HMP Eastwood Park
HMP Eastwood Park, in the village of Falfield, is close to the busy centres of Bristol,
Bath and Gloucester, and within easy reach of the M5 motorway.
HMP Eastwood Park is a closed remand prison situated 15 miles north of Bristol in
South West England. It is a Category B female prison and usually has between 300
– 400 prisoners. It has a Mother and Baby Unit; a Juvenile Unit and an Integrated
Drug Treatment Service (IDTS). On average, 70% of the prisoners are addicted to
Class A drugs and/ or alcohol and come from some of the most disadvantaged
backgrounds in British society. The population changes constantly, with the average
length of stay being 21 days.
Hanham Health has contracted to deliver primary care, substance misuse and
specialised sexual health services to the women at HMP Eastwood Park. We bring a
community model of Primary Care to a very complex and transitory group of
patients, often with a poor understanding of how to access health care, and to use
the window of opportunity when these women are in prison to provide them with
comprehensive medical care including screening procedures and medical education.
Hanham Health took over responsibility for providing doctors to work in HMP
Eastwood Park in October 2005. It remains an ongoing project, but has already
established itself as an excellent working model. The scheme is being expanded to
include chronic disease management clinics for conditions such as diabetes; asthma;
coronary heart disease, etc, although this can be challenging given the average short
stay in the remand prison environment.
The project was initially led by Dr Stephen Illingworth and Mrs Cath McCarthy, the
Managing Partner, both from Hanham Health. As the project developed, Mr Tom
Hastings was employed to manage the prison healthcare centre, effectively as a
Practice Manager. The work steadily expanded to include other people who visit on
a regular basis, such as the midwife, optician and other specialist members of the
team. Dr Rupa Parmar is the Lead GP Partner. Dr Lizzie Stafford and Dr Ellie Carslake
are the other two salaried GPs who have dedicated time in the prison.
There are two Hanham Health GPs in attendance every morning from Monday to
Friday and one doctor in the afternoon. The full team includes nurse practitioners;
fully qualified nurses; healthcare assistants; a specialist substance misuse midwife; a
comprehensive mental health team supported by a consultant psychiatrist; an
optician; an ultrasonographer; a podiatrist, as well as admin and housekeeping staff.
A local physiotherapy department provides a secondary service off-site to which
patients can be referred to if needed.
The Prison Service has been fully supportive of this innovative approach to prison
healthcare, quickly recognising the enduring benefits to the prisoners and, by
extension, the prison staff. This is now an all-embracing initiative which has the full
support of many departments within the prison, from the education department to
the kitchen department which has willingly become involved in the preparation of
special diets, as well as the promotion of a healthy eating lifestyle, etc. The culture
within the prison has changed to encourage rehabilitation and to take responsibility.
The prison’s aim is now very much to provide optimum, focussed primary care to
treat patients while in detention, and thus help prepare them for potential integration
back into the community.
The GP team at HMP Eastwood Park has developed links with Bristol University
where final year medical students can come and spend several weeks towards the
end of their training studying custodial medicine as a specialist subject. Hanham
Health is a training practice which is also developing plans for GP Registrars to
extend their training by two to three months so they can also have experience of
working in the prison environment. Our work in the prison targets all prisoners to
make the best possible use of their period in detention. There is a particular
emphasis on the most chaotic individuals who may hitherto have chosen to have
erratic or no contact with state medical care. The work is also aimed at educating
prison staff; developing links with community health services, and involving external
groups such as Bristol University and General Practice (GP) Registrars with special
interests in substance misuse and custodial medicine. The aim is to open up prison
medicine to the same levels of medical scrutiny as are experienced in community
general practice, simultaneously exposing needy patients to the best range of
medical care possible. Arrangements are made as a matter of course for patients to
attend any pre-existing hospital appointments. Effort is made to ensure that no
patient is disadvantaged by being in prison: on the contrary, the majority of them
are exposed to the most comprehensive and wide-ranging medical care that they will
ever have had access to, and it is hoped that the medical benefits will outlast their
period of detention.
Patients come to the welcoming environment of the Pathways Medical Centre within
the prison. The centre is modelled on a community practice and is well-equipped
and provides a calm and neutral environment where confidentiality can be respected.
Doctors are available on site Monday to Friday from 8:00 am to 5:00 pm and there is
an out of hours service delivered by the same GP Practice which provides 365 days
per year continuous cover, along with an on-site experienced nurse. (Participation in
the OOH is separately remunerated)
It should be noted that there are a significant number of foreign nationals, many of
whom are unable to speak any English. The team works closely with a prison officer
who has considerable experience in this field and has close links to immigration;
foreign embassies and interpreting services. Doctors are able to access the Big Word
language line from the National Health Service which provides 24 hour access to live
interpreters in any language. This maintains confidentiality in sensitive situations
and is an invaluable resource, as used in the community model. Interpreters are
also arranged to accompany prisoners to external medical appointments as required.
This initiative is vital work which is spearheading the British approach to custodial
healthcare, providing comprehensive and pro-active care on the community model
for one of the most neglected groups in British society. A detailed assessment is
carried out on every new arrival which is used to augment any known medical
history. A multi-disciplinary action plan can then be developed, optimised to the
needs of that particular patient.
The team have been particularly keen to ensure that the patients are offered bloodborne virus testing with the very significant support of the Integrated Drug
Treatment Service; an accelerated vaccination programme, and onwards referral
where necessary. Dedicated sexual health appointments are offered for Sexually
Transmitted Infection screening. It should be noted that cervical smear testing is
offered to every new arrival where appropriate.
The team aims to have emergency care available around the clock via an on-call
rota. There are significant levels of deliberate self-harm and there is a dedicated
mental health team available with a psychiatrist, community psychiatric nurses;
psychologists; occupational therapists (including the use of art and music therapy) as
well as administrative support. There is also a dedicated medicine management
team with a pharmacist and specialist nursing team.
The Integrated Drug Treatment Service team includes nurses who specialise in the
assessment and management of substance misuse. They are supported by
Counselling, Assessment, Referral, Advice, and Throughcare services (CARAT) which
provide support to the women and fulfil the vital role of linking up with the
community drug and alcohol services (confirming prescribers; looking into
rehabilitation placements, etc) as well as the probation services.
All of the GPs that work in the prison are supported by the practice to obtain both
Parts One and Two of the Royal College of General Practice Certificate in the
Management of Substance Misuse in Primary Care. This is open not only to doctors
but to nursing staff and pharmacists as well. This training means that all staff are
aware of the latest guidelines for the management of substance abuse. In trying to
provide a community model of general practice, all the GPs working at HMP
Eastwood Park work in a large community general practice based between Bristol
and Bath.
There are user groups within the prison so the team can get feedback from the
prisoners themselves as to how best to improve the service delivered.
GPs and nurses regularly attend external meetings to ensure that care provided is
based on the latest models, for example, the programme of blood-borne virus testing
and treatment as well as offering brief interventions to encourage abstinence or
reduction of those identified as problem drinkers through use of the Alcohol Use
Disorders Identification Test (AUDIT) screening tool. This includes maintaining
awareness of national and international best practice and making it an integral part
of custodial healthcare in the HMP Eastwood Park model.
We aim to improve the entire process of providing quality Primary Care on the
community model to the most needy in detention. It is worth emphasising that the
women in HMP Eastwood Park are viewed first and foremost by the medical staff as
patients, and hence treated as such. Medical care is provided absolutely on the basis
of need, and is completely independent from the parallel process of legal justice.
We are extremely proud to have just won the World Health Organisation ‘Health In
Prisons Project Best Practice Awards 2011’ for our work in HMP Eastwood Park.