Monday 6 March 2017

Treating – or tricking?

One of the issues that often causes people genuine concern in the modern age is the question of security of their personal data, especially confidential medical information. In recent years there has been a lively debate over proposals for data sharing between the NHS and other agencies, yet when it comes to prisons and prisoners there seems to be something of a ‘black hole’ where elementary patient rights are ignored.

Does it go beyond the door?
The specific issue of professional confidentiality in our prisons seems to be very poorly developed or understood. In theory, at least, prisoners are supposed to be provided with the same level of patient care and treatment as is available to all other users of the NHS, yet we know from successive reports from HM Coroners’ inquests that, sadly, on occasion there have been some very serious shortcomings when individual prisoners have died in custody. I am personally aware of one case in which the healthcare manager in a specific prison resigned following a particularly damning inquest verdict that highlighted medical neglect.

Again – in theory – prisoners’ interactions with professionals working in prisons, including doctors, nurses and psychiatric staff, should be treated in the same way as in the local health centre or clinic in the community. While certain types of information sharing are permissible (particularly to protect the vulnerable or children at risk) I think it is fair to say that most of us would take a very dim view of a local GP or nurse who chose to write a sensational ‘treat and tell’ book exposing our confidential medical information to the wider world, or even in a tabloid newspaper, especially when the patients are identified by their real names.

HMP Altcourse - a G4S prison
I was reminded of this today when I saw that a former psychiatric nurse who had worked at Liverpool’s HMP Altcourse – and who states that she has 38 years of clinical experience – has published a book about her time working at this private prison managed by G4S. The book has since been picked up by a leading tabloid and, in an article, very specific details concerning this nurse’s professional interactions with one particularly notorious prisoner are explored.

Reading the article – although not the book (which I am also not naming as I don’t feel I should be giving it the oxygen of further publicity) – I was struck with a sense that this is clinical information that really shouldn’t be in the public domain. This is not only because of the potential impact on the prisoner concerned, but also because of the likelihood that the newspaper coverage will come to the attention of the victim’s family. Details of a particularly grisly crime, including photos of both the prisoner and the victim, are included in the article.

Healthcare: behind bars
I think it is also important to note that this does not seem to be a scientific study that might be of use to criminologists or forensic psychiatrists, but it is rather an exploitative and sensational book that appears to have been self-published for sale online. To be honest, I was shocked that a qualified health professional who claims to have 38 years of experience couldn’t see the potential conflicts of interest, let alone a probable violation of a duty of care to a former patient who is portrayed as particularly vulnerable.

There would be serious ethical issues involved even if every prisoner mentioned in such a publication had given free consent, yet I very much doubt that this was obtained, let alone permission from the families of victims involved in specific crimes. Perhaps if names had been changed or anonymised, the potential breaches of trust might have been largely avoided, yet it is clear that real names and specific offences are being described in gory detail.

In my view the publication of this book – and others like it – are a serious indictment both of our present prison system and of the professional bodies that are supposed to regulate staff members that provide medical and clinical care to prisoners. I believe strongly that this duty of care and confidentiality should not cease when either a prisoner is released or a healthcare professional retires. Surely this should be reflected in staff employment contracts?

Asking the right questions
The potential pitfalls should be there for all to see. If serving prisoners become aware that even a tiny minority of healthcare staff might be intent on publishing sensational books or giving interviews about them to the tabloid media then it is hard to see how any degree of trust can ever be established between patient and practitioner. What negative impact could that have on inmates seeking medical help in a time of crisis or illness? Should prisoners forfeit the right to basic levels of clinical confidentiality simply because they are in custody?

I recall that when I was in prison I was asked by a healthcare department to sign a document giving my permission for the sharing of my medical data with the prison authorities. I declined, not because I had anything I wished to conceal about my own health but because no one could explain why this access would be of any specific benefit to me. Indeed, I have come across cases where the sharing of prisoners’ medical information - for example a diagnosis of autism - has impacted negatively on indeterminate sentenced inmates’ chances of parole.

Let's talk about medical ethics
This sort of book merely feeds to public’s seemingly insatiable appetite for sensational information about prisoners who have committed notorious crimes. As always there is a wide gulf between wanting to know private information about others and the right to have access to it.

Surely at a time when we have a well documented mental health crisis across our prison estate, any publication that further undermines the very fragile relationship of trust between prisoners and prison medical staff should be a matter of concern for the Ministry of Justice and for the wider prison service. So, will any action be taken to be prevent unauthorised disclosure of clinical data? I’m afraid I’m not taking a deep breath.


  1. Well said, Alex. I find it hard to process that someone with that much supposed experience would feel compelled to violate confidentiality in such a manner. If they didn't gain consent to use individual accounts, then they ought to be prosecuted for their actions.

  2. From first hand experience, there is no sign of this issue getting any better in prisons any time soon.
    Like you I was recently asked to consent to the disclosure of my medical records and declined for the same reasons you did. My records were disclosed anyway and, when I challenged this, I was told that staff had not been informed that I had declined and therefore they "presumed consent". The fact that someone has now written a book about their work in prisons just highlights how much disregard some staff have for the rule of law whilst simultaneously telling prisoners that they should have respect for it.
    Hypocrisy at the highest level. Not all staff are like this though. There is one officer here at HMP Wakefield who is doing a number of criminology related courses in her own time and who told me that she is always very strict with herself that, when writing assignments, she limits what she writes to what she knows from the set texts and does not include any information about the prisoners she is writing about which she knows by virtue of having worked with them personally. She said that this is really important to her because she signed the official secrets act and doesn't intend to break it. Well, surely the nurse who wrote the book you refer to (and kudos for not publicising the name by the way) also signed the official secrets act. If so, she has breached it. That is a serious criminal offence. So where is the prosecution? Let me guess: It's "not in the public interest".

  3. Addition: It can become even more bizarre when the doctors/nurses have convinced themselves that they have stopped the meds for your benefit. Try to get your head around that one. And if you manage to get your around it from a distance (when you aren't going through it personally), then try to imagine what it is like when you ARE going through it, and experiencing the intense suffering, frustraton and confusion involved!!

  4. (This should've been posted first)

    Inmate patients are treated very differently to ordinary patients. I feel that there needs to be more laws to protect inmates in this sense. Both through proper medical confidentiality, and continuation of medications prescribed pre-prison. Many inmates have their medication stopped when they go to prison. In many instances they would of been on, and highly dependent on the mental health medication possibly for many decades. Then they have it stopped. Saying to the prison doctor that your 'real' doctor/s outside prison have been prescribing it to you for many years, and you need it to cope is pointless and futile, once they make up their minds. The way they get around it is to say 'it is our opinion that you don't need this'. Then that's it, there is no budging and every attempt to try to defend yourself may result in various types of bizarre dynamics happening. You literally have to try to shut up, and just take it. But its difficult, particularly if you are suffering and cracking up, and particularly if you are doing a long time. There are vast numbers of ill inmates who are actually waiting for the end of their sentense. Not because they want to be free, walk on a beach or any other type of similar activity. But just for the very simple reason they are waiting to get out so they can go back to their own doctor; strange but true. It is surprising how many prison workers think that people in prison cut themselves because they are being manipulative etc. Does anyone stop to consider that the reason they are chopping themselves up and/or trying to kill themselves is actually because they are no longer receiving medication as described above??

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