Powerless Patients: An investigation of healthcare complaints in prison environments

An effective complaints system allows for systems to be monitored, poor practice to be identified and damage to be rectified (McCreaddie, Benwell and Gritti, 2018; Kroening, Kerr, Bruce and Yardley, 2015). Yet, for the inhabitants of the British prison system, the complaints system is shrouded in mystery. Whilst complaints processes exist these systems of accountability mainly focus on traditional 'prison activities' e.g., time out of cell, purposeful activity, violence.

The current literature clearly sets out the challenge posed by this area of research. Namely, that specific groups struggle to access effective redress methods and that these groups are particularly overrepresented in prison environments. There are also significant learning barriers to engaging with complaints, the literature establishes that those who have higher educational qualifications and those who are better off are more likely to take action about problems, while those on lower incomes are more likely to take no action (Leabetter, 1996). Naturally there are significant limits on information gathering in the custodial environment, with prison literacy so poor that half of those currently incarcerated have a reading age of 11 or lower - with 20% falling well short of that mark (PRT, 2008). What the literature clearly demonstrates that complaining about healthcare and seeking redress is particularly difficult and challenging for a variety of groups which are disproportionately overrepresented in the prison system. Consequently, studying how those incarcerated by the state, ultimately powerless, assert their rights is vitally important in driving improvements in care.

This research will offer a meaningful insight into the dynamics at play in how the vulnerable realise their rights in clinical settings as well as substantial insight into how healthcare organizations respond to complaints. This is interdisciplinary research, crossing healthcare and criminological research, whilst exploring workplace cultures and providing insight into some of the most pressing policy and practice challenges.
Research Aims: to provide an empirical insight into the healthcare complaints process in prison and to provide a contribution to the development of the quality assurance frameworks which govern prison healthcare. Research Objectives: to explore the ways in healthcare complaints are constructed and responded to and to explore the interface between prison staff cultures and the prisoner efforts to realise their rights.

This research will deploy a mixed methods approach. Firstly, this research will examine anonymised and randomised prison healthcare complaints. This will use Content Analysis and Discourse Analysis to analyse how those complaining attempt to present, persuade and accomplish certain actions (Hepburn and Wiggins, 2007). Access to complaints will be sourced through the Freedom of Information Act (Gillespie and Reader, 2016). However, these will provide a broad overview of the themes that prisoners complain about. This will not include accessing broader medical records nor accessing complaints which correspond to the prisons in which interviews will be conducted. I will aim to collect a sample of 5% of total complaints to provide a solid sample. This research will also use qualitative research, covering semi-structured interviews with participants, providing participants with room to explore attitudes to complaints and experiences. Via purposive sampling participants will be drawn from the following groups: Prison healthcare staff (this will include prison officers, managers and governors who operate prison healthcare services, as well as nurses, doctors and clinical managers within the NHS and contracted healthcare services. Across the sites I aim to interview 20 staff drawn from these groups) and Prisoners (I intend to draw prisoner participants from 5 prisons, purely within England and the male and female adult estates.