It is essential to understand the health and social care needs of the prison population in Scotland in order to improve health outcomes for the prison population and therefore support a reduction in heath inequalities. NHS Scotland subscribes to the principle of 'equivalence' meaning that people in prison should have access to the same level, range and quality of healthcare as that provided in the community, proportionate to need. In both contexts, efforts to improve the provision of health and care services should be evidence-based to ensure effectiveness.
In Scotland, the last national assessment of health care needs in prisons was carried out in 2007. There have been significant developments in healthcare planning and delivery in prisons since then. A key change was the transfer of responsibility for health care delivery in Scotland's prisons from the Scottish Prison Service (SPS) to NHS Scotland in November 2011. Therefore, NHS Scotland Boards are now responsible for the provision of healthcare services for people in prison within their geographical boundary. There are nine Boards that have prisons within their boundaries, and five that do not. A Memorandum of Understanding (MoU) between the SPS and Health Boards with prisons in their area details respective responsibilities and governance. The commissioning of social care in prisons remains the responsibility of the SPS.
A review of the transfer of health care services by the Royal College of Nursing Scotland in 2016 presented a mixed picture of progress towards delivering better outcomes for people in prison, and substantial room for improvement to reduce health inequalities and meet the health care needs of those in prison. Although the review indicated improvements in access to services and continuity of care in some cases, it also highlighted significant challenges to healthcare provision in prisons. These included pressure on staff and resources, low morale of the nursing workforce, and a lack of national reporting and quality outcomes data to shape service planning. More recently, some local health needs assessments have been carried out, or are being considered, with examples of in-house data collection generating actionable, prison-level recommendations.
Fifteen years on from the last national assessment, an up-to-date review of health and care requirements in Scotland's prisons was a recognised priority to ensure the most appropriate services are in place for individuals in prisons across the country. Therefore, in 2020/21, the Scottish Government commissioned research to provide a comprehensive, national assessment of needs in the prison population in relation to four domains of health: physical health, mental health, social care and substance use. These studies were carried out by:
- The University of Leicester;
- The University of Edinburgh and the Forensic Network;
- Alma Economics; and
- Figure 8 Consultancy Services Ltd.
Each research project took a broadly similar approach, estimating the prevalence of certain needs, which is consistent with standardised approaches to conducting prison health needs assessments. The substance use project, however, relied less on quantitative modelling and took a more qualitative approach. Across the projects, the Covid-19 pandemic hindered face-to-face data collection with people in prison. Reviews of literature, mapping methods, and remote interviews with stakeholders and people with lived experience were used to overcome these methodological challenges.
This report draws out common themes from the four projects. Taken together they provide a rounded picture of health and social care needs, service provision, and key issues and challenges to meeting health and social care needs in Scotland's prison population. The evidence synthesis was conducted by analysts in the Scottish Government Health and Social Care Analysis Division in three stages:
1) A thematic analysis of recommendations (from the project reports where these are explicitly provided) to identify key themes.
2) A review of each report to test and refine identified themes iteratively.
3) A presentation to the Prison Population Needs Assessment Advisory Group to discuss the proposed themes, with a subsequent revision.
The recommendations presented in this synthesis report are taken from the three reports where they are made explicit (the social care report does not include recommendations). Recommendations here are not exhaustive of each individual report, but provide a summary of strategic and operational recommendations that appear in more than one report and cut across health domains. The purpose of this report is to draw out those common themes; however, it may be that the most important recommendation(s) for one aspect of health is not relevant to another. Therefore, it is important that the recommendations within individual health needs assessment reports are acknowledged and considered as part of any work to implement change in their respective areas.
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