Prisoners' Healthcare (Hansard, 29 March 1999)

§ The Minister of State, Home Office (Lord Williams of Mostyn)

A copy of the report by the joint Prison Service and National Health Service (NHS) Executive working group on the future organisation of prisoners' healthcare has been placed in the Library.

The report identifies a range of weaknesses with the current organisation and provision of healthcare to prisoners. While there is good work being done, looked at as a whole, there is considerable variation in the organisation, funding, delivery and quality of prisoner healthcare, with variable links to the NHS. The report makes clear that this situation is largely the product of a historic legacy of ad hoc development and relative isolation from the NHS. This means that, on the whole, prison healthcare is reactive rather than proactive; and well developed primary care teams, health needs assessments and appropriately planned services are the exception rather than the rule.

The Government reaffirm the existing aim of prison healthcare to give prisoners access to the same quality and range of health services as the general public receives from the NHS. The reform of prison healthcare poses problems and issues of a complex nature and will take place against the background of NHS reform. This means that change must be carried out in stages. The Government's response combines immediate action to improve service delivery, with a joint approach to future policy development and further work on identification of prisoner needs, priorities, timescales for improvement and organisation.

First, the report has identified a number of areas where priority action is needed and which can begin to be addressed within the existing comprehensive spending settlement. As a start the Government intend 5WA that, by the end of 1999, work will have been carried out to pilot a new prison reception health screening tool. This will help staff more effectively to identify the health needs and status of each individual prisoner and plan how to meet their individual treatment needs. In parallel with this work a health needs assessment template will be developed to help prisons and health authorities determine the health needs of their prison population.

With immediate effect, doctors newly appointed to undertake any kind of primary care in prisons will be required to hold a certificate from the Joint Committee on Postgraduate Training for General Practice (JCPTGP) or have recognised equivalent accreditation to practise primary care medicine. Doctors currently providing primary care services who do not hold the JCPTGP certificate will be encouraged to work towards obtaining it. The Government also accept the case made in the report that nursing care in prisons should be under the direction of registered nurses. Where this is not the case, Prison Service establishments will work towards achieving it as soon as possible.

The report draws particular attention to the needs of the large number of prisoners with mental health problems. Within the framework of radical reform set out in the Government's White Paper Modernising Mental Health Services—Safe, sound and supportive, published in December 1998, the needs of prisons will he taken into account when planning all inpatient mental health services including high and medium secure services. And, in order to support prisoners for whom a transfer to hospital would not be appropriate, health authorities will ensure that service agreements with NHS trusts include outreach services for prisoners. These services will aim to provide appropriate mental healthcare for persons in prison custody and to achieve continuity of care when moving between secure prison accommodation and community mental health services.

Secondly, the Government in particular welcome the proposal for greater joint working between the Prison Service and the NHS. This is in keeping with the Government's broader policy initiative, modernising government, by removing barriers and disincentives to cross-departmental working where that is necessary to the delivery of better and more effective services.

Ministerial and departmental accountabilities will remain as now, the Prison Service being accountable for the provision of primary care and the NHS for specialist services and for care provided in NHS hospitals. But future planning and delivery of prisoner healthcare will be underpinned by joint working and planning at national, regional and local levels. Practical benefits on the ground are likely to include the proper integration of health promotion and healthcare into prison regimes, and arrangements to ensure continuity of healthcare on receipt into custody, transfer to hospital or on release back to the community. Health improvement programmes will be expected to reflect these objectives.

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In order to put the joint organisation and planning of prison healthcare on a firm footing, the Chief Executive of the NHS Executive and the Director General of the Prison Service will, as recommended in the report, establish in the course of 1999 a joint prison health policy unit and a joint prison healthcare task force. These units, working with the Prison Service and the NHS, will lead and manage the process of change.

The joint prison health policy unit will be expected to set overall standards and policy, to provide clear strategic direction for prison healthcare and to advise both Home Office and health Ministers. This unit will replace the current Prison Service Directorate of Healthcare and will be physically located in the NHS Executive in the Department of Health. The prison healthcare task force will draw on staff of appropriate experience from the Prison Service, the NHS and other organisations. Its principal roles will be to offer expert advice and support the joint work that prisons and health authorities will need to do in identifying and implementing plans to improve health services to prisoners and in making the best use of available resources. The publication of this report signals the importance that the Government attach to establishing joint working arrangements between each prison and their local health authority. Prisons and health authorities will be asked to start their joint work in the course of this summer.

Thirdly, this reorganisation will not only greatly strengthen the co-ordination of prison healthcare, but form the basis for further work, including an assessment of how budget-setting might best reinforce effective care, the identification of prisoner health needs, the formulation of improvement plans and consequent financial implications, and advice on priorities so as to achieve the effective use of resources.

The report notes that the scale of the problem with prison healthcare will not become clear until health authorities and prisons have jointly assessed the local health needs and have formulated improvement plans. It is not therefore possible at this stage to say when all the objectives set out in the working group's report can be achieved. However, the Government will be taking steps to identify the scale of the problem and the resources needed to improve performance against standards comparable to those available in the community. The task force will aim to provide advice on good practice. Also through pilots and in other ways it will help to identify different organisational models of local delivery that meet the primary health needs of prisoners and that are cost-effective. In the course of next year a formal review will be carried out to assess structural issues, priorities, timescales and future possible resource requirements.

While the arrangements set out above will apply to England, there is a need to ensure consistency throughout the Prison Service, including the four prisons in Wales. The Secretary of State for Wales fully endorses the principles behind the report's 7WA recommendations. The Welsh Office, and in due course the Welsh Assembly, will be working with the Department of Health and Prison Service to implement proposals to improve prison healthcare in ways compatible with Welsh circumstances.