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Last Updated: Sunday, 9 April 2006, 23:45 GMT 00:45 UK
The challenge providing NHS care in prison
By Nick Triggle
BBC News health reporter

Campaigners say poor health care should not be part of a prisoner's sentence.

To address the long-standing problem of providing good services in jails, local health bodies have taken control from the prison authorities. But will the changes make a difference?

Prison health care has often been criticised

A common tale that does the rounds in prisons is of the man who keeps complaining of stomach pains and is given indigestion tablets time and time again.

Eventually the pain becomes intolerable and he is given a full examination only to be told he has cancer.

Whether the story is true or not, the fact it is told is indicative of the state of prison health care during the last few decades.

"The service has been awful," said Brian Caton, general secretary of the Prison Officers Association.

"Like the rest of the NHS, it has been starved of investment and our staff have not been given the right training."

I know of one jail that has a walk-in centre similar to the ones you find on the high street. It is possible if you try
Dr Jane Senior
Prison Health Research Network

Ten years ago the then chief inspector of prisons, Sir David Ramsbotham, said enough was enough and called for prisoners to be given the same standard of care as NHS patients.

After a few years of tinkering, prison health services have undergone the biggest upheaval since the formation of the NHS.

At the start of April, health responsibility was fully handed over from prisons to local health bodies called primary care trusts (PCTs), which already have responsibility for commissioning services for the general population.

All prisons have some form of medical centre, often with their own pharmacies, nurses and doctors and with access to regional hospitals for patients who require more intensive care.

The government believes the 300 trusts in England and their Welsh equivalents have the necessary knowledge to drive up health service standards in prisons which reports down the years have described as "intolerable", "disgraceful" and "crisis-ridden".

Community

Dr Jane Senior, research project manager at the Prison Health Research Network - set up by the Department of Health to encourage improvements in standards - said: "What we want to see is innovative ways of providing health services you would find in the community in prisons.

"Obviously you don't get the chance to do some of the things - it's hard to ask a prisoner to make 10,000 steps a day or whatever it is, but in some areas we are beginning to see changes.

"I know of one jail that has a walk-in centre similar to the ones you find on the high street. It is possible if you try."

Medical equipment
PCTs now have responsibility for health care in prisons

One of the first trusts to be given responsibility for health in prisons was Durham and Chester-le-Street PCT, which covers three prisons.

It took part in the pilot scheme launched in April 2004. Over the last two years, 10m has been invested in health services.

The money has helped to increase health staff numbers, introduce ophthalmology services and improve diabetes and podiatry care.

The trust has also employed more senior nurses and ensured GPs provide the doctor care - one of the most common criticisms of prison health services is that primary care has not been carried out by properly trained doctors.

Julie Dhuny, the trust's prison health care development manager, said: "It has been hard work. The two cultures are very different, but I think we have made some real development towards providing NHS-standard care."

Substance abuse

Nonetheless, PCTs are facing a challenge. Three-quarters of prisoners have two or more mental health disorders, while heart disease and smoking rates are way above the general population.

There is also a problem with sexually transmitted infections. HIV rates among prisoners are 15 times the national average and only half of prisons have sexual health policies.

William Higham, head of policy at the Prison Reform Trust, said: "Prisoners have complex social and health needs. Many will not have been registered with a doctor before they came into prison.

"What we need the government and PCTs to recognise is that the challenge of providing an equivalent service cannot be met in the same way as it is in the community."

Some governors will not want to lose control of part of their prison services
Brian Caton
The Prison Officers Association

And Professor Nigel Sparrow, vice chairman of the Royal College of GPs and a prison-doctor trainer, said: "Huge strides have been made, we now have a situation where the doctors have the right training and background, but prisons still lag way behind the community in respect to IT, mental health and substance abuse services.

"It is not going to be easy and my fear is that at a time when the NHS is facing deficits, prison services are the easiest in many respects to cut."

And not everyone is convinced PCTs are the right bodies to be taking control of health services.

Mr Caton said he would rather have seen prisons keep control, but with stronger partnerships with PCTs.

"My fear is that care will not improve, and it needs to. Some governors will not want to lose control of part of their prison services, while some PCTs will see it as empire building and won't work with the prison authorities.

"But I also think there is a real possibility that PCT staff won't be able to handle the situations they find. They are not trained like prison officers to deal with these often difficult people and can end up frightened, which undermines their work."

And former prison doctor Dr Paddy Keavney, who authored a report for the British Medical Association in 2004 on prison health care, also has reservations.

His report was critical of the role played by prison governors who, he found, could sometimes interfere with care.

"The new arrangements should rectify that by putting PCTs in control, but my concern is that prisons are not using experienced enough nurses.

"Any good general practice has a very senior nurse, but what we are seeing is nurses taken off the wards and expected to do an equivalent job. It is an issue of competence."


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