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A day in the life of ... a prison nurse at HMP Littlehey

Over 11 years ago I felt, after several years in the NHS nursing on acute medical wards, that my life had come to a crossroads and that I needed to look at different avenues to explore. After scanning various nursing magazines I realised that I wanted something different - I wanted something challenging that was also rewarding, yet had the scope for career opportunities. I browsed the job vacancies column and was attracted to those advertising nursing posts within the prison service. I was excited at the prospect of something different, but apprehensive at what the job would entail and the receptiveness of the clientele. After much consideration I decided to rise to the challenge and apply, and after receiving the acknowledgement that I had been successful in the appointment to the post, I convinced myself that it would be a good learning curve and offer me a wealth of experience.

On commencing duty, I soon realised that working in a prison bore no resemblance to the portrayal of prisons that I had witnessed on television - it was much better, and after several months in post I realised I was hooked. Eleven years later, I still remain in the prison service.

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Prison nursing offers the opportunity to work with staff across a wide range of disciplines. Healthcare is an integral part of a larger team, which is continuously developing in order to meet the needs of a growing population. HMP Littlehey is a category C training prison for adult men; it is situated seven miles west of Huntingdon and is based in the Eastern Prison Service area within Cambridgeshire. The operational capacity of Littlehey is 706. The prison can house 80 life-sentenced prisoners, and over half of the population are sex offenders. The age of the population can range from 21 upwards, the oldest at the moment being 84. The prison itself is set in extensive grounds that are meticulously maintained by the prisoners themselves.
 
Healthcare services are provided in the form of a primary care facility that offers a comparable service to a GP surgery. We open the healthcare department at eight o'clock in the morning, when we administer medication. This includes prescribed drugs and "special sick" medication such as paracetamol. Eighty-five percent of our population have "medication in-possession", where patients take responsibility for their own medication, as our philosophy is to rehabilitate our prisoners ready for release. This is also the time to book any appointments they may require, such as physiotherapist, dentist, optician, GP, chiropodist or pharmacist. This can be a very busy time within the department as everyone has the opportunity to access Healthcare from 8.00-8.30am.
 
Prisoners also request medication to be represcribed by filling in a repeat prescription form and delivering it to Healthcare. This ensures continuity in the supply of their drugs and is a parallel service to that experienced in the community. The GP then commences his surgery at 8.30am, with all his appointments generated on our clinical system - EMIS. Our doctor cover is mornings only, Monday to Friday, with telephone advice until 6.00pm, when Huntsdoc takes over our out-of-hours service, which incorporates weekends.

During the morning we operate numerous nurse-led clinics, inclusive of phlebotomy, asthma, hepatitis B immunisations, well man, smoking cessation, diabetes and confidential HIV/hepatitis testing. We also deal with any injuries sustained as a result of work or sport, as well as self-inflicted injuries and the result of fights between individual prisoners.
 
Prisoners who have expressed suicidal tendencies, or are considered depressed or at risk of self-harm, are placed on a self-harm document called an F2052SH or more recently ACCT document. Healthcare and the doctor have a responsibility to see each prisoner within a dedicated period of time in order to assess their mental/physical requirements and to determine what support mechanisms can be established to reduce the risk of further attempts.

We are also required to attend the scene of prisoners being escorted to the Care and Separation Unit under restraint, due to altercations, as we have to document and report any injuries sustained while continually checking on the prisoner's health during the relocation process. During the course of the day we also have a variety of dressings that need renewing and assessing, both in the department and on wing locations. We have further suicide/self-harm risk prevention reviews in the afternoon and also deal with new receptions into the prison from a wide variety of establishments.
 
All prisoners received at Littlehey are screened by a member of the healthcare team in the reception area of the prison. This is a detailed assessment of the client's needs, ensuring continuity of treatment or medication and the provision of any services required. There are approximately 30 new receptions per week. Healthcare is extremely lucky to have its own pharmacy on site with a fulltime pharmacist and pharmacy technician. We also have strong links with our mental health in-reach team, as mental health issues affect an increasing number of our population.

Healthcare closes its doors to prisoners at 5.30pm Monday-Friday and 12.30pm at weekends, but the care doesn't stop there. Littlehey has an abundance of first-aid trained prison officers located on the wings. We are also very keen to liaise and network with outside agencies in order to develop and enhance our delivery of healthcare provision. These can include the HIV specialist nurse, HIV social worker, tissue viability nurse, palliative care nurse and speech therapist, all of whom attend the prison when required. We also have strong links with the local hospitals and have developed clear clinical pathways of care. Healthcare at Littlehey forms a small portion of a larger team working closely together for the benefit of the prisoners.

Littlehey has just received the World Health Organization award for best practice in providing a dedicated service to prisoners who are challenged by their sexuality and have gender issues. Its aim is to provide support and reduce isolation, by running a monthly group, which is driven by prisoners for prisoners.
 
Since my arrival 11 years ago, I have witnessed numerous changes to prison health. The job, although frustrating at times, continues to remain rewarding and always challenging, which makes no two days the same. The staff and the atmosphere are like no other, and the clientele generally appreciative. I came into the job with apprehension and naivety, and remain in the job with an overwhelming desire to continue to be part of the ongoing modernisation agenda for prison health.