hmp_coldingley_01.jpg

United Kingdom: England & Wales

Capital city — London

+
Panorama

Health

Organisation of health care

Ministry in charge

Department of Health and Social Care

The National Health Service (NHS), a non-governmental public body, is responsible in England for the provision of care units in prisons. Local Health Boards (LHB) are responsible in Wales for the provision of care units in public prisons (including detoxification).

Every prison facility has a health care unit

yes

The National Health Service provides the following services:

  • general medicine
  • dentistry
  • nursing care
  • psychological care
  • specialist education
  • withdrawal services
  • optometry
  • chiropody
  • pharmacy and drug management
  • stopping smoking 1

Medical teams vary from prison to prison. Most medical teams are composed of:

  • nursing staff (24 hours a day or during the day)
  • general practitioners (full-time or part-time)
  • mental health professionals (full-time or part-time)
  • addiction professionals (in most institutions)

Permanent specialists can be found in facilities according to specific needs.

  1. National Health Service of England, Standard annex to health and justice specifications, March 2018. ↩

Hospitals do not have dedicated units for prisoners. Two prison officers accompany the patient to hospital and monitor them. Some correctional facilities have care units with beds. These are mainly used for people suffering from addiction. People suffering from mental illnesses may be placed in these units while awaiting admission to hospital.

Access to health care

Health care is free

yes

A medical examination is performed upon admission

yes

All prisoners are received by a member of the medical team when they arrive at their ward. The health professionals question them about their medical background, treatment, addictions and psychological state. 1 A second medical assessment, carried out by another professional, is mandatory within seven days of admission. 2 This second examination is usually an opportunity, in women’s facilities, to address issues of pregnancy, parental responsibility, domestic violence, sexual violence and sex work. 3

  1. Department of Justice, PSI 07/2015 on the first days in prison, p. 8. ↩

  2. HM Inspectorate of Prisons, Expectations: Criteria for assessing the treatment of and conditions for men in prisons, criteria for assessing treatment needs for male prisoners , 2017, p. 31. ↩

  3. Michael Spurr, ”Women in prison in England and Wales”, in Piet Hein van Kempen and Maartje Krabbe (éds.), Women in Prison: The Bangkok Rules and Beyond, Intersentia, 2017. ↩

A medical file is opened upon admission

yes

SystmOne is the hospital information system used in all English prisons.1

Data cannot be disclosed without patient consent, except:

  • legal obligation (court order, legal prescription)
  • existence of an overriding public interest (to protect a third party from serious harm…)
  • other legal reason

Patient consent is not required if the data is anonymous.2

  1. The Guardian, Prisons linked to single health record IT, April 2011. ↩

  2. National Health Service, Standard Annex to Health and Justice Service Specifications: Adult Prison Estate, March 2018, p. 8. ↩

Prisoners can access health care units after

  • written request
  • oral request

The process depends on the facility. The presence of a telephone in the cell allows an oral request to be made.

Medical examinations are carried out on a confidential basis

in most cases

Prison staff attend medical examinations when they consider the situation to be at risk.

Continuity of care is ensured during incarceration. All 118 prisons use the same SystmOne software1. Professionals are required to “maintain, through the hospital information system, an adequate and complete medical record for each prisoner. If necessary, health professionals may share information with services outside the institution: rehabilitation services, community service, probation services, social services…” 2

  1. The Guardian, Prisons linked to single health record IT, April 2011. ↩

  2. National Health Service, Standard Annex to Health and Justice Service Specifications: Adult Prison Estate, March 2018, p. 7. ↩

Some treatments cannot be done inside the facility. The prisoner can access these in three ways:

  • a specialist is invited to examine the patient
  • the patient is transferred to another facility
  • the patient is taken to the hospital 1

The Care Quality Commission notes in its annual report 2017-2018 that “ care provided is of lower quality: poor medical environment, partnerships and services not adapted to people’s needs…. The lack of prison staff may also limit prisoners’ access to the care and treatment they need“. 2.

  1. National Offender Management Service and Prison Reform Trust, ”Information book for prisoners with a disability“, p. 26. ↩

  2. Commission on Quality of Care, “Annual Report 2017-2018”. ↩

Hospitalisation is subject to the opinion of the medical team. Admission must be made within 14 days of their decision.

Physical health care

Patients are guaranteed access to all types of treatment. For some patients, registration on a waiting list is necessary. Their quality must be equivalent to that offered outside.

Measures to prevent epidemic or communicable diseases must be implemented. They must be comparable to measures taken externally.

According to the Howard League, “the need for risk reduction measures is widely recognised, but the measures themselves are not compelling”.

  • Condoms, dental dams and lubricants are widely available to prisoners in some institutions. In other facilities, condoms are distributed only on request. 1
  • Health professionals use substitution treatment to treat addiction.
  • No institution operates a needle exchange.

  1. Howard League, “Consensual sex among men in prison: Briefing paper 1”. ↩

Mental health care

Generally, people suffering from mental health disorder are not held in special facilities butsome prisons do have such. Severely mentally unwell prisoners may be admitted to them. Otherwise, they are transferred to another institution or hospitalised.

Guards are inadequately trained in caring for people with mental health disorders.

Addicts receive special follow-ups. They are examined within five days of admission to prison. They can be placed in a special unit if there is one available. Nicotine and opiate therapies and substitutes are offered in most facilities. The prisoner may be transferred if necessary.