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Case study: Prison telemedicine Fellowship improves healthcare provision during the COVID-19 pandemic

Find out more about Clinical Doctoral Research Fellowships (CDRF), part of the HEE/NIHR Integrated Clinical Academic Programme.

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Researching telemedicine to improve healthcare for people in prison

For the last two years Chantal Edge has been assisting clinically with prison telemedicine implementation while also researching its effectiveness, funded by an NIHR Clinical Doctoral Research Fellowship (CDRF). Her research interest started while on a placement during public health specialty training, where she was asked to improve the delivery of hepatitis treatment in local prisons, including the use of telemedicine.

“Speaking to the prison healthcare teams opened my eyes to a whole new world of healthcare delivery and to the challenges prisons face in trying to deliver healthcare equivalent to that in the community.”

She found that telemedicine represented a big change for the patient population and realised how hard it was to implement digital innovations in prison. However, she felt that robust evaluation could really benefit the service, which her Fellowship is allowing her to do.

Prison healthcare during the pandemic

With COVID-19 impacting the whole country at the end of March 2020, Chantal returned to full time public health practice working with NHS England’s (NHSE) National Health and Justice team. Here she is helping lead the rollout of telemedicine across all prisons, Immigration Removal Centres (IRCs) and the entire children and young people secure estate in England which includes young offender’s institutions, secure training centres and secure children’s homes. Chantal’s Fellowship meant she had the relevant knowledge and experience for the role, and a well-established relationship with the digital teams at Her Majesty’s Prison and Probation Service (HMPPS).

As part of her Fellowship she had received approval for video conferencing software in Surrey, and this software has now been selected from amongst a handful of options for use across the entire English secure estate for a two-year pilot period.

“My NIHR Fellowship work meant we could hit the ground running on this rollout.”

Chantal also worked with HMPPS to achieve ground breaking approvals for the use of secure 4G tablets in prisons, as part of the pandemic rollout. This will allow for the delivery of telemedicine and mobile access to primary care health records. Prior to this, use of 4G devices in prisons was illegal. This policy change will remain in place even after the pandemic period has passed, and has the potential to bring huge benefits to healthcare service delivery in prisons.

“I was very much the right person at the right time to lead this programme, and this was all thanks to my NIHR Fellowship and the support received from NIHR to release clinical academics during the pandemic.”

Chantal hopes telemedicine will improve service access for prisoners, to address inequalities that may have widened as a result of the pandemic lockdown. It also prepares prisons for future outbreaks or a potential second pandemic wave.

The impact on research and career development

For Chantal it’s been a busy time juggling a full time clinical role and single parenting whilst also maintaining her PhD trajectory. However she’s been in touch with her supervisors throughout the pandemic to understand how to encompass the new telemedicine rollout and also deliver a PhD at the end of her Fellowship.


Her research proposal has changed a lot as a result of the pandemic and the wider rollout of telemedicine. Rather than a local focus her time has been spent ensuring robust evaluation will take place on the national programme. For example, her questionnaires developed to understand patient and staff perceptions may now be used as a core service evaluation measure in some sites.


“I’m also focussing a lot more energy into collecting a wider sample of research data around patient acceptability of telemedicine seeing as the model is going to be widespread across England.”


A further complication is that currently all research in prisons is prohibited, with no date yet as to when it can re-start. Chantal is planning for this by ensuring she will have enough data to complete a PhD thesis, even if her patient data collection is delayed and needs to be analysed fully after submission.


“Personally, it was tremendously rewarding to be able to contribute directly to pandemic response, especially as it was in my niche area of interest!

Professionally, it was amazing to see the work I had been undertaking as part of my Fellowship put into widespread national use, it also allowed me to step up and understand what it is like to work in a national capacity for health and justice which is a clinical role I would love to hold one day.”

 

Read more about Chantal’s work in her commentary published in The Lancet Digital Health, ‘COVID-19: digital equivalence of health care in English prisons’.

Images credit: Tjoff Koong Studios