Crime Reduction

25.11.16

Reform prisons offer chance to halt rise in inmate deaths, doctors’ union says

Increasingly poor health conditions for prison inmates could be prevented by devolving more powers to prisons, the British Medical Association (BMA) said yesterday.

In February, David Cameron promised to create six new ‘reform prisons’ by the end of the year, with full autonomy over how they operate and spend their budget.

The Ministry of Justice published its ‘Prison Safety and Reform’ report earlier this month, in which it set out new powers it will devolve to prison governors by April 2017.

These include deciding how they spend their budgets and structure staffing; jointly commissioning health services with local NHS commissioners; choosing which programmes they run for offenders; and building relationships with local businesses to develop work opportunities for prisons.

In its submission to the Justice Select Committee report into prison reforms, the BMA described reform prisons as “a significant opportunity to improve health provision in the secure estate” by enabling governors to tailor healthcare to the needs of their individual prison populations.

It said that governors would be able to plan and design facilities that are fit for purpose, avoid situations where inmates are unable to visit health facilities during lockdown, and provide services such as radiotherapy, physiotherapy and dialysis on-site.

The IPPR has also recommended devolving prison budgets to make the system more sustainable.

However, the BMA cautioned that reform prisons should still be required to follow guidance and minimum standards to ensure that prisoners’ wellbeing is safeguarded.

In particular, it said prisons should sign up to the Royal College of Psychiatrists’ quality assurance framework for prison mental health.

The average life expectancy of a prisoner is only 56, and Ministry of Justice figures show that natural deaths in custody have increased by 26% in the past year, while suicides increased by 28%.

The Prison Reform Trust estimates that 90% of inmates have one or more of the five main psychiatric disorders (psychosis, anxiety disorder, personality disorder, alcohol dependence and substance misuse).

Figures released by the Howard League of Penal Reform show that prison officer numbers are down to 14,689 despite government efforts to recruit more.

Prison Officers Association members held a walkout and protested outside prisons last week, saying the staff shortage is making it impossible to guarantee prison safety.

The government obtained a High Court order to end the protest. Chancellor Philip Hammond then promised funding for an additional 2,500 officers in the Autumn Statement.

The BMA warned that prisoners suffer from particular issues which make them more likely to have health problems.

The prison population is ageing, with the number of prisoners over 50 growing by 161% since 2002. Drug and alcohol addiction are high, and prisoners are more likely to be illiterate or speak English as a second language, which makes it harder for them to understand medical information.

The BMA said prisoners’ health problems risked being made worse because of a “security first” approach, with prisoners having to cancel hospital appointments because of a lack of guards to escort them. Female prisoners also had difficulty accessing a doctor of the same gender.

Other recommendations from the BMA included encouraging healthy eating, exercise and stopping smoking in prisons; establishing health plans so that the different agencies contracted to provide healthcare work more closely with each other and with prison staff; modernising facilities to reduce the risk of suicide and self-harm; and providing suicide training to staff.

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