Incoherent Government policy and inadequate funding is creating a crisis that threatens to overwhelm the prison health care system, said the British Medical Association on 8th February 2007.

At a BMA conference on prison health today (8th February), leaders of the BMA's Civil and Public Services Committee will call on ministers to address the chaotic and bleak situation facing prison doctors by rectifying a raft of problems that are undermining health service provision to offenders.

Dr Redmond Walsh, a London based prison doctor and member of the BMA's Civil and Public Services Committee says:

"What concerns prison doctors is that there is not just one problem facing our profession, but a whole raft of serious challenges that begin at the very moment an offender enters the system and continue even after they are released into the community. Prison doctors, and indeed offenders, are facing a constant battle against a range of deep seated health problems in prison, from drug dependency to mental health, without the resources or suitable systems in place. It is ridiculous that offenders sometimes don't see a prison doctor immediately after conviction and irresponsible that they are not registered with a GP after release. The whole situation is chaotic and getting worse."

Dr Clare Jenkins, the chairman of the BMA's Civil and Public Services Committee, says:

"Prison doctors need assurances that the Government is ready to tackle the problems in our prison system. Leaving the status quo intact, especially with the extra burden of a rising prison population, is not an option. We welcome the initiative of the BMA in Wales this week in producing its report 'Prison medical services: Ensuring a future for services in Wales'. I am sure that the findings of the report will be equally applicable elsewhere in the UK. The recommendations must be given serious consideration."

Key concerns raised by the committee include:

Funding and services

-- The need for a full review of prison health care to ensure that clinical need is matched by adequate levels of funding. This analysis must be followed by an immediate increase in financial support to rectify historic levels of underinvestment that have left services stretched and struggling.

-- The importance of an investigation into the health of the prison population and the implementation of well funded, coherent strategies to combat the most serious medical conditions identified. Mental health disorders, drug dependence and the after affects of alcoholism remain endemic problems in the UK's prisons while the threat posed by sexually transmitted diseases continues to be unquantifiable owing to a lack of research. Urgent action is required to provide prison doctors with the knowledge and tools to arrest the drastic state of prison health.

-- That the recent transfer of prison care commissioning responsibility to primary care bodies is properly monitored and assessed to detect shortcomings in the new arrangements. The BMA is extremely concerned that confusion and conflict over the provision of services is arising between Primary Care Trust (PCT) commissioners, who are charged with providing prison health services, and prison managers, who still operate the prison health care budget.

-- Required Government action to ensure that all newly convicted offenders see a doctor immediately after sentencing so that serious conditions can be detected and assessed without delay. Currently it is not unusual for offenders sentenced during morning court sessions to reach a prison doctor as late as 10pm - an unacceptable and potentially harmful delay for those suffering from severe conditions.

Prison Accommodation

-- The importance of a Government guarantee that police station cells and other inhumane accommodation will not be used as a long term form of residence in order to ease prison overcrowding.

Deaths in Custody

-- The need for assurances from the Department of Health that they will work with the Prison and Probation Ombudsman and Prison Health Providers to provide trained and professionally appropriate clinical review panels for investigating deaths in custody.

After prison care

-- The urgent need for newly released offenders to be registered immediately with a GP practice to ensure that their care is continued in the community. Failure to support individuals with serious conditions, such as mental health problems and drug addiction, can only lead to a decline in health and in some cases the possibility of re-offending.

1. The BMA Civil and Public Services Committee represents doctors working for civil service departments and organisations, including prison doctors.

2. The BMA Wales report, Prison Medical Services - Ensuring a Future for services in Wales - highlights the day to day problems faced by doctors in the prison system and those working with former offenders in the community. A copy of the report and press release can be obtained from the BMA Press Office.

3. The Prison Reform Trust, an independent charity campaigning for penal reform, publishes regular updates (entitled the Bromley Briefings) on the state of the prison population. The latest update from November 2006 can be accessed at: prisonreformtrust/temp/factfilenov2006finalsp4.pdf

This update reveals:

Mental Health

-- Over 70% of sentenced prisoners suffer from one or more mental disorders.

-- 7% of male and 14% of female prisoners have a psychotic disorder, 14 and 23 times that of the general population.

-- At any one time there are likely to be at least 40 prisoners in the UK who have to wait three months before being transferred to hospital for serious treatment.

-- The Chief Inspector of Prisons estimated in 2004 that 41% of patients held in prison health centres should have been transferred to secure NHS accommodation so that their mental health problems could be properly treated.

Drugs

-- Four out of ten prisoners use illegal drugs at least once during their time in prison.

-- More than four out of ten prisoners who had used illegal drugs could not find services to help them with their dependency.

-- A third of prisons are unlikely to be able to continue drug treatment programmes if a prisoner is transferred - an increasingly regular occurrence as the prison population increases.

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