A prison sentence is a deprivation of someone’s liberty, not a sentence to poorer health or healthcare. That’s the headline conclusion of last week’s House of Commons Health and Social Care Committee report on health and care in prison.
Deterioration of standards
The Committee’s main conclusions were:
- Standards inside England’s prisons have deteriorated in recent years, following budget reductions and the loss of prison officers.
- Many prisons are unsafe, with incidences of violence and self-harm at a record high.
- Prisons, as a result of staff shortages and overcrowding, are limiting prisoners’ access to healthcare and their ability to lead healthy lives.
The health and care of prisoners is a public health issue
The mortality rate of people in prison is 50% higher than the general population, reflecting the poor health of prisoners and people in contact with the criminal justice system. This is often the result of, or is exacerbated by, early childhood experiences (abuse, neglect and trauma) social circumstances (problems with housing and employment) and higher rates of smoking, alcohol and substance misuse. The Government must take the opportunity to try to tackle this cycle of disadvantage, by reducing the health inequities people in prison face.
The Committee recommends that the Government’s programme of prison reform, and the way it talks about its plans for reform, should place greater emphasis on health, wellbeing, care and recovery, recognising the poor health of people in prison and the trauma many people in prison have experienced in their lives. As well as improving outcomes for prisoners, it is the Committee’s view that such an approach will also improve the safety of prisons and reduce reoffending.
Improving health outcomes for prisoners and those in contact with the criminal justice system requires a whole systems approach, which has its origins in sentencing and release.
Prisons should take a whole prison approach to health and care, but this requires a sufficient, stable and well-trained workforce, both of prison staff and health and care professionals, whose own safety and health is valued.
Service provision needs to reflect the needs of the prison population and governors need the financial and other levers necessary to make prisons safer and healthier.
The prison service often fails to learn lessons, even from serious incidents and inspection reports. This is not acceptable, says the Committee. Every death by suicide must be regarded as preventable and yet there are still delays in the response to those known to be at risk who need transfer to more appropriate settings.
A whole prison approach must be supported by a rigorous, respected inspection regime that provides a robust picture of the state of health and care in prisons and drives improvement. Inspection reports need to be accompanied by real powers to drive implementation and consequences for failure to do so.
HMIP’s inspection reports, to which the CQC contribute, should provide a clear rating about the extent to which prisons enable prisoners to live healthy lives. A rating should include not only the quality of health and social care provision in prison, but the extent to which all aspects of prison life allow prisoners to enjoy their fundamental right to health.
Chair of the Committee, Dr Sarah Wollaston MP, says
“A prison sentence is a deprivation of someone’s liberty; not a sentence to poorer health or healthcare. Too many prisons remain unsafe and unsanitary. Violence and self-harm is at a record high, with illegal drugs adding to the problems for both prisoners and staff. Poor living conditions, diet and restricted access to healthcare and activity are compounding a cycle of deprivation and health inequality. We need assurances from Government that it will urgently address the very serious situation in prisons with a whole systems approach underpinned by sufficient funding and attention to the prison and healthcare workforce.”