On 1 November 2018 the House of Commons Health and Social Care Committee published a report on Prison health. Their headline was “Government is failing its duty of care towards prisoners”.
The Committee’s summary states that too many prisoners die in custody or shortly after release. Whilst they note that deaths (including by suicide) in prisons have fallen slightly since their peak in 2016, they are of the view that so-called natural cause deaths too often reflect serious lapses in care. They express concern about the increase in deaths during post-release supervision and about reports of people being found unresponsive in their cells. They state clearly that every suicide should be regarded as preventable and therefore go on to state that it is unacceptable that those known to be at risk face unacceptable delays awaiting transfer to more appropriate settings. And all this is just on page three of the report!
The Committee’s 32 conclusions and recommendations are set out at pages 43 – 47.
Some points to note
- Incidences of self-harm continued to rise during 2017 and 2018 and remain at a record high.
- Charts at pages 10 and 11 summarise physical and mental health problems in the prison population.
- The average age of death of people detained in prison in England is 56. The standardised mortality rate of prisoners is 50 per cent higher than the general population.
- Equivalence (in terms of access and quality of services) is vague. One prisoner told them that “if you believe that then you may as well believe in fairies at the bottom of the garden”.
- Since 2011 there has been a 25 per cent decline in the use of hospital orders.
- Liaison and diversion services do not yet exist in 20 per cent of the country.
- Screening is covered at pages 18 and 19. The National Prison Healthcare Board is told to develop a more comprehensive and robust approach to health screening.
- They came across examples of prisoners:
- struggling to get health concerns acted upon in a timely way;
- experiencing problems getting help in an emergency;
- experiencing problems getting the medicines they need;
- struggling to see a dentist, doctor, speech and language therapy or an optician; and
- reporting problems when making a complaint.
- Missed appointments and illicit drugs are both noted as serious issues.
- Mental health in prisons is covered at pages 28 – 30. Her Majesty’s Inspectorate of Prisons for England’s latest annual report noted that “despite similar recommendations in the past, prisons had made insufficient efforts to help prisoners in crisis”. This section also covers:
- a gap in commissioning;
- difficulty in ensuring continuity of care when prisoners are transferred to other prisons;
- only 33.7 per cent of transfers to psychiatric hospitals taking place within the recommended 14 days. 66.3 per cent took longer (with 7.1 per cent taking more than 140 days);
- in 2017 there were 44,651 reported incidents of self-harm – up 11 per cent from the previous year; and
- the number of self-harming individuals increased by 6 per cent to a new record high of 11,630.
- Healthcare provision at present is often disjointed between prison and the community. In this regard, they recommend that the Government undertake a thorough investigation of deaths during post-release supervision in the community.
- The WHO have stated that health in prisons is too important to be left solely to the health team so the committee recommend a “whole prison approach”.
- The Committee were concerned to hear about the use of short-term contracts, in which providers frequently have to retender, which disrupts the continuity prisoners can experience and acts as a disincentive for current providers to improve services. They were therefore pleased to hear about longer-term contracts.
- The Committee recommend that the Secretary of State for Health instruct the CQC to conduct a special review of the commissioning of health and social care in a number of prisons and report next year.
- The prison service frequently fails to learn lessons in response to concerns that are raised, including through inspections (as HMIP does not have enforcement powers to take legal action against prisons).
- Legal powers of entry should be given to CQC inspectors.
- The Committee recommends that CQC and HMIP work to develop a rating system and that where a provider delivers services in prisons these services are classified as core.
The Government’s response is awaited with interest.
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