Prisons: Health Services

Question

Asked by

To ask His Majesty’s Government what assessment they have made of the provision of health services in prisons.

My Lords, a full health needs assessment for every prisoner is undertaken at least every three years by NHS England, which then updates service specifications and commissions appropriate services to ensure that the health needs of offenders are being met. All 19 health service specifications for prisons and other detention environments are currently being updated to ensure that they remain fit for purpose and are expected to be published by March 2026.

My Lords, I thank my noble friend for her Answer. I have heard first hand, through the work of the charities the Prison Reform Trust and Revolving Doors, about the challenging and degrading experience that some prisoners have had trying to access healthcare. Does the Minister agree that there is a huge opportunity to make progress here with the development of better facilities in new prisons? Does she also agree that it be would a positive thing to include prison healthcare services in ICBs’ commissioning to ensure that people in secure settings have access to the advances and developments that are available in the community?

I certainly agree with my noble friend that there are huge opportunities to improve healthcare for prisoners. On new prison design, I reassure her that all prison design will be fit for purpose because medical architects will be commissioned. That new design includes, for example, medical cells so that as many healthcare needs as possible can be met in prison. On my noble friend’s point about ICBs, it is a retained service, so it is not currently delegated to ICBs. It is the responsibility of health and justice commissioners to collaborate closely with ICBs to ensure continuity of care. The electronic referral service means that patients in prison can have access to the developments to which others in the community have access.

My Lords, a quarter of a century ago, I worked with the then Minister for Prisons following the difficulty we had releasing a shackled remand prisoner. The recommendation was that every prison should have a link with a hospice service in their area to ensure appropriate care, particularly for prisoners who cannot be transferred out of prison and who may wish to die in their cell, with their cellmate providing some of the support for them as they are dying. Can the Minister tell us how many prisons actually have such links?

I thank the noble Baroness for raising such an important point and for having worked on this in the past. I will need to write her with the exact figures, but we do know that more needs to be done to address health issues. However, we are keen to ensure, and are working towards making sure, that healthcare for prisoners, whether at the end of their lives or earlier, is appropriate and meets their needs, whichever is the right way to do it. Great strides have been made in that regard.

My Lords, the Minister will know that the most common diseases in prisons are diabetes, high blood pressure, HIV and mental illnesses. What are the Government doing to ensure that psychosis resulting from the use of illicit drugs is being controlled effectively, so that there are not more cases of psychosis and mental illness in our prisons?

Substance misuse in prison, to which the noble Baroness refers, is of course a major issue, and prison security has a crucial role to play in reducing it. I should also say that the use of illegal drugs can impact on routine healthcare for all prisoners, as resources have to be directed to the more immediate cases. Noble Lords may remember that we recently had delegated legislation to ensure that nasal Naloxone could be administered, including by prison staff, to prevent opioid-induced emergencies. All these things will help, and substance misuse support is available in all prisons in line with the national service specifications, but we are working across government to see what more we can do. It is a big issue.

My Lords, many of the issues preventing prisoners getting equivalence of care with non-prisoners clearly relate to access to hospitals and health specialists. As we know, delays can exacerbate conditions. Will the Government ensure that the Nuffield Trust recommendations on improving transparency, prisoner escort numbers, reviewing the supply of prison escorts and increasing access to out-patient services via telemedical services are implemented as fully as possible?

The use of technology is hugely important in all areas, particularly in respect of prison services, as the noble Baroness says. There is a policy specifying that escorts must consist of at least two prison officers, with at least one being of the same gender as the prisoner unless there are exceptional circumstances. I take this opportunity to say that every effort is made to ensure that female staff support women, particularly where appointments are specifically related to services such as gynaecology. It is very important that we are aware of the possibility of retraumatising women prisoners, and we have been particularly mindful of that in relation to escorts.

I start by thanking the noble Baroness, Lady Morgan, for sending me a briefing in advance of this Question. She rightly and importantly highlights that cancer outcomes for prisoners are poorer than for the rest of the population, while the cost of services is greater. However, given that we will be debating the Mental Health Bill later today, I want to ask a related question. Over 30% of prisoners have a learning disability, so what steps are the Government, the NHS and the Prison Service taking to protect and care for prisoners with learning disabilities? They may be there partly as a result of their learning disability, and while in prison are often at their most vulnerable. What care is there for prisoners with learning difficulties in order to protect the public and reduce the risk of reoffending when they are released?

As the noble Lord rightly says, the Mental Health Bill is in Committee this afternoon and I know we will refer to that. Certainly, the reforms in the Bill will speed up access to specialist in-patient care and treatment, in particular by introducing a statutory 28-day time limit for the transfer of patients from prison and other places of detention to hospital. On particular needs, which may be learning disability and autism, as I know noble Lords are aware, the Mental Health Bill is very focused on ensuring that people are being cared for in the right places in the right way, and that in places of detention people are being not just held but supported and their healthcare needs met.

My Lords, women in prison have very specific health needs. Will the new women’s justice board look at ensuring that health and social care services across the women’s estate are consistently gender-specific and sensitive to women’s protected characteristics?

I can give that assurance to the right reverend Prelate, and I certainly agree about the particular needs of women in prisons. It is perhaps helpful to tell your Lordships’ House that new women’s health and well-being hubs will begin in all 12 female prisons from 1 April.

My Lords, it is very well known that IPP sentences have broken the mental health of hundreds of prisoners. Does the Minister agree that it is the responsibility of the state to help fix the damage caused by these torture sentences, and that greater resources are needed for medical treatment for and support of IPP prisoners?

I know that the Ministry of Justice is also looking at this, and my noble friend is certainly right to make that point.