Recommendations for research
The guideline committee has made the following recommendations for research.
When should subsequent health assessments be carried out in prison for people serving long-term sentences?
Case management of chronic conditions in prison is difficult, and opportunities for self-care may be limited. The number of older people and people serving long sentences in prison is increasing. There is emerging anecdotal evidence that long-term incarceration exacerbates chronic ill health and causes early onset of conditions associated with old age. Research on this topic would help inform whether additional health checks may be needed to prevent potential health deterioration and quickly identify any new health-related conditions.
What is the prevalence of disease in the UK prison population?
At the time this guideline was published (November 2016), it was estimated that there were around 90,000 people in prison in the UK with an annual throughput of around 180,000. To date, there is little clear evidence of the prevalence of disease among people in prison. This was highlighted by our reviews of chronic conditions (for which there was no disease prevalence data) and when searching for prevalence data for the health economic model.
Systems are now in place that will allow the relevant data to be gathered to inform a longitudinal study. Such a study would provide a useful starting point for a better understanding of how to shape healthcare provided to people in prison, both in terms of:
meeting the needs of the prison population and
providing commissioners with priority areas for developing and delivering health services.
What is the most effective method for delivering health promotion activities and who should lead them (peers or professionals)?
There are few data on how health promotion interventions should be delivered and who is best to deliver them. People in prison sometimes find it challenging to use services provided by people they think are in positions of authority, such as prison officers and healthcare professionals. This is acknowledged in the qualitative review in this area.
There are many examples of health promotion activities, ranging from information leaflets to one-to-one sessions and group-based learning. If it can be shown which methods of health promotion are more effective, then both the NHS and prisons could better target their resources to inform, educate and support people to take a more active role in looking after themselves. This would lead to greater equivalence of service, a better experience of health promotion activities and more confidence in overall health provision.
What are the most effective tools to determine the health promotion needs of people in prison?
Health promotion in prison can vary and may not be seen as a priority by healthcare staff. But people in prison are entitled to an equivalent standard of healthcare to that which they would receive in the community. Prison offers an ideal opportunity to help people who perhaps have not previously attended health services. The prison population is known to have a high prevalence of smoking, often a poor diet and difficulties in accessing exercise programmes or information on sexual health. All of these may exacerbate existing health conditions or lead to poor health or infection.
No evidence was identified for health promotion needs assessment and a study would inform future recommendations in this area. An effective, valid assessment tool for identifying health promotion needs would ensure that people received care that met their needs. It may also identify specific healthcare needs more quickly so people can be given information and advice about self-care, both in prison and after release.
Since 2003 self-administration of medicines by people in prison (known as holding medicines 'in-possession') has been encouraged. Directly observed administration is reserved for high-risk medicines and vulnerable patients. But different medicines are categorised as high risk by different prisons so the approach has been inconsistent. This is influenced by local factors including capacity. Delivering directly observed medicines is labour-intensive and difficult to include in the daily schedules of people in prison.
There is no evidence base underpinning which medicines should be administered under observation. This research would provide evidence to inform the development of a more consistent list of high-risk medicines that need direct observation to improve safety. The research would also inform commissioners of health and offender management services about the need to provide the workforce and operational capacity to administer high-risk medicines safely.