ii RCGP’s 7th Health and Justice Summit: Journeys Through Justice – Leadership and Transformation

Before moving to day 2 ...

- the keynote by Cllr Asher Craig Deputy Mayor (Communities, Equalities & Public Health) at St George West Ward and Bristol City Council provided a city-wide perspective on public health, public mental health, the lived experience of child poverty and with it adverse childhood experiences, the impact of institutional racism and deaths in custody. I've taken more notice locally of community initiatives and sadly note speaking to what was once a local authority day care centre is now a social enterprise with uncertainty about its future. Cllr Craig spoke of Bristol's One City Approach and Learning Circles.

I attended Dr James Matheson's workshop, a GP at Hill Top Surgery and three medical students at Manchester Medical School - “Resources for primary care support to people in contact with the criminal justice system and their equally-affected others”

"Whilst the GP workforce is short, never have we had so many GPs in training. Is general training enough without extra specialist skills training on top? How then do we create and deliver a curriculum to inspire and prepare the next generation adequately for the challenges they will face?"

With posts to follow reviewing Kinchin's book the care environment presented by prison health  seems to encourage a network approach to learning, not merely linear - procedural - chain like approaches. As air safety methods demonstrate (outside of recent design?) checklists have their vital place as a heuristic and decision-making algorithm, but prison immediately challenges a student's attitudes, their expectations of themselves and others. Meeting prisoners crystalises a focus on self-awareness, what is subjective, objective, verbal and non-verbal communication. As per the synopsis the enthusiasm and feedback of the students to their learning was great to hear.

In addition to the student's contributions Dr Matheson highlighted inequality and referenced the "Deaths of Despair" that we have reached.

Another by Dr Matthew Langley, Consultant Forensic Psychiatrist for Rampton Hospital addressed:
“Remote vital signs and activity monitoring”.

"Early experiences with remote vital signs monitoring technology in High Secure (Women’s) Coral Ward (NHSHSW) is trialling Oxehealth’s remote vital signs and activity monitoring system. This is an innovative solution to support our staff but also presents challenges to integrate effectively. This presentation will discuss initial feedback from staff and patients and investigate our experience as a service with this new technology."

This project was already underway when Dr Langley returned to work at Rampton. Apparently the technology is very effective, Dr Langley trying it himself. Risk is a cost-rationaliser and here the risk is acute. Generally in health care professionals will need to weigh the ethical pressures in adopting technology. Technology will be a factor in making health care (and universal health care) sustainable, but as with electronic health records and their benefits the latter need to be assured. Does a technology 'solution' really free senior staff to focus on more 'complex' work?

I did not ask in session Dr Langley about his awareness of work on socio-technical approaches and Enid Mumford's work. At coffee we had a chat and will follow up with some information. I am very much an advocate for technology - students expect no less, the public look at what we do, the way we work and rightly wonder: wither the technology?

Another concern, however, is the word 'recognition'. Facial recognition is already politically and ethically loaded. States are deploying this technology with 'emotional recognition', so careful consideration and critique is needed (imho).

Sarah Bromley, National Medical Director Health in Justice at Care UK, covered:
“Patient Safety and Quality in Prisons”

"Deaths in Custody are still rising and the PPO have identified repeat recommendations that continue to contribute to deaths. How do we learn lessons and implement change and how do we know when we have been successful. Dr Sarah Bromley will discuss the challenges faced, the Care UK PROTECT programme and quality assurance measures in use."

Sarah appealed to my 'information-oriented' focus, as it was noted how teams can still reach a point with a new referral / patient ' client and question:

"Have we got more information"?

"No."

"Oh, right."

They then elect to carry on without this (acute - in contrast to the uncertainty it represents?) need being pursued and fulfilled. A useful distinction was made by Sarah between training for staff - Wellbeing approach, ASSIST training 2-days on self-harm and suicidality, TRIM training; and support for staff who experience extreme trauma, clinical supervision and clinical forums.

There are subjects that need regular update and so I was very grateful for:

Dr Iain Brew, Deputy National Medical Director of Health in Justice Medicines Safety and
“Hepatitis C – developments and outcomes”.

This was very helpful personally as a nurse, and in the national and global objectives that have been set. With Hodges' model incorporating an individual -- group (population) axis and a Political care domain two further talks were greatly appreciated:

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.’ Ms Lyon explained feedback from prisoners on how "... you get the odd officer who really takes care and really wants to do something but there should be an officer on every landing who spends at least twenty minutes with one prisoner at a time through the time he is there and understand him and get to know him rather him just being a number ...".

A comment Ms Lyon made concerned the training of prison officers. The time is limited. I spoke briefly to Ms Lyon as there is a resource that imho should be a part of all course 101's and again I will reach for the email. This resource might help many prisoners too. One of the needs identified was prevention, improving prisoner - officer relationships and preparation for release. It must surely help in all of these if prisoners themselves were better equipped to reflect and have a better relationship with themselves? Self-esteem counts for a great deal and whether inside or out it seems many prisoner's self-esteem is challenged, even if sufficiently coherent and emotionally mature?

A quote also struck a chord: "All my life just got the better of me since aged 13" and a self-harmer.

And, Dr Brad Hillier, Consultant Forensic Psychiatrist at Heathrow Immigration and Removal Centres on “Mental Health and Substance Misuse in the Immigration Estate”. A topic that is clinically remote to me and yet conceptually 'visible'. Visible through geopsychiatry, the impacts of conflict, enforced migration.

Dr Hillier outlined the history of immigration removal in the UK from "Immigration Act Prisoners"
1970 - small detention unit in Harmondsworth, similar units in Dover and Gatwick.
Most IAPs held in prisons (180 in 1982).
1993 - Campsfield House converted from prison to IRC
Current system dates from around 2001-6
Home Office Policy to detain and deport developed
Detention Centre Rules (2001 - statutory instrument)
Immigration Detainees

More background on 'Routes into Detention'; the impact of detention on mental health (Von Werthem et al. 2018; Adult at Risk and Rule 35 - consideration for release on medical/professional evidence that there is a history/evidence of

• Torture/trauma
• self-harm
• Health condition (mental and physical) ...;

and Issues on removal / release.

This insight was new for me.

Although the programme is primarily divided between plenary sessions and workshops, the workshops - at least those I attended are essentially presentations. The room layouts reflected this. A workshop for me should have an audience work.

More to follow ...