Letters

Promoting health in prisons

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7087.1128b (Published 12 April 1997) Cite this as: BMJ 1997;314:1128

Discussion is needed between prison health service and NHS

  1. Olwen Williams, Consultant in clinical effectivenessa,
  2. Jan Cassidy, Prison healthcare audit facilitatora
  1. a Anglia Clinical Audit and Effectiveness Team, Box 111, Clinical School, Addenbrooke's Hospital, Cambridge CB2 2SP
  2. b Verne Prison, Portland, Dorset DT5 1EQ

    Editor—The chief inspector of prisons recently proposed that the NHS should assume responsibility for the delivery of all health care, including that required in prisons.1 2 The prison health service understandably believes that this implies criticism of its previous performance and threatens its future. For example, J M Hall claims that in many ways the prison healthcare service provides a better service for its patients than does the NHS and that the NHS would provide an inferior service for prisons.3 Perhaps this view rests on the assumption that the existing staff would be replaced and the existing service revamped by people with no experience of the special problems encountered in prisons.

    Prison health care requires special skill and needs to build on the existing base of caring staff to provide support and rehabilitation for inmates. The service's problems, however, include isolation and the low pay and status of healthcare staff. Prisoners are part of the general population, who will shortly re-enter society–hopefully, better able to contribute to it. The provision of rehabilitation for drug misuse, care and support for those with learning disability or psychiatric illness, immunisation against hepatitis B, and health education about bloodborne viruses are an essential part of the care required in prison and are already being supplied by the service. Acute psychiatric care is often, however, lacking, because NHS psychiatrists may not regard inmates as their responsibility. Better support from the NHS would greatly enhance the effectiveness of these interventions and provide seamless care for prisoners moving back into the community.

    The chief inspector of prisons advises discussion about urgent, genuine, and lasting improvements, and the prison health service should welcome this proposal.

    References

    1. 1.
    2. 2.
    3. 3.

    More resources are needed

    1. S Rossiter, Medical officerb
    1. a Anglia Clinical Audit and Effectiveness Team, Box 111, Clinical School, Addenbrooke's Hospital, Cambridge CB2 2SP
    2. b Verne Prison, Portland, Dorset DT5 1EQ

      Editor—I fear that, since the somewhat vacuous statements from the Inspectorate of Prisons suggesting that the NHS should take over prison care, a predictable argument is developing over whether the healthcare service for prisoners or the NHS would provide a better service to patients who are prisoners.1 2 This is a meaningless debate. Having worked in the NHS for 10 years and now moved into the healthcare service for prisoners, I see a great deal of talent and enthusiasm among medical and non-medical healthcare staff. What is lacking is resources. When this subject is raised there is a great temptation among those who pass their time by shifting paper in Whitehall to determine that resources do not count and that the only question is which logo should adorn the front door of the healthcare centre in prisons, or whether yet another costly change in management structure would improve the likelihood of patients receiving adequate care. The result is that few people in prisons now have the slightest idea of who is responsible for providing each service.

      Currently the main lack in the provision of medical care in my prison is the absence of any strategy for helping mentally disordered offenders. A costed bid to provide this service, which had the backing of all the healthcare workers in this establishment plus the governor, has received no backing at all. Apparently the answer to my problems is to come from another reorganisation, in which another tier of management is to be placed above me and a senior medical officer will be added to the healthcare adviser to advise me on how to handle the psychiatric morbidity at my prison. Needless to say, my hopes that the senior medical officer appointed might work in the same county as my patients at the prison have proved vain. The solution is obvious: provide the doctors and other healthcare staff who are actually working with patients with the resources necessary to fulfil their roles.

      I fear that the problem will continue; while the great and the good spend their time arguing over which particular bureaucrat should be managing this structure they fail to divert their attention and resources to the people who are the most important parts of this organisation.

      References

      1. 1.
      2. 2.
      View Abstract

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