BMJ. 2012 Sep 17;345:e5921. doi: 10.1136/bmj.e5921.
Prison environment and health.
"Prison is a difficult place in which to provide health services, and concerns about the health of prisoners and the quality of healthcare available to them are long standing.1 In 2006 prison health services in England and Wales were transferred to the National Health Service. Scotland and Northern Ireland recently followed suit. In this first of a series of articles on prison health I examine the landscape of British prisons and the obstacles faced by prison health services.
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Six years on, NHS prison healthcare remains a work in progress. Anecdotally, the transfer of responsibility for prison healthcare to the NHS is regarded as a success. The NHS has introduced community norms and expectations, and there are examples of new facilities, innovation, and investment. Prison doctors are now all qualified general practitioners, and professional isolation has been reduced as doctors often combine practice in prisons with work in the community. Primary care trusts now provide healthcare to both prisons and local communities, and the same standards of service can be offered to both.
But challenges remain within the service. In the following articles in this series I consider some of the most important: meeting the needs of the growing population of elderly prisoners, for whom Victorian era prisons are not suitable; treatment of prisoners with serious mental health problems; and the appropriateness of prison for women, who are arguably often victims as much as they are offenders and have high rates of self harm.
Prison healthcare and broader problems of imprisonment are not easily separated. The health of some prisoners improves after a prison sentence, and in my final article I will ask whether prisons can ever be “healthy” places."
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