Prisoners should receive the same level of healthcare as people in the general population, a health watchdog has said as it released new guidelines for the wellbeing of inmates in a drive to improve the situation.
Prof Mark Baker, the director of the National Guideline Centre, which is funded by the National Institute for Health and Care Excellence (Nice), said that it had become clear that healthcare provision in prisons was often poorer than in the general community and not sufficient to meet the needs of prisoners.
“Something had to be done, I think, about defining what healthcare should look like in custodial settings,” he said.
From 2006 NHS primary care trusts commissioned healthcare for prisoners, with the responsibility for prisons in England transferring to NHS England when it was set up in 2013.
Baker said that adequate healthcare provision for prisoners would reduce pressure on community services later. “If their health needs are not properly cared for while they are prisoners, then their demand on the NHS afterwards is going to be that much more difficult to handle,” he said.
The recommendations, issued for prisons in England, include carrying out a healthcare assessment on arrival – with questions on physical health, mental health and alcohol and substance misuse, testing for TB within 48 hours of entering prison, and offering tailored advice on issues such as exercise, diet, smoking and sexual health. The guidelines also highlight the need for confidential testing for hepatitis B, hepatitis C and HIV.
Some of the recommendations, says Baker, are subtle, but important. “HIV testing is offered, but it should be done in a way which encourages people to take it up, rather than avoid it, which is sometimes the case now,” he said. Other recommendations include ensuring that condoms, dental dams and water-based lubricants are easily and discreetly accessible to prisoners. “Condoms are made available in prisons but currently you have to make an appointment with a doctor, whereas outside prison that is not the case at all,” said Baker.
The new guidelines also focus on the growing pressures of an ageing prison population, with older inmates more likely to have multiple conditions and a higher risk of chronic illnesses such as diabetes and heart disease. What’s more, said Baker, “they are sicker and more likely to have complex health needs than people of an equivalent age who are living in the community”.
According to recent figures, there are more than 4,400 prisoners aged 60 or over in England and Wales, nearly three times that in 2002, making it the fastest growing prisoner age group.
Inadequacies in monitoring chronic diseases, and in making sure that care is continuous when prisoners are moved between custodial settings such as prisons or courts, or are released, need to be addressed, said Baker.
“Doing that and maintaining that continuity is not only good for the health of the prisoners,” he said. “But it is much better for the operation of the prison system as a whole and reduces the burden on both the prison service and the NHS in having to deal with emergencies that could have been avoided if chronic disease management had been good enough.”
Mark Day, head of policy and communications at the Prison Reform Trust, welcomed the new guidelines. “People in prison should receive the same treatment and care as they would in the community, but too often their health needs go unrecognised and unmet,” he said. “With an ageing prison population and rising numbers of deaths, both natural and self-inflicted, behind bars, ensuring that people get the physical, mental health and social care they need is vital.”
Day added that new guidelines on mental health, currently in draft form, are also much anticipated.
“The new Nice guideline is an important and welcome step towards achieving parity of healthcare for people in prison,” he said. “We hope the forthcoming guideline on mental health will do the same for the high proportion of people in prison with a mental health need.”
Adam Horner, national lead nurse from Care UK, which provides healthcare for people in around 30 prisons, said: “Whilst we haven’t yet had an opportunity to review the guidelines in full, we welcome their publication. We are certainly seeing a growing number of older prisoners with long-term conditions such as heart disease, cancer and dementia.”
