This thesis is concerned with the transfer of prison healthcare to National Health Service (NHS) responsibility, and investigates whether equitable provision has been achieved for prison-based patients. The chronic ill health of prisoners in England has been recognised for centuries. For example, Howard debates the issue in 1784. When released from prison, English prisoners’ abilities to carry ill health and infection into the community is more recently acknowledged as an additional significant concern (Ramsbotham, 1996). Three themes are evident when analysing the policy and legislative background demanding fair and equitable provision for all. These are: Philanthropy and Concern for Prison Healthcare, Prison Specific Policy and Recommendations, and the Wider NHS Policy, National Service Frameworks and Strategies. Three distinct phases of the Public Health Agenda are considered in this thesis: 1784 - 1890, 1945 - 1996, and 1997 - 2010. Investigation of the Public Health Agenda is divided into sub-categories: Health Promotion, Health Education, Disease Prevention, Healthy Settings, and Prisoner Health providing a valuable structure within which the wider literature can be evaluated empirically via this thesis’ fieldwork. Interpretivist in its methodology, this qualitative study adopts Case Study as an appropriate methodology. Research methods include focus groups, interviews, and participant correspondence. Presentation of research phenomena through graphic representation was designed to overcome reported literacy and language issues present within the research population. Combined, these methods offer an opportunity to build a “polyhedron of intelligibility” (Foucault, 1981, p. 6) demanded of this methodological approach. Between 2005 and 2010, this study explored prisoners’ experiences of healthcare post-transfer to NHS responsibility via five distinct phases of fieldwork: the identification of key patient themes of interest within a self-selecting sample, the validation of Phase One material and the generation of 5 | P a g e additional themes, focus group discussions, followed by interviews with participants and wider stakeholders, and finally a discussion group. Data are analysed and structured according to prison category and gender, age, and ethnicity. Resultant analytical themes linked to a central coding category, the overarching topic of Patient Equivalence. Furthermore, there are three analytical Key Themes: Beliefs, Attitudes and Behaviour; Service Commissioning, Delivery and Constraints; and Patients’ Health and Patient Outcomes. Here, the identification of Imprisoned Carers provides a unique and novel finding of this work. From these three analytical categories, a Core Theory emerged. Research data indicates that, despite considerable policy focus and activity, the lack of integrated service commissioning means that equitable provision for this prisoner population has not been consistently experienced by imprisoned patients. In its absence, prisoners have themselves adopted the role of carer for the sick and frail amongst their prison communities. These individuals report that they undertake these caring roles unsupported by the NHS and/or the Prison Service, whilst at considerable risk to both themselves and the person for whom they care. To achieve equitable provision for English prisoners, this thesis suggests the development of a prison multi-agency health and social care integrated service commissioning plan which recognises the needs of imprisoned carers as highlighted in this study.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:617574 |
| Date | January 2014 |
| Creators | Tabreham, Julie Dawn |
| Contributors | Butterworth, Tony; Jackson, Christine; Jones, Kelvin |
| Publisher | University of Lincoln |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://eprints.lincoln.ac.uk/14681/ |
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