High-level and strategic recommendations:
1) Prison should be viewed as a unique opportunity to address the physical health inequalities commonly experienced by those living in prison. To achieve this, prison health care services and SPS, should view the prison sentence, or remand period, as a time to provide appropriate physical health care assessment, treatment, care and education to those who require it.
2) SPS and prison-based health care should adopt a holistic and proactive model of care which recognises the social and economic determinants of health, encourages those within prison to prioritise their health, and supports them to increase their personal agency in health care related decisions.
3) Physical health care in prison should be patient-centred and incorporate regular check-ups, screening, health education and health promotion activities. Care should be determined in consultation with patients and health care decisions clearly communicated.
4) There is a clear need to address the issues of health care staff shortage and retention within Scotland's prisons. The establishment of a career route for prison health care staff is recommended which incorporates appropriate remuneration to reflect the nature of the work undertaken by prison health care staff, emotional and practical support, and opportunities for training and career advancement.
5) Steps should be taken within the NHS and SPS to ensure greater levels of organisational recognition and value for the work undertaken by prison-based NHS staff.
6) There is a need for coordinated, joined up data sources relating to the physical health of Scotland's prison population. Ideally, such a system would allow the establishment of a robust record of physical health, mental health and social care needs, including data on both prevalence of disease/illness and health care outcomes (e.g. treatment and disease progression over time). The PHS-PCLS dataset is an example of how such data linkage can be achieved, and, if expanded to include a wider range of health data, could yield further insight into the health care needs of Scotland's prison population.
7) SPS (and private contractors), health and social care, and third sector organisations should jointly determine a model of health care provision to prevent gaps in the provision of prescription medication and/or ongoing primary and secondary care treatment. This model might seek to incorporate increased in-reach of third sector organisations who provide support on release, GP pre-registration prior to liberation as standard, and the provision of specialist community-based holistic support for unplanned releases.
8) A common pathway to access primary health care services across the prison estate should be established. This pathway should permit confidential self-referral and incorporate support for those with additional needs (e.g. literacy) to ensure equitable access to all. The pathway should allow for the prioritisation of those with immediate needs and should incorporate a clear mechanism for requests for second opinions and complaints from people in prison (or their carers where appropriate).
9) A method of establishing a comprehensive health record to follow the individual into prison, through the prison journey, and back into the community on liberation should be determined. This health record should be accessible to people in prison and those with formal care or guardianship arrangements relating to people in prison.
10) A common prescribing formulary should be introduced across Scotland's prison estate to ensure consistency and to reduce the need for prescription variation following inter-prison transfers that may cross health board boundaries.
11) The initial primary care assessment for new receptions into prison should be followed up with a second more thorough physical health assessment in the following days. This is in recognition that physical health care conditions may not be prioritised at the point of reception and to ensure the enhanced capture of health care needs.
12) SPS and health care providers should jointly establish a system to escort people in prison to clinical and dental facilities that maximises the time available each day for health care staff to see their patients. Consideration could be given, where appropriate space exists or can be re-purposed, to locating health care facilities and the dispensary on the halls to reduce the demands on SPS staff.
13) The current arrangements for the transportation of patients to secondary care appointments should be reviewed to develop a model of transportation that ensures the minimisation of missed appointments.
14) To alleviate the burden presented by transportation of patients to secondary care appointments, the expansion of Near Me technology to support secondary care appointments within the prison environment, where appropriate, should be supported
15) To combat low awareness and knowledge of health-related issues amongst those living in prison, training in health literacy should be mandatory for all staff working within prisons. All new staff (SPS, NHS and third sector) should be provided with education on the health inequalities of those residing in prison, the health services available to those in prison, and the pathways to access these.
16) The quantity and quality of accommodation available within Scotland's prison estate should be reviewed to ensure accessible and adaptable facilities for those with physical disabilities, those recovering from a hospital stay or other illness, and those with palliative or end of life care needs. This review should give consideration to Scotland's aging prison population and ensure that the prison estate is fit to support the physical health care needs of those residing there.
17) A range of exercise options should be made available for people residing in prison for whom the gym is not preferred or appropriate.
18) Access to healthy food options for people living in prisons should be reviewed, giving consideration to the provision of food storage facilities within cells or close by on the halls.
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