MSPs have called on the Scottish Government to prepare a strategic plan covering health and social care in prisons, setting out how prison healthcare can reach parity with wider society within the next two years.
Parity of care with the wider community was a key aim of the transfer, in 2011, of healthcare delivery from the Scottish Prison Service (SPS) to the NHS. A report says that improvements promised by the move have not materialised and the prison population in Scotland has been underserved by the changes.
The report says that the prison environment presents an opportunity to engage with people who often do not engage with the healthcare system and to tackle health inequalities in wider society. MSPs looked at whether prison healthcare was contributing to efforts to reduce health inequalities, but found that this “unique opportunity” was not being taken up.
The Committee also heard that up to 50% of clinical time was being wasted due to missed appointments as a result of difficulties in transferring prisoners to prison health centres. The report says the Committee expects the SPS, contractors and health boards to ensure that patients are able to attend healthcare appointments.
The Committee says the SPS were unable to tell them how many prisoners have mental health needs. However, evidence received by the Committee, suggests that an estimated 70% of prisoners have mental health problems. MSPs have called for steps to be taken to ensure that the mental health needs of all prisoners are addressed.
The report also draws attention to a change in the age profile of the prison population with more complex health and care needs. Improved life expectancy, longer sentences for serious crimes and more convictions for historic offences are all factors leading to an older prison population. The last five years have seen the number of older people (aged over 50) in the prison population increase by 50%.
Neil Findlay MSP, Convener of the Health and Sport Committee, said:
“The overriding impression we took from our evidence is of a population very much underserved by the shift to NHS provision of care in Scotland’s prisons. This is a particular concern with our prisons housing growing numbers of older prisoners with more complex health and care needs.
"The point of transferring prison healthcare from the prison service to the NHS was to ensure prisoners receive healthcare equivalent to that of the wider community in Scotland. It also offered a unique opportunity to address health inequalities within the prison environment, so it’s disappointing to discover that that opportunity is not being taken up.
“The fact that missed appointments are accounting for 50% of clinical time represents a waste of resources that needs to be addressed through better joint working between the SPS, health boards and contractors.”
Other conclusions and recommendations reached by the Committee include:
- Ministerial and civil service leads should be immediately identified as being accountable.
- Any cultural difficulties between the SPS, NHS and others need to be addressed.
- An agreed set of Performance Indicators on prison healthcare be adopted by each health board, including the extent to which health inequalities are being tackled in prisons.
- Disappointment that prisons have been omitted from ongoing IT developments for the wider NHS.
In 2007 the Prison Healthcare Advisory Board (PHAB) was established to advise the Scottish Government on the feasibility of transferring prison health care from the (SPS) to NHS Scotland. The driver for that transfer being the need to ensure prisoners received healthcare equivalent to that of the wider community in Scotland.
The PHAB reported in December 2007 that such a transfer was feasible setting out 4 main reasons:
- To tackle ongoing health inequalities within the prisoner population;
- To meet international standards on prison health and treatment;
- To provide continuity of care to prisoners on leaving prison; and
- To provide sustainability of services with the support of community based services.
The PHAB report noted that HMIP had also recommended that healthcare should be provided by the NHS on the advice of NHS Quality Improvement Scotland.
On 1 November 2011 responsibility for the provision of health care in prisons transferred from the SPS to the NHS.