can affect many aspects of a person’s life. We deliver an integrated approach to care that enables men and women in prison to make lasting changes. Central to this new model is a Recovery Wheel, a self-assessment tool that we encourage service users to use to score themselves.

Ongoing innovation

National Safer Prescribing Strategy: Many prisoners are on a cocktail of drugs (illicit and prescribed) when they enter prisons. The risk is that these can find their way into the rest of prison. At Care UK we believe we have a duty to safeguard the prisoner’s health and that of the rest of the prison population; we also want to reduce drug dependency. As a result we’re using a range of practical and psychologically informed strategies to reduce drug use in prison. These range from stress management and peer support, to the use of health trainers. Read more about how we’re tackling prescription misuse in a South of England prison: Reducing prescription misuse in prisons.

Health trainer programmes:  The level of self-care a prisoner demonstrates will typically be far lower to that shown by someone in the general population. Prisoners will generally present in urgent care situations, and won’t be good attenders in secondary care situations. Therefore, supporting them to develop greater self-care is crucial to their longer term health and wellbeing and key to moving from healthcare that takes a crisis-driven reactive approach to one focused on longer term health and wellbeing.

With a healthcare trainer working on a group and individual basis with service users, they will be coached to develop better coping mechanisms and to understand why it’s so important to comply with their medications. We’re in the process of introducing this programme into primary care, but we plan to eventually use it in substance misuse and mental health pathways.  

Peer support programmes: People with ‘lived experience’ are vital for helping those starting out on the journey of recovery. We’ve seen how peer support has been central to reducing reoffending and poor compliance with medicines and are the first organisation to introduce peer support across the three main care pathways. It’s still very unusual to find this approach in primary care and mental health.

Showcasing the results

Our innovative approaches have had hugely positive outcomes already, particularly in relation to our work with women prisoners at HMP Low Newton in County Durham. The work we have done at this all-female prison is well-recognised nationally in terms of improving sexual health.

Many of the women in this prison have had multiple partners, became sexually active at a young age, and rarely used protection. Unsurprisingly, the rate of cervical abnormalities is high. The work our team at Low Newton has done in educating service users in contraception has reduced the rates of unplanned pregnancies upon release. They’ve also increased women’s engagement in healthcare services, all as a result of using outreach workers in the prison, as well as buddying and coaching through treatment.

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