iii RCGP’s 7th Health and Justice Summit ...

Returning to Juliet Lyon CBE, Chair of the Independent Advisory Panel on Deaths in Custody, who presented ‘Keeping Safe – how consultation with women and men in prison and health and justice professionals informs our work and advice to ministers.’

In February this year the Independent Advisory Panel on Deaths in Custody (IAP) and the national newspaper for people in prison, Inside Time, began a ground-breaking collaboration - Keeping Safe - to help keep people in prison safe. Supported by the Samaritans and Prison Radio, the IAP called on Inside Time readers to say how best to prevent suicide and self-harm. Prisoners’ recommendations in this Inside Time special report reflect evidence from, and recommendations made repeatedly by, amongst others, the Prisons and Probation Ombudsman, HM Chief Inspector of Prisons, the Chief Coroner and the National Audit Office.

Ms Lyon spoke of the clinical context, hope and time:

What was done in the  ::   Being in Prison  ::    What might be done in the

Past                        Now                             Future

Mention was made of a 'Keeping Safe' event in February 2020. If I learn more, I will add details.

Mark Langridge took us through some technology developments in healthcare as Care UK National Lead Pharmacist:

Socrates (with reference to 5-domains of well-being)
PharmaSelf24
PrisonAssist
Turning-On

There was discussion of "Opt-out" in respect to population screening for antibody positive screening tests and how the question is framed:

"Want your bloods done, luv?"

"We test everyone because    ...

is that OK with you?"

On day 2 Suzy Diamond-White, Governor at HMP Eastwood Park shared management experiences and the quest for change in ‘Delivering Health and Wellbeing in a Women’s Prison’

A look at how health services are delivered within the operational demands of daily life at Eastwood Park given its complex population and wide geographical catchment area. How we keep wellbeing on the agenda to support our contracted health teams. What is so specific about a women’s prison? What needs to be overcome to ensure equivalent service to the community.

Gender was obviously fundamental here, the fit and appropriateness of P.E. kits, the procurement and supply of sanitary towels and incontinence pads. What is 'hygiene' being accounted for through a 'cleaning' budget and other historical legacies to be challenged. The geographical range of Eastwood Park across nine counties and all the consequences for family and children. Talk of prison as a punishment and the public's view was echoed a few times at the summit.

Elizabeth Moody, Deputy Ombudsman at Prisons and Probation Ombudsman provided more reflection on deaths in custody, stressing the families affected by and need for action and lessons to be learned. High profile cases were mentioned in several presentations. The talk gave me a sense on one hand of what families must go through, especially when circumstances suddenly engulfs an individual in the criminal justice system. The work that independent agencies do behind the headlines and sometimes in the midst of them

Chantal Edge, NIHR Clinical Doctoral Research Fellow for Department of Epidemiology and Public Health described research on “Systems barriers to telemedicine in prisons”.

Experiences of systems barriers (prison and hospital/community) encountered in England whilst attempting to operationalise a local prison-hospital telemedicine model, alongside broader evidence on prison telemedicine implementation barriers drawn from a systematic qualitative literature review of published prison telemedicine evidence.

I was late arriving to this session. As per my thoughts concerning Dr Matthew Langley's presentation the potential socio-technical studies might provide some insights?

Although it is also a commercial vehicle, Raconteur published with The Times had a special report on 5G in June. In a similar way to my references to the 5-Care-Domains of Hodges' model, many people talk of 5G and its speed, without fully understanding the change and opportunities this can bring. The report's summary:

"5G is so much more than faster 4G, but the extraordinary hype surrounding it has left many confused over what it will actually do for them. The 5G special report, published in The Times aims to shine light on this, exploring how 5G can transform healthcare and make smart roads a reality ahead of autonomous cars. It covers how to address public concerns over the health impacts of 5G and examines whether the rush to be first in the 5G race is a fool’s errand, with comment on how it might be better to deploy 5G best, rather than deploy it first. Also featured is an infographic measuring the true impact of 5G and looking at the sectors which stand to benefit the most ..."

Page 3 is enlightening.

Chantal provided some copies of an associated paper:

Edge, C., Black, G., King, E., George, J., Patel, S., & Hayward, A. (2019). Improving care quality with prison telemedicine: The effects of context and multiplicity on successful implementation and use. Journal of Telemedicine and Telecare. https://doi.org/10.1177/1357633X19869131

Rachel Gibbs "Equalizing Spaces"

Rachel Gibbs, Assistant Director for Prison Healthcare Services for Northern Ireland shared a travel fellowship “Equalising Spaces”.

Rachel Gibbs was awarded a Winston Churchill Memorial Trust Fellowship in 2019. She will share learning from her visits to Prison Healthcare services/Transitions clinics/Harm reduction rooms in California, North Dakota, New York, Barcelona, Geneva and Stockholm over an eight week period in order to being back innovative ideas to the UK. She will share some of the user involvement work happening in Northern Ireland.

Churchill Fellowship

The title of this session including 'spaces' had my immediate attention and did not disappoint. Rachel's Gibbs also provided help in making me feel a little less guilty in the future. Rachel highlighted and reminded me of the value of travel in the exchange, transfusion and diffusion of ideas, a difficult equation to resolve in these flight-shaming days.

Rachel Gibbs - findings

I do wonder what a global consensus would be on models of care, nursing theory and what other continents have to say (if anything?) on this topic that might inform my study of Hodges' model. Rachel recounted her travels and learning not just from her peers but from prisoners and ex-prisoners. Existing awareness of international health and justice provision was used to focus countries to visit.

Rachel shared her time with:

Transitions Clinic Network (TCN), USA.

and 

One Day at a time
Empowering youth to lead positive lives

Hodges' model repeatedly 'takes' me to spaces of all kinds and also transitions:

Life course - infant - child - teens - adult - older adult - end of life

Life course - infant - child - teens - adult - older adult - end of life :: Diagnosis X (Rare?)

Health - Social Care

Critical information giving :: Pre - Post

Adult service - Older Adult Services

Looked after Children - Adult

Younger Adult, Adult, Older Adult :: Early Onset Dementia

Home care - Day care - Respite care - Residential Care

Continuing Health Care

Justice and Health

Veteran - Civilian

Risk

Formative education - Lifelong learning

Health - Trauma - Intensive Treatment - Return Home

and other Transitions (Prevention!) ...

We often think of tools and the need for them to be ready to hand, as in organising your workspace. Increasingly as the list above suggests there is a need for tools to help keep things 'close to mind' also.

Professor Graeme Henderson (School of Physiology, Pharmacology and Neuroscience for The University of Bristol) gave a serious and yet entertaining talk on“Why are fentanyls so deadly?”

Fentanyls are highly potent opioid agonists. Only small quantities are required to produce their effects and this may make them attractive drugs for smuggling into prisons. fentanyls have pharmacological properties that make them more likely to lead to overdose than other opioids – in addition to their high potency and rapid onset of action these drugs induce respiratory muscle stiffness making it difficult to breath, are less sensitive than heroin to naloxone reversal and may show reduced cross tolerance to other opioids.

Prof Henderson provided statistics that had you paying notice, supporting the first answers to the title:

• High potency
• Faster rate of onset of respiratory depression
• Muscle stiffness (wooden chest) making it harder to breathe
• Lower cross tolerance between heroin and fentanyl
• Resistance to naloxone reversal

The Chairs for the summit had quite rightly drew delegates attention to the exhibitors, so I was a bit late again here. The photo is not very good, but brings home the potency of fentanyl. (That is Prof Henderson in the biohazard suit.)

... (still) to be completed - part iv to follow ...