Health needs assessment in a male prison in England

To assess the health needs of prisoners in a male category B prison in Bristol, England, to identify areas for improving health in the prison.

Cross-sectional and qualitative.

Analysis of prisoners' self-reported health needs at reception and at a secondary health screen; prisoners' access to primary care, inpatients, mental health, sexual health and substance misuse services; and prescribed medications. Random selection of prisoners for interviews. Focus groups and interviews with staff and stakeholders.

18 prisoners were interviewed (29% of those randomly selected), five focus groups were held with staff and stakeholders involved in health care provision in the prison and four interviews were held with staff and stakeholders. The areas of greatest health needs were identified as dental care, mental health and substance misuse. Prisoners and staff generally reported good access to most health care staff, provision of prescribed medication, bloodborne virus vaccination and treatment of substance misuse. Twenty nine recommendations were identified with five high-priority areas for improvement including an urgent review of dental services; stronger joint commissioning arrangements for health and social care; installing an integrated IT system; prevention of disease and health promotion; better use of the voluntary sector. A detailed action plan was developed to address all the recommendations and this has formed the basis of a programme of ongoing quality improvement work which is monitored by the Prison Partnership Board. Progress has been made against all key areas.

The mixed methodology which involved analysis of health data and talking to a wide group of stakeholders, including prisoners, helped triangulate the data. The process of undertaking the health needs assessment shifted the focus from 'health care' to 'health'. This has facilitated a significant reframing of the concepts of 'health' and 'health need' with ongoing work now focused on the prison as a whole system, not merely on the provision of health care within the prison. Many improvements have already been made in response to the assessment.