Prisoners missed more than four out of 10 outpatient appointments last year, according to a new report highlighting the challenges accessing decent healthcare in jail. The report by the Nuffield Trust revealed that the percentage of missed appointments where no advanced warning was given (18%) was three times higher than in the general population (6%). It also reported prisoners missed 42% of outpatient appointments in 2019/20.
‘We found that a lot of health care was needed to manage the impact of violence and self-harm, and that pressure on access to services leads to a lot of missed appointments,’ commented lead author Dr Miranda Davies. ‘Prisons are often a contentious topic, but misconceptions about them being a “holiday camp” hide the fact that in prison are a range of people whose health needs are not always being met.’ She cited the death of a newborn baby at HMP Bronzefield as an example.
The report recorded that at the start of the national lockdown in March 2020, admissions to hospital by prisoners were at their lowest in England at 1,019 in any month of the previous year. ‘Even accounting for the fact that people in the general population used hospital services less during the pandemic, this finding remains stark,’ the report said.
Davies, a senior fellow at the Nuffield Trust, said that their work revealed that when prisoners were able to access hospital services it was often as a result of violence or self-harm which ‘points to wider challenges facing the prison system around poor living conditions, overcrowding and a loss of experienced staff’.
According to Davis, since 2016 injury and poisoning had consistently been the most common reason for inpatient hospital admission. ‘Compared to people of the same age and sex in the general population, the latest data shows that admissions for injury and poisoning are twice as high for those in prison,’ she noted. In 2019/20, admission rates for these causes were more than double the general population (43.3 per 1000 compared to 20.3 per 1000).
The proportion of hospital admissions relating to cancer and conditions such as dialysis had increased post-lockdown suggesting that from the earliest stage of the pandemic ‘only the most urgent cases were seen’.
The report also focused on the poor provision of mental health services in prisons. A report by the HM Inspectorate of Prisons in 2020 found that 71% of women and 47% of men in prison have mental health problems. Data from the Prisons and Probation Ombudsman revealed that of the 218 deaths of prisoners with a mental health condition between 2012 and 2014, one in five had not received mental health care whilst in prison.
Problems were exacerbated by the lack of access to appropriate off-site facilities. In 2017/18, 40% of outpatient appointments (32,987) were not attended, double that of the general population. The most common cause was practicality as at least two members of staff are required for transport. An inspection of HM Lowdham Grange in 2021 found prisoners waiting up to 14 weeks for a GP appointment. Measures to improve this include the use of telemedicine consultations, increasingly used during the pandemic. In 2019/20, there was 1,567 remote consultations; a higher roll-out of these services may improve access to healthcare.