Healthcare in British Prisons: Why You Don't Want to Fall Ill When Behind Bars
Patterns of sub-standard treatment, medical negligence and misdiagnosis are rife – particularly with end of life care. You are an inmate at all times, even if you're dying.
Prison is the last place you want to be if you fall ill. Patterns of sub-standard treatment, medical negligence and misdiagnosis are rife. Even if you are transferred to a prison ward in a regular hospital, you'll probably be handcuffed to your bed, no matter how intimate the examination. You are an inmate at all times. Even if you're dying.
In 2013, a report on end of life care, the Prisons and Probation Ombudsman's found that over a quarter of prisoners in their sample facing death had no palliative care plans. They also found that support for families was inconsistent. More inmates needed to be granted compassionate release – allowing them to die with dignity, around family and friends.
As the British prison system has been cut by £263 million and lost 28 percent of its staff in the last three years, more and more hospital appointments have been cancelled due to a lack of officers to escort prisoners. If you have chronic chest pain, for example, you might have to wait months to see a doctor. By which point, the prognosis of the cancer you may have been incubating will become far less promising.
Jason Grant experienced the ills of prison healthcare first-hand. For months, he requested to see a doctor about pains in his chest but failed to get an appointment. "There was a long delay in complaining and being seen by doctors," Jason's sister, Jessica Grant, tells me. "If he'd been able to walk into a doctors like we can, maybe he'd still be here now, who knows."
Jason – on an IPP sentence (indeterminate imprisonment for public protection) for attempted robbery, unlawful wounding and possession of an imitation firearm – was told he had terminal cancer, while handcuffed to a prison officer, last March. "They didn't even warn us or let us know we could go with him to the hospital to be told the news," his sister explains. Without treatment, it was thought that he would live for three months. With treatment, eight months.
While in prison, Jessica says the healthcare Jason received was sub-standard. He had to wait all night for his painkillers – not an unusual occurrence in prisons, as night officers don't have the authority to administer drugs. "I remember one day he wanted to go the hospital, but there was nobody to take him so he had to sit in agony for two days without his proper medication," Jessica explains.
In light of this, Jason and his family decided to apply for compassionate release – a process that grants prisoners early release, allowing them to die at home. His first two applications were rejected because the doctor said he might live for a couple more months, meaning Jason no longer met the "critical" category that warrants release.
By this point, however, Jason's chemotherapy treatments had taken their toll and began to make him very ill. In the end, he made the difficult decision to stop the treatment. "He said, 'I'd rather die quickly and be with you than have my life last longer and die in here alone'," says Jessica.
Nevertheless, Jason's request for compassionate release was beset with bureaucratic obstacles. "They would ask for impossible certainties," says Jessica, "like the doctor promising he would not reoffend while he was out". His probation officer – the woman who was in charge of deciding whether he came home – hadn't been to visit Jason once during the whole time he was in prison. In the end, when she finally did meet him for the first time, Jessica says: "She cried with my mum and said, 'I'm so sorry that I've done this, I didn't realise how ill he was.' But it was too late."
Ibuprofen is the only drug sold in prison canteens, and prisoners must wait for prescriptions to pass through various departments. So, whether it's a migraine or a heart attack, the long chain of actions involved in receiving treatment overburdens the system. Inmates may have to sit in pain for hours. Days, even.
Eventually, the family decided to start a campaign for his release, gathering thousands of signatures for a petition and writing to MPs. Finally, Jason was released in September. By this time, though, he was gravely ill.
"By the time they let him home, he had no quality of life whatsoever," says Jessica. "He was so ill he couldn't even make it down to my house a quick drive away. He was in so much pain that he couldn't be away from the hospice for more than a few hours to have his medication."
After less than two months at home, Jason died on November 11th 2014. He was 46. Born and bred in Hackney, the father of two had served nine years, despite the fact that, when he was sentenced, the judge had recommended a sentence of three years, three months. IPP sentencing – introduced by Labour in 2003 and designed for serious violent and sexual offenders, rather than those convicted of theft, like Jason – has no fixed length of time, i.e. there is no date set for the individual to be released.
Only, more than six years after his recommended release date, he was still inside. Jason was given the IPP sentence in the first place because, according to Jessica, he was "deemed a danger to the public". At the time he was sentenced, though, countless people were given IPP sentences for non-violent and sexual assault crimes. It appears to have been mis-used in many cases during the period. The case of mobile phone thief Leroy Douglas is another example.
