Prison healthcare so bad it would be shut down on outside, say doctors

NHS doctors working in prisons have warned that the conditions in which they operate are so unsafe that the services would be closed down had they been outside the prison system, the Guardian has learned.

The warnings have been issued in emails from an internal prison doctors’ email group seen by the Guardian. The fears about failures in prison healthcare come at a time when prisons are under huge pressure as a result of violence, overcrowding, drug use and high suicide rates.

One of the doctors, Polly Backhouse, who has worked in a category C prison for the past year, expressed alarm about current conditions.

Speaking to the Guardian, she said: “There are very few doctors in the field. There has been no regular doctor since February in one prison I’ve been working in. There is a high turnover of administrative staff with little support, so patients are lost to follow-up as they move through prisons.”

Backhouse added that the prison routinely cancelled urgent referrals to hospital where patients should be seen within two weeks, due to lack of escorting staff. “I have to decide on a daily basis which outpatient appointments to cancel due to prison officer staffing,” she said.

“There is a higher than average percentage of chronic disease and no nursing or GP capacity to manage them. Healthcare is constantly at odds with prison staff as we ask for escorts that they don’t have. The first time I had to urgently admit a patient whose neck tumour was obstructing his breathing he had missed his two-week wait appointment due to an administrative error.

“There is little or no management support despite concerns being raised over and over again. This is a vulnerable and needy group of people who are being let down by an inadequate healthcare system.”

Another doctor currently working in prison healthcare said that resources were “grossly misapplied”.

“These complex patients need medical care,” the doctor said. “Currently we have fractured teams, and primary care degraded. The prison I am at has 1,250 [prisoners] and turnover of 6,000 [prisoners] a year. It needs two doctors every day. We have one. Great expense is created trying not to employ doctors. Lack of doctors mean we can do so much less for prisoners in-house. This leads to expensive escort costs to outside appointments and risks. Escort costs are billed to healthcare.”

In the emails seen by the Guardian, doctors working in prisons highlight the unsafe clinical conditions that they say are the result of understaffing.

“I am at a prison that is so dangerously under-doctored, together with a lack of clinic time forced by the regime that nurses add tasks, and keep adding, many of which [are] dangerous requests because nurses cannot get the patients seen,” says one.

Another writes: “It’s very unsafe. This sort of practice forces doctors to work outside every aspect of GMC good clinical practice guidelines.”

A third GP writes: “The problem is such that some wiser doctors now refuse to work at this establishment. The problem has been reported to everyone I can think of. CQC somehow passed it at a low level. Any GP’s surgery with such a performance would have failed and closed.”

A fourth says: “Firefighting at one place I go to. That’s all. Main thing is trying to prevent the next death in custody.”

A spokeswoman for NHS England, which is responsible for health services in prisons, admitted that conditions in jails were sometimes “challenging”.

“Healthcare staff working in prisons do work in what are sometimes challenging circumstances despite funding of £500m a year on related health and justice services. Local teams are working with the prison and probation service to create a supportive environment for staff to deliver the best care for inmates who are patients,” she said.

A British Medical Association spokesman said: “It is important that prison healthcare get proper levels of investment and support. Like other parts of the NHS, many local services are overstretched and struggling to cope with rising demand.”

A spokeswoman for the Prison Reform Trust said: “We know that prisons are in crisis and healthcare is suffering along with every other kind of care prisoners are supposed to receive.”

The latest report from HM Inspectorate of Prisons found that many prisons struggled to recruit healthcare staff of the right calibre and that health services in prisons were repeatedly impeded by the unavailability of prison officers and restrictive regimes.

England and Wales has the highest imprisonment rate in western Europe. The prison population has risen by 82% in the past 30 years. Some 68,000 people were sent to prison last year – 71% for non-violent offences, almost half for sentences of less than six months.