Healthy Prisons?

 

What should be done following the horrific report last week about the baby who died at Bronzefield Prison two years ago? There’s a lot to be said for restricting much more tightly, if not banning outright, the use of imprisonment for pregnant women; and for strengthening the criteria which must be met before young adults are remanded to custody – something I argued for in a report for the T2A Alliance earlier this year, but which hasn’t so far led to concrete proposals for change  – in contrast to welcome changes to remand arrangements for children in the Police, Crime Sentencing and Courts Bill.

The Action Plan published alongside the PPO report addresses many of the specific failings which led to the tragedy, but there’s a case for a more fundamental look at the adequacy of healthcare provided in prison, for women, men and children.  Sue McAllister’s conclusion that the care offered to the mother of the baby who died was “not equivalent to that she could have expected in the community” seems something of an understatement.

The standard of healthcare varies widely in prisons – the four most recent Independent Monitoring Board Annual Reports  have suggested it’s as good if not better than that provided in the community at HMP Styal, but not at HMP Hull, while medicine management was “totally unacceptable” at Stafford and problematic at Pentonville.

During the pandemic, many prison health care services were reduced to emergency access only and the Prison Inspectorate reported that the physical health of prisoners has deteriorated in lockdown. The House of Commons Justice Committee is currently in the middle of inquiries into mental health in prisons and women in prison, but there’s surely a case for a post pandemic investigation of how the physical health care needs of prisoners are being met and arrangements could be improved.

It’s true that three years ago the House of Commons Health and Social Care Committee looked at Prison Health and recommended the Government make a “serious attempt to tackle the unacceptable health inequalities present in the current prison healthcare system.” But progress on its recommendations seems to have been limited.

Very surprisingly, in the light of what happened a year later, the report commended the “provision of counselling and support for women in crisis pregnancy and around the loss of a baby or child” at HMP Bronzefield as a best practice.  While as this shows, things can go wrong quickly and disastrously in prisons, it’s the Committee’s recommendations on monitoring and inspection that are none the less among the most significant.

Prison healthcare in England is jointly inspected by HM Inspectorate of Prisons (HMIP) and the Care Quality Commission (CQC), the independent regulator of health and adult social care. The Health Committee argued that greater prominence should be given to CQC’s judgements in inspection reports which should provide a distinct rating about health outcomes rather than merely contribute to a wider assessment of whether prisoners are treated with respect for their human dignity.

They also recommended that CQC should conduct a review of the commissioning of health and social care in a number of prisons and report in 2019; and be given legal powers of entry into prisons. Apparently CQC must notify a prison in advance of any visit which makes something of a mockery of the notion of an unannounced inspection.

I may have missed something, but I’m not sure what if any of these proposals have been taken on board. HMIP and CQC operate to a memorandum of understanding from 2016 and CQC regulate according to a handbook from 2015. HMIP reports don’t yet seem to include a distinct health rating.  The review of commissioning does not seem to have taken place or if it has, it’s not published. It would for example be useful to have an expert view on the model in place at Bronzefield where Sodexo directly employs nurses and healthcare assistants and has a corporate contract to employ GPs from Cimarron UK which describes itself as a locum agency.

If there has been inaction, it may be perfectly well explained by the COVID crisis. But as the pandemic hopefully wanes, there is a case for revisiting the 2018 report. One of its key recommendations was that CQC should assess the range of services provided in prisons, including physical health and the prison environment, against the five criteria they apply in other settings- whether they are safe, effective, caring, responsive and well-led.

Services for pregnant women should be top of that list but there is much else to be looked into. There is a case for an assessment to be made under the aegis of a Parliamentary Committee or an independent Task Force set up for the purpose.