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Guest blog: Liam King, Managing Director at Healthcare Gateway

Today, across the digital health and care landscape, interoperability is a recognised solution used to join up patient and citizen data across a complex architecture of systems from multiple settings.  Integrated Care Systems (ICSs) have formed partnerships to meet health and care needs to improve population health and reduce inequalities.  Despite the efforts of transformation, gaps in the delivery of care are still being uncovered.

In the criminal justice sector, prison systems do not appear to be effectively communicating with the systems used by the NHS. If systems are able to talk to each other the transfer of care is streamlined and safer for prisoners accessing healthcare whilst in prison and on release from a prison setting.

The only caveat being that appropriate information sharing governance and/or required consent is in place.

Our mission at Healthcare Gateway is to improve health and care for all by being the number one managed service; supporting integration across health and care systems in the UK. We build solutions to solve interoperability challenges regardless of technology or standards, bridging gaps by integrating data to provide a holistic view in real-time.

The latest government statistics show the prison population is close to maximum capacity. It is our view that the large population in prison today require efficient care, aligned to the criminal justice journey. Without safer, more joined up care wider issues can prevail. A patient journey that is disjointed, especially in this space, creates wider issues for prisoners whilst in prison and upon release.

Holistic views inside

In our experience, patient information held across disparate systems generates silos of data which are unhelpful for the healthcare professional providing care. Presenting all the information in one single view and in real-time builds a full picture of the patient’s medical history. A holistic view of patient data needs to be aligned to prisoners moving into prison, while inside prison and on release. For example, the first few days upon release is deemed to be most vulnerable for prisoners and critical to health and welfare. If clinicians have access to discharge summaries and transfer of care documentation transition can be coordinated to ensure the best patient outcomes. In our research, we believe that clinicians have inadequate access to real-time patient data across geographical and organisational boundaries currently exists in the sector. Resulting in the loss of patient data, and restricting the ability for supporting organisations to recognise those in need quickly enough to avoid damage to welfare, or the potential for re-offending.

Effective care planning for prisoners

The creation and continuation of care plans for patients during their sentence and following release is critical in improving care pathways. Interoperability is required to ensure care plans are informed, joined-up and readily accessible to all professionals involved in a patients care.

Medication

Accessing health records which provide detailed views of prisoner’s medications, allergies and addictions minimise errors in prescription such as duplication or risk of overdose, and supporting successful rehabilitation on release. Particularly as the associated anxiety of prison release can result in self-medication if not appropriately managed. However, views of prescribed drugs used within the prison can be lost during the transfer of care as typically interoperability isn’t in place to facilitate the consumption of prison data in out of prison healthcare systems or settings.

Mental Health Crisis

The Institute of psychiatry recognises that there is an existing crisis of unmet mental health needs in the prison system. Findings show that over half of prisoners have mental health problems, yet the Prisons and Probation Ombudsman (PPO) report that one in five prisoners diagnosed with poor mental health receive no care from a mental health professional in prison.

Addressing mental health by co-ordinating and improving the process of care planning relieves pressures created by this crisis. When entering the prison system, knowledge of inmate’s mental health history prior to admission enables better provision of care while incarcerated.  Using the Medical Interoperability Gateway (MIG) a patient search presents all available information about a patient, including mental health data. So if mental health care plans are in place, the continuation of care is extended upon release. The provision of integrated care is of particular importance in mental health instances to avoid triggers, and prevent escalation by ensuring patients only tell their story once.

Safeguarding prisoners

The Care Act 2014 states a requirement for the local council of the prison region to assess prisoner’s social care needs, informing a care and support plan where required. In the instance of prison transfer or release, local councils need to communicate and transfer the details of the prisoner’s social care needs to the new local council and social services to assess their needs in the new prison or living in the community.

Looking ahead

For a truly integrated care system, levels of care must be comparable across all settings where medical intervention exists.  However, there are significant interoperability gaps in the sector which need addressing to ensure the care received a prison environment is the same quality of care as received by the wider population. Adopting solutions that are widely used across the UK, such as the MIG, can support the criminal justice sector in its capability to rapidly achieve smarter, connected care.

It is our passion to provide interoperability between systems and settings. Healthcare Gateway are exploring how they can support interoperability between data silos within a criminal justice setting and also connectivity inside and outside of a prison, as a patient’s care is managed between Criminal Justice and the NHS Health and Care, we are open to explore these further.