Prison healthcare ‘dangerously under-doctored’

NHS doctors working in prisons have warned that the conditions in which they work are so unsafe and understaffed that the services would be shut down if they were outside the prison system, the Guardian has revealed.

In emails from an internal prison doctors’ email group seen by the Guardian, NHS staff tell of understaffed services and patients missing hospital appointments due to clerical errors or lack of escort.

Polly Backhouse, one of the doctors, who has worked in a category C prison for the past year, told the Guardian: “There are very few doctors in the field. There has been no regular doctor since February in one prison I’ve been working in. There is a high turnover of administrative staff with little support, so patients are lost to follow-up as they move through prisons.

“There is a higher than average percentage of chronic disease and no nursing or GP capacity to manage them. Healthcare is constantly at odds with prison staff as we ask for escorts that they don’t have. The first time I had to urgently admit a patient whose neck tumour was obstructing his breathing he had missed his two-week wait appointment due to an administrative error.

“There is little or no management support despite concerns being raised over and over again. This is a vulnerable and needy group of people who are being let down by an inadequate healthcare system.”

Another doctor said: “These complex patients need medical care.

“Currently we have fractured teams, and primary care degraded. The prison I am at has 1,250 [prisoners] and turnover of 6,000 [prisoners] a year. It needs two doctors every day. We have one. Great expense is created trying not to employ doctors. Lack of doctors mean we can do so much less for prisoners in-house. This leads to expensive escort costs to outside appointments and risks. Escort costs are billed to healthcare.”

A third GP said: “I am at a prison that is so dangerously under-doctored, together with a lack of clinic time forced by the regime that nurses add tasks, and keep adding, many of which [are] dangerous requests because nurses cannot get the patients seen.”

A spokeswoman for NHS England admitted that conditions in prisons were sometimes challenging, adding: “Healthcare staff working in prisons do work in what are sometimes challenging circumstances despite funding of £500m a year on related health and justice services. Local teams are working with the prison and probation service to create a supportive environment for staff to deliver the best care for inmates who are patients.”

A British Medical Association spokesperson said: “It is important that prison healthcare get proper levels of investment and support. Like other parts of the NHS, many local services are overstretched and struggling to cope with rising demand.”

The latest report from HM Inspectorate of Prisons also found that many prisons struggled to recruit healthcare staff of the right calibre and that health services in prisons were repeatedly impeded by the unavailability of prison officers and restrictive regimes.