Date Published: 12 February 2009

Watchdogs urge NHS to improve healthcare in prison

The Healthcare Commission and Her Majesty's Inspectorate of Prisons (HMIP) today (Thursday) joined forces to call on the NHS to provide better healthcare for adults in the prison system.

The Commission and HMIP published a joint report on the commissioning of healthcare services in prisons.

The watchdogs said commissioning of healthcare services by primary care trusts (PCTs) was variable and did not always meet the health needs of individual prisoners.

The report points to lack of planning and poor assessment of the health needs of prisoners. This meant that PCTs were not always able to provide the right services or ensure the right number or mix of staff.

The watchdogs also said that many PCTs did not commission court diversion schemes, which may help to divert offenders with mental health problems out of the criminal justice system and into appropriate health services

Anna Walker, Healthcare Commission Chief Executive, said:

"We know that prisoners generally have poorer health than the general population. Statistics show that 90% have a mental health problem, a problem with drugs and alcohol, or both.

It is clear from our work that, while improvements have been made, healthcare for offenders is not what it should be - for adults and young people. This must change, not just because it is the right thing to do for individuals, but because it is the right thing to do if we are serious about addressing the causes of crime.

Planning and commissioning the right health services for prisoners is the first step to ensuring that health needs are met. This review shows that PCTs have a lot of room for improvement. The Chief Executive of the Care Quality Commission, Cynthia Bower, and I have written to the chairs of PCT boards to ask them to satisfy themselves that their PCT is meeting its obligations to young and adult offenders. In March, as part of the 2008/09 annual health check, they will need to declare how they are doing this and we will carry out follow-up checks if necessary.

Dame Anne Owers, Chief Inspector of Prisons, said:

"This report shows the value of the joint approach to inspection of prison healthcare, with the Healthcare Commission inspecting commissioning and the Prisons Inspectorate inspecting delivery on the ground. Together, we can identify improvements and gaps, and ensure that recommendations for improvement are effectively followed up, either with the PCT or the prison."

PCTs are responsible for commissioning healthcare services including GP services, dentistry, podiatry, mental health, optometry and pharmacy. Some PCTs also commission other specialist services based on the health needs of the prison population, such as physiotherapy, sexual health and substance misuse services.

In parallel with HMIP inspections at 35 prisons, the Commission interviewed staff at the 18 PCTs responsible for commissioning healthcare services for prisons in their communities.

Positive findings from the report include:

* All 18 PCTs interviewed said they had processes in place to manage serious untoward incidents
* All 18 PCTs said they had initiatives to promote better health for prisoners, mostly in relation to smoking, sexual health, substance misuse, healthy eating and exercise
* PCTs said they had good and effective relationships with the prisons in their area and provided evidence of regular meetings of partnership boards taking place
* All PCTs interviewed said they had service-level agreements in place to monitor health services in prisons
* All PCTs could provide evidence that they reviewed all deaths of people in custody.
* All PCTs had clear links with the prisons to manage the prescription and distribution of controlled drugs

However, the report also highlighted issues such as:

* Only four of the 18 PCTs had conducted recent assessments of needs for healthcare in prison, although six said they had assessments underway.
* Half of PCTs interviewed did not formally measure whether prisoners had equal access to healthcare as the general population.
* Thirteen out of 18 PCTs said they did not commission court diversion schemes, however three of these PCTs said schemes were in place, but not commissioned by them.
* While 10 out of 18 PCTs said they ring-fenced money for healthcare in prisons, there was no specific budget in the remaining eight and it was not clear how money was allocated.
* There was limited evidence of clinical audits and only two PCTs used clinical audits to improve services. The ability to conduct audits was hampered by lack of computerised records.
* Where healthcare staff were employed directly by the prison, it was not clear how training was monitored.
* All PCTs interviewed needed to do further work to plan for the number of staff needed for prison healthcare.


Source: The Healthcare Commission (England, UK).

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