A prison sentence is a deprivation of someone’s liberty, not a
sentence to poorer health or healthcare. However, standards
inside England’s prison 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 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.
We recommend 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 our view that such an
approach will also improve the safety of prisons and reduce
reoffending.
Prison reform
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 their fundamental right to health.
Chair of the Committee, 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.”
