Objective: To create an equitable Parkinson’s nurse service for people with Parkinson’s detained at a Category C, men’s prison in West Devon, UK.

Background: There are 85,851 people detained in prisons across England and Wales(1).It is suggested that around 5% of prisoners may have a Neurological condition(2).No formal data on the prevalence of Parkinson’s is currently available. Prisoners have the same right to healthcare as those not in custody, however prisoners still have a higher mortality than the general population(3).The Parkinson’s Disease Nurse Specialists (PDNS) at Livewell Southwest offer telephone and virtual calls, home visits, and outpatient clinics as ways of reviewing the 700 patients on their caseload. No pathway existed for the review of prisoners with Parkinson’s.

Method: Referrals are sent to the PDNS team from the local Prison GP. The referral is triaged and date for review agreed. The Prison staff organise the necessary security clearance and clinic space at the prison for the PDNS. A member of the Prison staff will be present throughout the review as a familiar face for the prisoner and also to ensure safety of the visiting PDNS. A Buddy (a prisoner supporting vulnerable prisoners) is also welcome to support the patient. Any treatment plan changes will be agreed with the prisoner,PDNS and prison staff, with medication changes being implemented by the GP. Referrals to the wider MDT will be completed by the PDNS. Advice from the Consultants can be accessed at the weekly Neurology MDT. Treatment plan reviews will usually be a planned telephone or virtual call.

Results: This method of PDNS review is comparable to standard practice offered to other patients on the PDNS caseload. However, implementation of complex medication regimes has proved challenging with only twice daily drug rounds taking place in the Prison. Teaching is planned by the PDNS with the Prison staff and Buddies about the condition and treatment.

Conclusion: With collaborative working between Prison staff and the PDNS, comparable Parkinson’s healthcare can be achieved. Wider MDT working is needed though to achieve similar standards of care delivered in the community. Further research is suggested to better understand the needs of this population, especially in view of difficulties with medication administration. Index offences of prisoners of Parkinson’s may also prove to be of interest to see if there are similar themes.

Photo of Dartmoor Prison, UK

Photo of Dartmoor Prison Front gate

Photo of Dartmoor prison cell

References: 1) UK Prison Population Statistics – House of Commons Library (parliament.uk)
2) . Managing_persistent_pain_in_secure_settings.pdf (publishing.service.gov.uk)
3) Locked out? Prisoners’ use of hospital care (nuffieldtrust.org.uk)

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MDS Abstracts - https://www.mdsabstracts.org/abstract/behind-the-prison-gates-creating-a-nurse-led-parkinsons-healthcare-pathway-at-hmp-dartmoor-prison-uk/