Skip to content

Q logo

What is the challenge your project is going to address and how does it connect to your chosen theme?

Improving healthcare within prison settings presents particular challenges as it involves multiple systems – those that support healthcare specific activities, and those that drive and support the prison.  These latter form the wider environment for healthcare service delivery.  To date QI activity within Offender Care has focused on relatively small scale improvement projects which are restricted to processes directly within the control of healthcare providers.  However, there is huge potential for significant improvement in service delivery outcomes for patients and staff if we work beyond healthcare boundaries, and develop quality improvement partnerships with our prison colleagues and healthcare colleagues working in community and/ or hospital settings.  Our work will develop skills and knowledge of QI approaches across  organisations working to support prisoners at HMP Woodhill, with a focus on two large scale improvement programmes, beneath which will sit multiple QI projects.

What does your project aim to achieve?

We aim to develop QI knowledge and skills within the CNWL healthcare team, prison staff, and our partners using two large scale thematic projects, with several QI projects driving our aims.

  • Eradicating Hep C by the end of June 2020:  this work involves developing QI skills and knowledge within primary care, addictions and our ODN partners.  It will will build on a 2018 QI project on screening within healthcare to include partners in Addictions, the ODN, the Prison and service users for better care outcomes.
  • Reducing Self Harm among prisoners will be co-lead by CNWL Mental Health and the prison’s Safer Custody department.  It will involve representatives from across several prison departments.  Using QI allows us to design a whole system approach to improvement, tracking changes leading to develop consistent approaches to non-clinical support, clear pathways to care and treatment, and improved levels of knowledge among prison staff about risk factors for self harm among prisoners.

How will the project be delivered?

We aim to secure one day a week of dedicated, IA support for these projects which would allow:

  • delivery of training and skills sessions related to QI
  • provision of specialized software to allow initial and ongoing data analysis
  • support the project team, including involving patients in the work
  • support with project design
  • support data collection and analysis
  • support to develop and carry out PDSA cycles
  • develop and maintain robust communication across partners
  • project management, aligning multiple QI projects towards specific strategic aims
  • promoting learning within the partnership and beyond

The biggest risks to this work include a lack of understanding of local systems, and that staff will be pulled from project activity into routine operational tasks.  The proposed QI lead is familiar with the setting, has already established good working relationships with the key stakeholders and is fully cleared to work in high security settings.

Governance will be provided locally and via the CNWL QI Board.


What and how is your project going to share learning throughout?

Two types of learning will be generated from this work:

* developing skills and knowledge to deliver QI projects in custodial environments, working across professional and organisational boundaries.  This will be shared with CNWL teams in other prisons and through local networks via NHS England Commissioning groups.  We are not aware of similar projects using QI of this scale being conducted in the prison estate.

* subject matter learning relating to working with prison populations on self harm and on blood borne virus identification and management.  These are both priorities for the prison population and eradication of Hep C is an NHS England priority with a particular focus on prison populations.  Our work will provide valuable learning which will be shared across CNWL services, NHS England Commissioning groups and local ODNs as well to support similar work in other custodial settings.

We will use a range of methods including papers, presentations, video and posters, website, articles


How you can contribute

  • Any comments or views on our ideas, or learning from similar type work would be welcome. We are also keen to contribute to research conversations involving other Q Community members, sharing our learning and enriching our work with the constructive criticism, support and learning that members are able to provide.

Plan timeline

31 Jul 2019 further development of idea with local staff groups
31 Oct 2019 final report
30 Nov 2019 Project team has met and agreed schedule
31 Dec 2019 driver diagrams complete, measures identified, first PDSAs
31 Mar 2020 interim report on progress
30 Jun 2020 Further update on progress


  1. This is a very topical issue at the moment and I find it really encouraging to see our Q community working to address it. You've got my support.


  2. Guest

    Great to see a project bringing in partners outside of health care to focus on blood-borne viruses in this population -- it's a perfect example of where effective cross-sector working is needed.  I'd be really interested to hear more about your plans to involve patients in the work, especially how you're thinking about approaching it in a custodial setting.

    1. Guest

      Michele Dowling 4 months, 2 weeks ago

      Sam, thanks for your comment.

      We're really keen to get patients involved at a range of levels - this was something that was missing in an initial piece of work we did on screening rates last year.  We've already done some patient experience feedback, and through this have identified a couple of men who are willing to act as patient reps to promote better awareness about BBV and especially Hep C among their peers. We'll hopefully be able to draw on the Hep C Trust for some support in this regard too - the precise details need to be worked out and this is something we will hopefully be able to work on this with our first volunteer patient reps.

      Over the next few months, we will also be developing a wider healthcare rep role in the prison so we hope to engage more than just patients who've been directly affected by Hep C or other BBVs.

  3. Hi Michele, have you already come across

  4. This is a really important topic Michele. I used to work as a 'harm reduction' nurse providing healthcare to substance misusers in Sheffield. One of the research projects I've been involved in recently used co-production methods to improve access to hepatitis C treatments. Engaging clients in the process was essential to developing interventions that were acceptable, for example implementing a buddy system.

    1. thanks for the support Rachel - we know that patient engagement will be a really significant part of the work.  I will probably be in touch to find out more about your work and the things that made a difference!

  5. What a great idea team! Such an important area of work. What if any help do you need from us Qs?

    best wishes



    1. Anna, thanks for the comment.  if anyone has some tips about similar work that would be really welcome.

Leave a comment

If you have a Q account please log in before posting your comment.

Read our comments policy before posting your comment.

* required fields

This will not be publicly visible

Please note that you won't be able to edit or delete comments once posted.