The continuing decline of healthcare in prisons

Deaths in English and Welsh prisons reached their highest on record in 2016, and those numbers have shown no sign of significantly reducing since.

Two recent reports have highlighted the standard of healthcare in prison as an area of key concern and have suggested that there has been little improvement despite the troubling statistics. 

On 1 November 2018 the Health and Social Care Committee published a damning report following the findings of their inquiry into prison healthcare.

It found: “The Government is failing in [its] duty of care towards people detained in prisons in England. Too many prisoners remain in unsafe, unsanitary conditions that fall far short of the standards we should expect. The Government must urgently fulfil its special duty of care for prisoners.” 

It cited inadequate health screenings, lengthy waiting times and frequently cancelled appointments as key failings. Failings such as these are particularly harmful to prisoners as they are entirely dependent on the prison service and healthcare providers to ensure that their healthcare needs are met.

Now, just over a year on, the charity INQUEST has just published a report, “Deaths in prison: A national scandal”, which suggests there has been no improvement: 

“Inquests regularly reveal that the standard of care is inadequate and not in line with standard provision in the community. 

“There is often a lack of provision for people with complex needs along with insufficient health screenings and incomplete care plans. 

“Inquests regularly reveal failures to assess, monitor and review existing health conditions (for example asthma and diabetes). Staff shortages, and a reliance on bank or agency staff who may lack relevant training, is a common problem. Cancelled and delayed appointments, and systems for prioritising appointments, is too often left to custody staff rather than clinicians.”

Many of the same failings it highlights had already been brought to the Government’s attention in the Committee’s report, and it suggests that these failings are translating into the preventable deaths of prisoners.

The prison team at Leigh Day has represented several clients in prison healthcare matters and their stories frequently reflect the same failings revealed in the reports. 

The exact numbers of deaths of prisoners caused by poor healthcare in prison is unknown. Ministry of Justice statistics show that the numbers of deaths in prison steeply increasing over the past decade and that the most common cause of death is given as “natural causes”.

However, this masks the fact that the figures for natural causes include deaths caused by poor healthcare in prison. 

Leigh Day recently represented the family of a deceased prisoner, who we will call Alex, at an inquest. Alex had a complex but well-managed medical condition when he entered prison. 

But within a few months, a prescribing error halved Alex’s dose of a crucial medication for around two months and he died just one year after arriving in prison. The inquest jury concluded that this error had probably caused Alex’s death. 

The jury also identified systemic failures in prison healthcare to screen prescriptions, to appropriately staff and manage time effectively, and a further two missed opportunities to detect the prescribing error sooner.

For the purposes of the Ministry of Justice statistics, Alex’s death would be classed as “natural causes”. 

INQUEST’s report makes a number of robust recommendations and calls for a “substantial reduction” in the size of the prison population, combined with investment in “health and community based alternatives”. 

Cutting the prison population would ease pressures on healthcare in prisons. However, repeated alarm bells appear to be falling on deaf ears. With the Government’s manifesto promises of tougher sentencing and 10,000 more prison spaces, it is difficult to foresee any improvement to the current state of healthcare in prisons.