AWARD WINNER 2012-13: Liz is the Head of Healthcare at HMP Full Sutton. She has transformed the healthcare provision there, introducing a range of services to improve patient care and reduce the need for hospital visits, including: tele-medicine consultations; visiting MRI and retinal-scanning services; in-house haemodialysis; and a palliative care suite. She has also set up a drug free wing and introduced protocols to improve the control of prescription medicines. (This Award is supported by Serco Civil Government).

IN THEIR OWN WORDS

[Liz Littlewood gives her account of the work for which she won her Award]

My Butler Trust Award was given for developing best practice within prison health by introducing a range of diagnostic services to detect early disease and ill health, introduce specialist interventions including haemodialysis and introduce and develop a palliative care service.

The work began some years ago following a detailed Health Needs Analysis of our prisoner population in order to develop the Prison Health Development plan and commissioning strategy for health services within HMP Full Sutton. I also looked at the level of escort and bedwatch activity which relates to the reason and length of stay of prisoners at outside hospital along with the associated costs.

After detailed analysis of the health demographics of the prisoners and cross referencing this with the protracted hospital admissions, I began to build the picture of the specific services that could potentially be provided in house. The aim was to prevent unnecessary risks of escorting prisoners to outside hospital for routine investigations and interventions and enable the prisoner to return to the prison hospital for intervention as opposed to extended stays in the community hospital where both the general public and prisoners felt uncomfortable with the position.

The plan was two fold; To understand the range of health needs, identify where external diagnostic services and specialists could be commissioned to provide outpatients clinics within the prison walls, and, to identify what interventions the nursing team could undertake with extended scope training to further enhance care provision locally.

Once I understood the main heath needs and levels of diseases prevalent I worked with the Primary Care Trust to co commissioning and introduce a range of diagnostic screening services that would identify early disease and ill health. These services included retinal screening, MRI and CT scanning, Ultra sound scanning and Aortic Aneurysm screening.

Armed with the disease register the next step was to approach our Acute hospital trust to negotiate specialist consultant services transferring from out patients within the hospital to an outpatient clinic within the prison where there was a high demand for the specialism.

I successfully transferred services for diabetes, Ear Nose and Throat, Elderly, dermatology, Orthopaedics and physiotherapy. This had a significant impact on the number of external hospital escorts and provided an efficient and effective in house service promoting access to specialists and reducing health inequalities.

When looking at the roles the clinical team could aspire to I completed a workforce analysis to identify the skills, competencies and development needs of the clinical team to manage more specialist procedures. A professional workforce training plan was developed and rolled out with key clinicians taking the lead in monitoring and managing long term conditions.

I identified two key areas where intensive treatment and intervention at hospital had a significant impact on the wider prisoner/patient population, pressure on financial budgets and escorting officers. There were a significant number of patients sent out to hospital with advanced disease and palliative care needs, and, two patients both requiring haemodialysis three times per week for up to 6 hours on each occasion. The associated problems with these admissions led to other prisoners’ escorts being cancelled due to the lack of escorts and vehicles available to transport prisoners to appointments.

In order to address improvements in managing terminally ill patients I approached the local McMillan nurses to work in partnership to develop a Palliative Care and End of Life policy which could be delivered with equivalence within the patients home/prison. Once we had agreement work in partnership and train the nursing team I commenced negotiations with the prison Governor to identify and refurbish a palliative care suite to meet the required standard. The result was the development of the palliative care and end of life policy including the framework for managing prisoners throughout their illness and where appropriate in their end of life in a dignified and caring setting.  The palliative care model is now fully embedded and the palliative care suite has been used on five occasions to date.

I approached our Acute trust that was providing six sessions of renal dialysis per week to our prisoners with a view to developing a partnership to train a number of nurses in the highly specialist area of renal dialysis and ultimately transfer the care to the prison. Introducing the concept of home haemodialysis into the prison setting was a significant challenge. This had not been achieved within a custodial setting anywhere else in the country and we had no guidance to work from. Despite the trusts seeing the benefits of the proposal there was some reluctance to engage in the transfer of services due to perceived risks and potential problems. Relationship management was key throughout the early stages to achieve buy in from the renal physicians once this was achieved we planned and rolled out an intensive training programme to equip the staff with all the skills and knowledge required to operate in line with the trusts policies and procedures. The Governor agreed to the refurbishment of an area to create a haemodialysis suite to the desired specification and the service was eventually transferred in 2011.

INSPIRE ARTICLE

[The following article appeared in issue 5 of the Butler Trust’s magazine, Inspire]

Liz Littlewood’s passion for good quality healthcare for all offenders at HMP Full Sutton has earned her a Butler Trust Award. Liz’s initiatives have not only improved health services for offenders and helped them to maintain dignity while needing treatment; they have also brought considerable savings in the amount of staff time taken up escorting prisoners to outside appointments.

Introducing tele-medicine services has been an important development at Full Sutton, enabling healthcare staff to link to a hospital consultant so they can see and speak to staff and the offender to make a fast diagnosis and prescribe medication or recommend a transfer to hospital. Offenders have particularly appreciated not having to walk through hospital in handcuffs, and in some cases category A bright green and yellow suits.

Through arranging for a mobile MRI scanner to come to the prison, Liz achieved similar efficiencies and significantly improved healthcare assessments. Introducing retinal scanning has also been highly effective, giving up to 40 offenders over a two day session the chance to be screened for conditions such as diabetes and glaucoma.

Her proactivity did not stop there. ‘I had a vision to introduce a haemodialysis service at HMP Full Sutton, as never before had the prison service delivered it from inside a prison’, she says. Sourcing external training and providing substantial support to the team through an intensive training programme, she has enabled the prison to provide life saving treatment to two offenders three times a week.

Liz has also tackled the challenging area of palliative care. ‘I wasn’t satisfied with the standard of care provided to offenders approaching the end of their lives’, she says. So she introduced a Palliative Care Suite, offering care and support with dignity and respect for both offenders and their families. Family visits can now take place in the suite for extended periods and other offenders have also commented positively on the level of care provided to their friends at the end of their lives.

HMP Full Sutton’s Governor and staff have particularly appreciated Liz’s ability to present her innovative ideas and propel them into action, calling her ‘inspirational and motivated’.

‘She always presents them with enthusiasm and is able to answer all concerns put to her with detailed replies’, says Governor Paul Foweather OBE. ‘Liz has created a supportive environment in the healthcare centre that has also empowered her staff to be creative with the way in which they deliver their work’.

Liz’s recent initiatives include introducing a drug treatment wing for offenders who misuse drugs, both prescribed and illicit. The offenders receive support and counselling, as well as attending gym sessions and being given advice on eating healthily. She is ambitious for the unit s potential, and hopes to do more.

‘I would like to further develop the ethos of the newly introduced drug recovery and abstinence unit to introduce a service user led programme’, she says, and hopes to do this through setting up in house mentorship, so that offenders can work as co-facilitators of the drug treatment programme, promoting mutual aid among peers.

She would also like to further explore the potential of tele-medicine, eventually promoting it in all establishments, because of its demonstrable benefits to offenders, prison staff, hospital staff and members of the public.

‘I believe true partnership working between the NHS and NOMS is crucial to tenable prison health services to operate effectively and efficiently’, she says.

• Liz Littlewood s award was sponsored by Serco Civil Government 

For more information: contact HMP Full Sutton