Posted by: ayrshirehealth | June 24, 2015

Prison healthcare by @docherty_e

Prison nursing

When Derek Barron (@dtbarron) asked me to write ANOTHER blog (‘made’ is probably more accurate) I wasn’t sure what area to discuss.  Previous blogs have looked at advanced practice, the clinical role of a nurse consultant and improvement work.  HMP KilmarnockOn reflection, I felt it best to discuss areas I’ve never touched upon before to discuss.

Health care, like all areas of our society, is changing. As health and social care have integrated across Ayrshire, my areas of professional responsibility have expanded, taking me out with the area of advanced practice. One of the most exciting, and challenging areas, is that of prison nursing.

In November 2011, NHS Ayrshire and Arran became responsible for the delivery of healthcare to the prison population in HMP Kilmarnock. This transfer of care was to ensure that healthcare provision for individuals serving a prison sentence was equitable to people living in our communities. I had limited exposure to the staff or the environment before December 2014, but was keen to learn.

A primary care service

Since the transfer in 2011, the Healthcare Department in HMP Kilmarnock has become in essence a GP practice, with delivery of Primary Care Services, mental health and addiction services and in-reach NHS clinical services : Blood borne virus and sexual health, physiotherapy, podiatry, dentistry and an optician service.

NHSaaaThe NHS healthcare team is made up of the Senior Management Team, Register General Nurses , Registered Mental health Nurses, Addiction caseworkers, Pharmacy Healthcare Assistants and Healthcare administrators who all work together to ensure safe, effective healthcare delivery to 500 prisoners.

Along with the managing the physical wellbeing of the population, there is a great demand on the mental health and addictions team within the healthcare team.

These teams are directly managed by Mairi Gribben, the Deputy Clinical Operations Manager.  Currently 25% of the population are on Opiate Replacement Therapy which has been a significant reduction since NHS took over in November 2011.  The Addiction Team delivers a range of interventions which is patient centred and recovery focused.  Patients can be seen on a 1-1 basis as well as in turn a group setting. There is now robust throughcare in place, ensuring that there is continuity of care between prison and the community.

Helping me understand

I met with the senior management team initially, “to help me to understand” the specific professional and environmental issues within the area. Ruth McMurdo, Mairi and Sheila McQuilken have been instrumental in helping me to understand the differences for prison nurses.,  Very quickly I realised I had to attend the prison to truly begin to understand the pressures for nursing staff, and link with team members.

HMP Kilmarnock 2Nursing in complex and challenging environments, such as a small health care suite, can be demanding, however with the prison health care environment the competing pressures are unlike any I’ve seen, due to the unique nature of the prison populace.  The staff have clearly risen to the challenges and meeting the local clinical team was incredibly rewarding.

Each nurse or health care provider came across as highly motivated and enthusiastic, with a passion to improve and embracing professional development.  All the staff I’ve spoken to have been highly engaging about areas that could be improved, building on the excellent work the senior team have already carried out. One area most of the staff highlighted as an area for development was in managing emergencies.

Over and above the Primary care element, the staff respond to emergency situations and at times manage these independently until, if required, a paramedic arrives on the scene. There are no ward (in-patient) areas within healthcare and the accommodation in Healthcare is limited.  This would be incredibly challenging for any band 5 or 6 nurse, with the prison staff being no exception.  medical_computerTwo of my colleagues from within Advanced Practice, Barbara Cowley (@barbaracowley) and Julie Smith, have been leading on an education program for the staff, even before I became involved, looking at short master classes for the staff on a variety of medical emergencies, looking at problem based learning approaches to support the decision making of the staff. The staff enthusiasm has been quite clear, with significant learning taking place.

Training needs

Building on this, Sheila, Mairi and Ruth have built on this, looking at training needs analysis for the team and re-formatting documentation to support decision making. Study Einstein

We are developing two study days for the next few months, looking at the most common presentations the staff see and generating professional infrastructures to meet the needs of the prisoners, including discussing early warning scores.

Nursing is a complex, multifaceted profession, with staff working in environments across our society, carrying out care with compassion and technical skill. I hope this blog has helped highlight an area that is unique, with challenges and opportunities that the nurses i have met within the prison have risen to in the spirit of nursing best traditions.

This week’s blog was by @docherty_e (Eddie Docherty), Associate Nurse Director, Advanced Practice, NHS Ayrshire & Arran; Interim Lead Nurse, East Ayrshire Health & Social Care Partnership.



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