Health Care of Prisoners (Hansard, 22 May 1991)

§ Mr. John Battle (Leeds, West)

I beg to move, That leave be given to bring in a Bill to make new provision for the health care of prisoners in England and Wales; and for connected purposes. The main purpose of the Bill is to transfer the function of the health care of prisoners from the prison medical service to the national health service.

The question of medical care in prisons is not new to the House. Statutory medical presence in prisons dates back to 1774 when the Health of Prisoners Act was passed empowering justices of the peace to intervene in the administration of prisons in order to ensure the maintenance of health standards within them. As a result of that Act, justices could order the scraping and whitewashing of walls and ensure the provision of sick rooms, ventilation and regular washing and cleaning facilities. In addition, they were allowed to appoint an experienced surgeon or an apothecary, paying them from the rates, whose duty was to report on the health of those in prison.

In the 19th century, the House frequently debated deaths in prisons. In July 1840, The Lancet launched an assault on the reliability of the official figures for deaths in prisons. It commented: Health is impaired and life is shortened by imprisonment. Since I was elected to the House in 1987, I have had to ask questions about seven suicides in Armley prison in my constituency. Six of those were committed by unconvicted youngsters held on remand. The issue is not confined to Armley prison by any means. With a national prison population of about 50,000 people, the United Kingdom has the largest number of prisoners per 100,000 of the population of any western European country. As a result of the Government's building expansion programme, the capacity will be increased to hold 80,000 prisoners.

In recent years, suicides in prisons have increased, especially among remand prisoners. Since 1987, the number of suicides has doubled each year. Last year, 51 prisoners died by their own hands and 12 have died in the first quarter of this year. There have been 13 "lack of care" verdicts returned on prison suicides by coroners' courts in the last four years.

In May 1989, the new suicide prevention guidelines were issued by the Home Office and were welcomed, but they need to be backed up by staffing and resources. Recently the British Medical Association focused on the prison medical service and described it as Unable to provide the necessary care of prisoners in general and particularly those prisoners on remand. In December 1989 Mr. Justice Pills, ruling on the suicide of Paul Worrell in Brixton prison in 1982, made it clear that the prison medical service has no duty to provide prisoners with the same standard of care as that provided by the national health service. The Home Office's scrutiny of the prison medical service published last October recommended closer alignment with the NHS, but encouraged the prison medical service to call upon clinical services from national health service authorities.

960 At present, three types of doctor are involved in the prison medical service: the full-time prison medical officer employed by the Home Office, part-time visiting general practitioners and visiting specialists. There are 110 prison medical officers who are backed up by 1,069 uniformed prison hospital officers, also employed in the dual function as Home Office prison staff. Of those, only 171—16 per cent.—have even basic nursing qualifications and, although their training was extended from 13 weeks to 24 weeks in 1983, the Prison Officers Association has described it as little more than an extended first-aid course". The 1989 report of the chief inspector of prisons for the very first time devoted a full chapter to medical services. It drew attention to a catalogue of practices which it described as well below the accepted standard and must not be allowed to continue. The report drew attention to diagnostic testing, X-rays not properly taken, badly maintained equipment, inability to read the X-ray films, failure to carry out routine blood and urine tests, prescription of out-of-date drugs, misprescription and even cases of jaundice and diabetes not being properly diagnosed and treated. The chief inspector's report also highlighted the shortage of prison hospital officers, who are particularly overstreteched at night time which is the crisis time for suicides.

The prison medical service is structurally accountable to the prison service, but, because there is not a separation of function and responsibility between disciplinary control and medical care in prisons, the result is a lack of trained staff and training opportunities, recruitment problems, lack of accountability and strained loyalties, all of which must affect the quality of health care.

I have received supportive and confidential letters from doctors who are aware of the difficulties caused by their accountability to the Home Office. My Bill would replace the facilities of the prison medical service with NHS provision, it would establish an independent medical council and ensure that free health care of an equal standard to that of the general public is available to prisoners as a basic right. My Bill is a common sense practical measure with widespread professional support within and without the prison service and in the probation and medical services. It is also supported by statutory and voluntary bodies such as the National Association of Probation Officers and Inquest. I hope that it will receive the wholehearted support of the House.