Saturday, October 17, 2009

Prison Healthcare

Not officially an oxymoron, but a conjunction of words guaranteed to make any prisoner raise an eyebrow. Healthcare provision in prisons has always been a point of contention.

The official stance accords with my own desire: that the healthcare provision should be broadly equivalent to that offered in the community. As with all things penological, however, the official version and the facts on the ground don't quite match.

Politically, this gap was recently revealed during the course of a legal challenge when the Ministry of Justice was forced to reveal that it had a secret policy. This was to the effect that, regardless of the medical opinion, elective procedures for prisoners had to pass a 'public acceptability' test. This is truly repugnant and that the MoJ kept this secret revealed that they must have understood the legal and moral unacceptability of such a criterion. Getting medical treatment on the basis of public popularity reveals the disgusting depths to which criminal justice policy has sunk.

Lofty legal, moral and political principles aside, what concerns most prisoners is the treatment they receive for their ailment from the NHS staff who now provide our healthcare. Three recent (and ongoing) events here highlight the level of that care.

Firstly, a prisoner is alleged to have been slapped round the head by a nurse. No big deal, you may think. But Healthcare is plastered with notices stating that NHS staff must not be abused or assaulted and such actions will be met with a stern response. So what would the reaction be if a lifer slapped a nurse? All the middle management who have been saying that “it was just a slap” would be at the front of the queue to have the con thrown into solitary and write long reports harping on as to his propensity for violence and unsuitability for release.

As it is, the attitude of the prison has been, 'it's nothing to do with us'. That we are in their care, that the place is wallpapered with policies about bullying and violence reduction, all means nought. It seems that NHS staff are perfectly able to enter a prison, assault any passing prisoner, and the prison staff won't raise an eyebrow. I'm assuming the same privilege doesn't apply in reverse?

Secondly, the man in severe and acute pain who was fobbed off with paracetamol for days. Until he suddenly had to be rushed out to hospital with what we now believe to be a life-threatening illness.

Thirdly, a man who is alleged to have over-used his painkillers to the tune of two - count 'em - two whole pills. He has been on these painkillers for 4 years but in the space of a week the Doctor has cut his dose by three-quarters. Seeing as his underlying medical condition hasn't changed, this raises an interesting question. Was he being massively over-prescribed these opiates for 4 years? Or is he suddenly being massively under-prescribed now? It's one or the other, and neither makes the medical staff look good.

There are countless stories that illustrate the reality of medical care in prisons. These are just three random stories from a single week, from one of the smallest nicks in the country.

The key to understanding these issues (failings) is the attitudes of the NHS staff. Simply put, they have been 'captured by the prison. Rather than importing a medical ethos into prison, they have been indoctrinated with the attitudes of prison staff. In their eyes we are not patients, we are prisoners first and foremost. By definition, we are said to be devious, manipulative and generally scheming bastards. If we present ourselves to Healthcare with a set of symptoms that outside would see the Doc reach for his prescription pad, here it is assumed that we are lying and get fobbed off with paracetamol.

Perhaps even worse is the fact that our treatment is dictated by the needs of prison management. As

is commonly known, prisons are full of drug abusers and we are regularly urine tested for drug

use. The NHS staff are quietly pressured by the prison to reduce the levels of prescribed drugs in

order to reduce positive tests. This would only be good practice, but for the fact that this leaves

people in serious pain from their illnesses.

This may go some way to explain why, even though the NHS has taken over our healthcare provision, prisoners are widely dissatisfied with the medical services. It also explains why, for many prisoners, their worst nightmare is to get a serious illness whilst in prison.


  1. And we are supposed to believe that our politicians govern for all of us?
    I have only recently come across your blog, but find it revealing and interesting.
    Thank you for sharing your life inside with us.

  2. I was a bit surprised about this comment. I do realise that in the early 90's there was an uproar following a BMA report on prison medicine and this eventually led to local PCTs taking responsibility. This was to ensure comparable treatment and that staff were up to date. That earlier report mentioned pressure to prescribe cheaper drugs but I have not read anything since. I would point out that my PCT has a policy of monitoring prescribing and ensuring that generic drugs are prescribed when possible. This has to happen as we cannot permit clinicians to prescribe unnecessarily expensive drugs. France has ensured this too by their pharmacists changing prescriptions.

    As to the examples you mention. We read in the press frequently about patients being told to take pain relief and the presenting difficulties would eventually ease. I am sorry but not all doctors are perfect and mistakes are made. You must have read yourself about deaths because of wrong diagnosis. This will happen whether in a prison or not.

    I am hopeful that the nurse who struck her patient was dismissed and removed from her register. I have read of similar disciplinary proceedings in the past but fortunately they are rare.

    It would have been helpful if you had outlined the High Court case regarding the refusal of treatment and the Ministry of Justices unpublished guidance. The only case I can remember of late was related to a sex change operation. Such cases do have a public interest hurdle to overcome given that Health Care is not and will never be unlimited. Again, to support your assertion the particular case would have to be outlined. Otherwise your example is meaningless.

    I have read of difficulties relating to hospitals accepting prisoners and problems of transportation and all the subsequent burdens. I can see certain situations were prisoners were not transferred as quickly as possible. I cannot see any GP permitting anyone to influence his clinical judgement. No GP would put their professional career on the line for any prison governor. I am sorry that prisoners with drug addiction difficulties suffer pain. However, they would not receive any different treatment from a surgery in the community. It is only in specialist units that their needs can ever be met. The European Court ruled on a UK Prisoner suffering from psychiatric problems on this issue when they accepted that the standard of care in a prison hospital could not be as high as a community hospital.

    I do not know what to say about medical staff employed by PCTs being compromised by prison staff who have no medical knowledge. It is a dreadful claim and one that needs investigating.

    Finally, I am not into medication unless it is absolutely necessary. A good doctor ensures this occurs.