Healthcare: Prison Sentence or Death Sentence?

Ask pretty much any prisoner in the UK prison system to name the most dysfunctional, least effective department in any nick and I’d be willing to bet that healthcare would probably come at the top of the list. Fairly or unfairly, there is a widely held perception that the standard of medical care inside prisons is extremely poor. Having had personal experience of four jails run by HM Prison Service (plus two others in transit), I’m going to offer readers an insight into just a few of the worst horror stories I’ve encountered.

Medical care behind bars

Virtually every prisoner in the system will have had some interaction with healthcare staff, even if only for five minutes during the initial induction process. Newly arrived at one nick, my healthcare assessment consisted of three questions: was I feeling suicidal (no). Was I taking any prescribed medication (yes – for migraines). Was I on the methadone programme (no). “Next!” And that was about it. 

Despite my being on prescribed medication, no fresh repeat order was placed as it should have been, so once what little I held in possession on my arrival was finished, I had a three-week wait for the new supply, which was only ordered – very grudgingly – after I made three applications. Of course, I was very lucky. Although they can be agonising, migraines don’t prove fatal, unlike diabetes, which afflicts a growing number of cons as the prison population grows older. 

I pretty much lost count of the problems that diabetics experienced inside the slammer. Insulin not ordered or not kept in proper conditions; special diets ignored; outside hospital and clinic appointments cancelled at the last minute. And as for specialist chiropody treatment for those with diabetes-related problems, the chance would be a fine thing.

According to its official website, the Ministry of Justice (MOJ) claims grandly that “Prisoners get the same healthcare and treatment as anyone outside of prison”. I beg to differ. The UK prison system isn’t equipped to deal with people suffering from serious or life-threatening conditions or illnesses. The MOJ will claim otherwise, of course, but take it from one who knows: it really can’t cope. It may be another story in the very few prisons that offer special units for inmates who require palliative care, but across the mainstream prison system the situation is pretty horrific.

UK's growing prison populations

It also needs to be remembered that Britain’s prison population is ageing. According to MOJ statistics, in the category of ‘older prisoner’ (defined as being aged 60 or over) the total number incarcerated as of 31 March had reached 3,577. That means that the actual number of older prisoners has almost doubled over the past ten years and now accounts for around five percent of the 85,700-strong prison population. Of those older prisoners, 102 of them are aged 80 or above, with five men older than 90.

Before I’m accused of special pleading on behalf of cons, I should point out that I’m only too well aware of the shortcomings on the NHS outside the prison gates. I have close family members who have waited two years or more to see specialists and my own mother’s medical conditions were misdiagnosed for years before it was confirmed that she suffered from multiple sclerosis (MS). The NHS is under-funded and under incredible strain. However, the National Offender Management Service (NOMS) is responsible for the contracting out of prison healthcare services and – in theory, at least – the Prison Service has a duty of care to those it holds in custody. It is also worth remembering that even if these inmates weren’t serving prisoners, their medical conditions would still require treatment by the NHS in the community.

Prisoners can’t call in at the local branch of Boots to pick up over-the-counter remedies for minor ailments, nor can they take advantage of local clinics or A&E departments. Everything, from a headache to a heart attack has to go through the prison healthcare system and this, in itself, causes an overload. 

Prison doctor

Anyone who has done time inside will be familiar with the long line of prisoners standing outside the wing healthcare office. They are sometimes referred to as the ‘walking dead’. They go up to the hatch, one con at a time, to collect whatever medication has been prescribed for them. Most will have to take their pills there and then under the supervision of the nurse to guard against bullying or the resale of “meds”.

Inmates are a truly captive audience, so when the system fails to deliver appropriate care, there is little that they can do other than try to survive or, as in the case of a friend of mine whose serious health conditions weren’t being managed because he was being refused the pain relief medication that specialists outside the prison had prescribed (on ‘security’ grounds), they can commit suicide.

I’ll give you another example of a young prisoner known to me personally. He was on the methadone programme to manage his addiction and he suffered from a range of other health problems, including being unstable on his feet at times. One night, he climbed out of his top bunk to use the toilet and slipped. He fell and landed over the back of a metal-framed chair, crushing his testicles. Although he was screaming in agony, and his cell-mate pressed the call bell to get staff assistance, the night screw (‘the clocky’) just told him to get back into bed and shut up.