Fortunately, IPP was scrapped and ruled unjust by the European Court of Human Rights in 2012. But with over 5,000 IPP prisoners still locked up and only 400 released each year, it could take nearly a decade to clear the backlog. Last year, it was thought that 3,500 prisoners were behind bars for longer than necessary.
For Jessica, there is no consolation to be found. "Everyone can take a wrong turn," she says. "It was disgusting the way Jason was treated."
Jason isn't alone, though. Most UK prisons have basic, overstretched healthcare departments with no internal hospital facilities. In most cases, prisoners must be sent to local hospitals for appointments. However, as Jason discovered, the shortage of prison officers to escort inmates means waiting lists are long and appointments are frequently cancelled.
When prison healthcare was taken over by the NHS in 2005, it was thought that quality of care would radically improve. Prior to that it had been managed by the Prison Medical Service – an institution famed for negligence. Healthcare has improved under the NHS, but the secure and bureaucratic nature of the prison environment means it cannot compare to what those on the outside receive.
Prison bureaucracy is iron-clad. Unlike us, inmates cannot simply call in at their local GP or Accident and Emergency department when they fall ill. Instead, they have to first wait for the prison healthcare department to respond to their query, then arrange an external hospital appointment and then free up some officers for the escort.
Access to medication is an issue, too. Ibuprofen is the only drug sold in prison canteens, and prisoners must wait for prescriptions to pass through various departments. So, whether it's a migraine or a heart attack, the long chain of actions involved in receiving treatment overburdens the system. Inmates may have to sit in pain for hours. Days, even.
A very small minority of prisons do have palliative care units, but there are no national standards on what an end of life care unit has to provide. What's more, there is no aggregate data on prison palliative care units – particularly surprising when you consider that older prisoners are the fastest-growing group in the custodial population.
Since 2002, the number of prisoners aged 60 and older has more than doubled – a direct result of increased sentence lengths, stringent licence conditions and the recent surge in historic sex abuse cases. As the prison population has aged, more have died while inside. In 2013, 100 people over 50 died of natural causes in prison – a staggering 79 percent increase in the last decade.
Recent research indicates that older prisoners have a physiological age of ten years older than they actually are – a result of bad diet, insufficient healthcare, smoking, poverty, alcoholism and substance abuse while incarcerated. But in a prison system built to punish young criminals, older prisoners are often denied proper healthcare and end of life palliative care plans. In addition, the number of prisoners who are granted compassionate release has slowly been falling for the last five years, because – as Jason and his family found out – prison policy only allows prisoners to apply for release once they've been given three months to live. In turn, slow paperwork means people often pass away before it's granted.
Alex Cavendish, who served five years in prison, worked as an "Insider" during his time sentence. This involved working as a peer mentor and helping prisoners draft complaints about medical negligence to both the prison service and solicitors. We spoke at length about some of the upsetting cases he witnessed.
"One time, someone got injured while playing football. It was put down as a bad sprain even though it was definitely a compound fracture – the guy's bones were coming through the skin, but healthcare was doing nothing," Cavendish explains. In the end, one of the gym officers who happened to have worked as a medic in the army noticed the injury. "He was finally taken to hospital in an ambulance, otherwise he would have had all kinds of other complications."
Recent research indicates that older prisoners have a physiological age of ten years older than they actually are – a result of bad diet, insufficient healthcare, smoking, poverty, alcoholism and substance abuse while incarcerated.
On another occasion, a prisoner was prescribed the wrong medication – even though it clearly stated on his file that he was allergic. "He arrived at the education department where I was working and took his medicine. Within five minutes, we had a code blue and he was unconscious and not breathing. It took 10 minutes from the code blue to healthcare getting to him because of all the communication and all locked doors. Luckily, a number of us were trained in CPR to keep him alive while they waited. But he could easily have died or suffered brain damage."
Despite stories like Cavendish's, the issue of prison healthcare does not look set to be improving. In fact, we've seen a clear drop in individual prison performances over the last year. The number of prisons whose performance is "of concern" and "of serious concern" rose from 13 percent in 2012-2013 to 23 percent in 2013-2014.
Prisons exist to keep potentially harmful individuals away from the public. Inmates are confined as punishment – not to be punished. You don't become a sub-species when you hand over your personal documents at the prison gates. Every human being deserves access to proper healthcare when they need it.
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