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Monday, March 29, 1999 Published at 18:15 GMT 19:15 UK


Prison healthcare breaches European standards

Prison healthcare sometimes falls below national standards

Healthcare in British prisons is in breach of European standards, according to a government report.

The report by the Joint Prison Service/NHS Executive Working Group found that the standard of healthcare provided in British jails breached Council of Europe rules on providing equivalent care in and outside prison.

It found there was no consistent approach to healthcare in prisons across England and Wales and that standards sometimes fell below those provided in the community.

There was particularly poor provision of services for the mentally ill.

The report says inmates have "a disproportionately higher incidence of mental health and drug misuse compared to the general population".

The report, which is backed by the government, recommends the setting up of a Joint Prison Healthcare Task Force and a Joint Prison Health Policy Unit to encourage a closer working relationship between the prison and health services.

It discounts calls for the NHS to take over prison healthcare entirely, saying the NHS needs prison service expertise on treating people in custody.

The government believes the provision of good healthcare is one way of tackling social exclusion and could cut reoffending rates.

But critics argue that it has remained silent on whether any new funding will be provided to back up the report - particularly its recommendations on improving mental health care.

This includes the development of mental health outreach teams in prison wings and provision for better screening of a prisoner's mental health on admission to jail. Partnership

The working group found that prisons which had a good partnership with the local health service offered better care.

Individual health workers also made a big difference to service provision.

Previous research, backed by the working group's findings, shows that:

  • Health staff working in the prison service feel isolated from their NHS colleagues and often feel their skills are being undermined
  • Healthcare offered in prisons varies considerably from prison to prison and, in some cases, falls below NHS standards outside prison
  • There are difficulties recruiting and retaining staff to work in the prison sector
  • Some nursing care is being delivered by untrained staff
  • There is no strategic direction to healthcare in prison.

The working group, which studied healthcare in 38 prisons in England and Wales, also found that there was no systematic assessment or monitoring of how services improved patient care and that contracts with the NHS were often set without reference to health needs.

Prisons minister Lord Williams said: "Prisoners are punished for their crimes by losing their liberty.

"It is not part of their punishment that they should receive a lower standard or inappropriate healthcare.

"Custody offers an important opportunity for prisoners to improve their health, to adopt healthy lifestyles that will contribute to their chances of rehabilitation."

Health minister Baroness Hayman said the strategy would reduce social exclusion "by giving healthcare that is consistent with that on offer in the community and which can be more effectively continued when they are released".

The BMA welcomed moves to improve prison healthcare and said the report provided "a damning indictment" of the existing service.

But Dr Ian Bogle, the BMA chairman, said it failed to tackle funding shortfalls or ways of improving doctors' position in the prison service.

The BMA wants prison doctors to be independent from prison governors.

Dr Bogle said: "We are concerned that, even with the evidence of serious shortcomings, the report reaffirms the influence of prison governors in the provision of healthcare in prisons."

But the Royal College of Nursing (RCN), which debated prison healthcare at its annual conference earlier in March, welcomed the report.

Ann Norman, chair of the RCN Prison Nurses' Forum, said: "Better partnership between the NHS and the prison service should be welcomed by prison nurses and the patients they treat.

"People in prison should have the same access to healthcare services as anyone else using the NHS."

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