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Scottish prison healthcare overhaul 'is falling short' five years on

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Nurse-led services in prisons have not improved Nurse-led services in prisons have not improved since overhaul

Prison nurses in Scotland are still reporting low morale and increased pressure five years after an overhaul to prison healthcare services, a new report by the Royal College of Nursing Scotland has found.

RCN Scotland carried out an online survey and consulted focus groups to determine whether prison healthcare services had improved since 2011. Up until 2011, healthcare in prisons was the responsibility of the Scottish Prison Service (SPS). In November 2011, responsibility for prison healthcare transferred from the SPS to NHS Scotland.

Just under half of survey respondents (45%) thought that nurse-led primary care services were meeting the healthcare needs of people in prison currently, with 40% of respondents saying they were not. Nearly 40% thought that management of long-term conditions were being met, with 37% of respondents thinking they were not.

Sheila Cron, former head of nursing for health improvement and inequalities and Perth and Kinross Community Health Partnership said she was 'disappointed, but not surprised, about the lack of progress with this agenda'.

'Nursing teams set up to support people leaving prison are being depleted due to budget cuts, reducing the "one stop shop" approach to steer ex-prisoners through the labyrinth of services they require. Nursing expertise is being lost, which can support the education of GPs to the needs of this group of people and contribute to information sharing and continuity of care,' she said.

Respondents reported that they wanted to provide clinics to the community, such as asthma,
diabetes and sexual health, but a lack of staff and resources prevented this. 'There are no nurse-led clinics. No
chronic disease management. This has reduced since the transfer,' said one respondent.

'RCN Scotland is clear from this research that there is real work to do to ensure that the aspirations of the prison transfer from SPS to the NHS are translated into consistent delivery of service equity and improved health outcomes for people in prison across the whole of Scotland,' said the report's conclusion.

Mental healthcare also surfaced as a major concern, as only a third of nurses who had worked in the prison service from before the changeover thought that mental health services had improved under the NHS and 22% thought they had deteriorated.

'I can only conclude that we are still a considerable way from achieving the outcomes set out in the original transfer. This report reveals the difficult reality for both people in prison and the nursing staff delivering healthcare to them. Our conclusion is that improvement must start with renewed and open collaboration,' said Theresa Fyffe, director of RCN Scotland.

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