How med-tech is changing care for prison populations

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he British prison population is aging rapidly, with the proportion of prisoners aged over 50 in England and Wales having increased from 7% in 2002 to 17% in March of 2020. Just like the rest of the population, incarcerated people’s healthcare needs become more complex as they age. Many older prisoners live with conditions which require regular hospital check-ups outside of the prison, visits which rapidly declined as elective and non-emergency appointments were put on hold due to the Covid-19 crisis.

The pandemic saw Britain’s prison population thrown into disarray, as Covid-19 restrictions left many prisoners stuck living in indefinite solitary confinement, confined to their cells for nearly 24 hours a day when they would usually be able to move freely around the facility. While the majority of prisons have loosened the rules, but it’s still the case for some inmates.

Now, NHS England and NHS Improvement have signed a new national agreement to rapidly connect prisons in England with local hospital specialists through health technology company Visionable’s video collaboration platform. Instead of coordinating physical visits to the hospital, prisons will be able to utilise Visionable’s technology, allowing prisoners and consultants to convene remotely.

Visionable chair and co-founder Lord Victor Adebowale says: “In most cases a prisoner would be seen in house for minor injuries, dermatological problems, that sort of thing. But when there was a requirement for some sort of clinical intervention at a hospital the prisoner would need to be escorted. That means you’d need three extra people, one driver and two escorts.”

The mandated security measures that surround escorting prisoners to hospital are both time consuming and costly, but Visionable’s technology can allow the procedure to be bypassed entirely. In addition to providing more dignified delivery of healthcare for the inmate in question, it’s also more Covid-19-compliant and when it comes to the pandemic, the fewer patients physically attending hospital the better.

A secure, encrypted version of the Visionable system designed specifically for use in prisons was initially rolled out to one facility, HMP Coldingley, in March 2020. It allowed hospital clinicians at Royal Surrey Hospital to provide specialist video consultations to prisoners under the supervision of the prison’s own medical team.

The initiative has proven so successful that it has now been scaled nationally and is in the process of being rapidly deployed to 114 prisons and young offender institutions, 15 secure children’s homes, and five immigration removal centres. In the longer term, it could also potentially be used to virtually connect patients to other NHS services, such as primary care and mental health.

“Our plan is to expand as quickly as possible,” says Adebowale. “It’s good that we can work rapidly with a client like the prison service in these complex areas.”

Security has been a paramount consideration as the system has been rolled out. Visionable video calls are carried out over secure laptops that only be activated with a remote key held by the prison’s healthcare team, who then take the laptop to the prisoner’s location.

A staff member will use the Visionable platform to join a virtual room where they connect with a hospital consultant before the laptop is then placed in front of the prisoner and the appointment can be carried out. Consultants are then able to use the system to show the prisoner important information and diagnostic images from X-rays and other scanning procedures.

“The solution that we’ve come up with comes from a deep understanding about what’s required. We’ve worked with the prison system, and it’s been tailored to the clinical needs of prisoners by actually observing what happens there every day,” says Adebowale. “The software that we use is quite intuitive and we’ve worked with a whole load of companies in the chain of clinical support for prisoners and dealing with prisons on a day-to-day basis.”

The laptop and software have been configured so that it cannot be used for any other communication purpose. Should the laptop be stolen, it would be rendered inoperable.

It isn’t just hospital visits that modern technology can improve for prisoners. Tunstall Healthcare, a firm that specialises in digital solutions for community social care settings, has worked with Lancashire County Council since 2017 to roll out a number of technologies to support the care of disabled and older people living at HM Prison Wymott.

Tunstall service development manager Angus Honeysett says: “When I was going around the prison looking at the capability of our solutions, I was quite surprised, I think because I didn’t understand the prison environment. A lot of prisoners were bedbound, a lot of them had breathing difficulties, a lot of them were on oxygen – they were high needs people, just in a different living environment.

“We asked what the procedure was if somebody needs help. The best solution the prison had come up with was a rape alarm. In the middle of the night, if a prisoner needed help, they’d turn on the rape alarm as it was the only thing likely to be heard by prison wardens. They did have an intercom button, but if somebody can’t get out of bed or they’ve fallen on the floor they’re not going to be able to reach it. The solutions that were there weren’t appropriate.”

Tunstall’s solution was to install its Lifeline Vi+ home unit in a secure room in the prison, which is connected to a dedicated telephone line. The unit acts as a hub for telecare throughout the facility and is compatible with a wide range of sensors worn by eligible prisoners.

According to their needs, these prisoners will be given access to a bed occupancy sensor and a Vibby wrist-worn fall detector. The bed occupancy sensor issues an alert if a vulnerable prisoner is out of their bed for more than ten minutes, while the Vibby will raise an alert if it detects a heavy fall. Wearers can also press the face of the wristband directly to signal that they need help.

All of these alerts are processed at a control centre manned by trained operators, who can then alert prison staff to go and check on the wellbeing of the prisoner.

Since working with Lancashire County Council, Tunstall has been in contact with Doncaster Council, the Ministry of Justice and the Care and Justice Network to talk about expanding the use of remote patient monitoring throughout UK prisons.

Honeysett says: “Typically what happens is that between 8pm and 8am, cell doors are locked. Twice a night, wardens will do a walkaround, but one could be at 8pm and the next could be at 5am. If somebody gets out of bed mid-evening and falls over, this might not be noticed until the next day, but with our equipment it absolutely will.”

Much like Visionable’s solution, these measures not only provide a higher standard of care for prisoners but save time and money too.

“In Wymott, where they had highly vulnerable prisoners, six of them needed a waking watch carer every night of the year,” says Honeysett. “With our solutions they didn’t need them, because they were being monitored using our equipment, rather than having someone sit outside the cell door all night making sure they were okay.”