The next day he was in a very bad way and was unable to walk. Delays in getting an appointment with healthcare meant a three-day wait before he was seen by a nurse, then it took almost a further week until he was taken, handcuffed, to the local hospital. Of course, by then it was far too late and his condition was so serious that he had to be castrated. Yes, you read that correctly. 

When he was finally returned to the prison, after surgery, the powerful painkillers he had been prescribed at the hospital were confiscated and he was given paracetamol instead. News about what had happened went round among the staff and a couple of the screws he encountered found his predicament extremely funny. Just try to put yourself in his position – or imagine that this youngster was your own son.

The same treatment as anyone else?

After this life-changing incident, this young lad received no psychological support or counselling, nor did anyone discuss the possibilities of taking testosterone replacement with him. There was no option to have prosthetic implants. When I encountered him he was in deep depression and constantly thinking of suicide. I know his situation well because I volunteered to take up his case and we tried to initiate legal action against both the healthcare department and the prison authorities.

I’ve witnessed other horrific incidents. A lad broke his leg playing football and even though it was a complex fracture and the bones were visibly breaking through the skin, was told by healthcare staff that it was “just a bad sprain”. Fortunately, the gym screw – who I suspect had more humanity in him than the whole of the healthcare team – had been an Army paramedic and he told them what he thought of their triage diagnosis in no uncertain terms before contacting the duty governor and getting an ambulance called to take the bloke to hospital for appropriate treatment. 

Or the con who had such a serious tooth abscess that he was unable to eat, but couldn’t get any kind of dental appointment for weeks. Instead he was prescribed painkillers. Due to a ‘clerical’ error, however, he was in fact given massively strong doses of antipsychotics that were intended for another con who suffered from violent delusions. Because the two men looked vaguely similar, the duty nurse didn’t check their ID cards – as she was supposed to – before dispensing the tablets. Since they were given their medication in small plastic cups and were required to swallow them immediately, neither inmate suspected anything was amiss. 

Medical care in prison

It was only when the guy with a toothache ended up wandering round in a heavily sedated state that anyone realised there had been a massive cock-up. Naturally, the whole incident was hushed up and the lad with dental problems was quickly shipped out to another prison before he could cause any trouble. 

Despite this catalogue of horrors, and I could add many, many more specific incidents, it would be unfair to blame healthcare departments for everything. The environment in which they operate is not conducive to good doctor-patient relations and I’ve also witnessed some horrific behaviour by prisoners towards medical staff.

I have encountered a few excellent clinical staff and doctors in prison healthcare teams. These are the individuals who genuinely treated cons as patients and behaved with tact and humanity. Unfortunately, they stand out in my mind now because they were fairly few and far between. At least in the D-cat (open) prison I was at for nearly a year, the healthcare department was pretty good. In any case, a lot of cons who felt that they needed over-the-counter medication just popped into the local chemist when they were allowed out on home or day leave (ROTL), even though this was officially against the prison rules. 

On the 'dog lead' in hospital

One of the major problems faced by healthcare departments is trying to coordinate outside medical appointments with prison security. Most prisoners requiring any kind of medical or dental treatment outside the walls have to be escorted by officers, to whom they will remain handcuffed throughout their treatment, no matter how intimate the examinations or procedures may be. If prisoners need to be kept in hospital overnight (very few prisons now have facilities for in-patient care on site), then they can expect to be handcuffed to an officer via a long chain (known to cons as the ‘dog lead’). 

Therefore, if there is a shortage of security staff available to serve as hospital escorts, the appointment – which may have taken weeks or months to arrange – gets cancelled with little or no notice. It would be interesting to know the amount of taxpayers’ money that is wasted every year on cancelled medical appointments for prisoners and the true cost of the NHS resources involved when inmates aren’t produced for treatment. Perhaps an MP might like to ask that question in Parliament, because I’m certain that this situation is likely to get much worse owing to the current shortage of prison staff. 

I fear that given the escalating crisis in our prisons there will be a rising number of incidents where urgent – possibly life-saving – hospital treatment will inevitably come second to ‘operational issues’ (ie staff shortages) and some prisoners will probably die as a result. It’s in cases like these that a prison term can actually prove to be death sentence in the UK.