Health Care Issues for the UK Prison Population

Health Care Issues for the UK Prison Population

Health Care Issues for the UK Prison Population

Introduction

Prison has several purposes. Amongst these are separation from society and confinement for the safety of society, punishment for crime, correction and rehabilitation to the community. Prisons are not, primarily, concerned with the health of the prison population and, indeed, 'The need for security and discipline can cut across the perception of individuals (prisoners) as patients'. The prison service in the UK has traditionally established its own health care facilities for prisoners who become patients, with its own doctors and nurses employed by the prison service. This has served to reinforce the image of prisoners who are patients as being separate, even in terms of health care, from the general population and it has also led to isolation of the professionals: doctors and nurses, working in the prison service. Consequently, they have been accorded a lower status by colleagues working in, for example, the UK National Health Service (NHS). The prison health service in the UK has tried to resist this negative image but it has been an almost inevitable outcome of their isolation. It has been considered, in the UK, since the middle of the last decade that it was time to change the separation of prison health care from the NHS and to move towards integration without duplication of services. A recent working group in the UK proposed several action points to be achieved in the integration of doctors working with prisoners including a rationalised pay structure, continuing professional development, career structure including appropriate qualifications and the provision of appropriate information technology.

Contemporary political and social influences in Prison

A Council of Europe report by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment expressed concern as to the quality of health care that people in English prisons received. They found, for example, that during reception procedures where people must be medically examined, the conditions were not private and this compromised confidentiality. In addition, the poor working conditions of the staff coupled with time pressures to complete examinations quickly limited good health care delivery.

Since 1993 the Prison Service has laid down standards for health care. An inspection of 19 prisons in England and Wales by Carlowe (2004)found that these standards were not always being met. They found that some health care in prison was good and of similar quality to that expected from the NHS, despite prison medical staff working in quite poor conditions. But the provision of health care was variable.

Whilst recognising that medical staff are fully trained to undertake their work, they note that staff are not sufficiently trained to deliver the same quality of care that would be provided in the NHS. Again working conditions prevented effective screening and proper medical examinations in some busy prisons where up to 100 new people could arrive each day. In addition, prisons were not conducting needs assessments and often did ...