Without change, health and social care services will fail to meet the needs of prisoners

Published 31/03/2021   |   Last Updated 31/03/2021   |   Reading Time minutes

The Senedd’s Health, Social Care and Sport Committee has found several failings in Wales’ prisons, with health and social care services not always meeting the needs of prisoners.

The Committee’s inquiry has highlighted problems arising from the complex way in which prisons are governed. Justice is the responsibility of the UK Government while health and social care in most of Wales’ public sector prisons is administered by the Welsh Government. The Committee heard how it had not always been clear whose responsibility it was to meet prisoners’ care and support needs, meaning they were often unrecognised or not met.

Missed medical appointments

The Committee’s inquiry into health and social care in prisons found that many prisoners are missing healthcare appointments for reasons beyond their control, affecting prisoners’ health and wasting NHS time and resources.

Evidence given to the inquiry showed a mixed picture across Wales’ six prisons, with some prisons not even monitoring missed appointments.

Although some prisons are now taking action to tackle the situation, the Committee believes it is unacceptable that some prisoners are unable to attend medical appointments for reasons such as a lack of availability of prison staff. The Committee is also concerned about the inconsistency across prisons in monitoring missed health care appointments.

The Committee is calling on the Welsh Government to establish a ‘national performance indicator’ for attendance at healthcare appointments, and to work with its partners to ‘facilitate the sharing of learning and best practice’ so that all prisoners can access health services when they need them.

Dementia and older prisoners

The increase in the number of older prisoners is predicted to continue and the committee heard that more prisoners are likely to have greater and more complex health and social care needs in future.

Members also heard that the absence of dementia screening and diagnosis makes it difficult to recognise whether a prisoner’s challenging behaviour stemmed from general distress, substance misuse or dementia. Health boards said the lack of screening and early diagnosis for dementia among the prison population was out of step with the Welsh Government’s dementia action plan.

The Committee is calling for:

  • The Welsh Government and partners to develop a dementia pathway for prisoners
  • The introduction of screening and early diagnosis for dementia
  • People who are diagnosed with dementia to receive the care and support they need
  • Training for prison staff on supporting older prisoners and prisoners with dementia

Fair funding

Evidence submitted to the Committee outlined how the current funding system for prison healthcare in Wales is outdated, and the funding level is insufficient to meet the demands of an increasing and ageing prison population.

The Committee is concerned that the funding arrangements for prison healthcare services are complex and lack transparency. The level of funding within the Welsh Block from the UK Government is inadequate, having not been increased since 2004-05.

The Committee is calling for:

  • The Welsh Government to reach agreement with the UK Government on fair, sufficient and sustainable funding for healthcare in public sector prisons
  • The Welsh Government to work with partners to collate, review and publish information about the costs of healthcare provision across all six prisons in Wales

COVID-19 data for prisons

The Committee is alarmed at the difficulty in accessing data on Welsh prisons. Without Freedom of Information requests, the impact of the pandemic on prisoners in Welsh prisons would not be known. Only FOI requests revealed how many people in Welsh prisons had tested positive for COVID-19 or died from it and there is still no available data on the level of vaccines offered or taken up in Welsh prisons.

The Committee is calling for the Welsh Government to include within its COVID-19 dashboard information the number of COVID-19 cases and deaths among prisoners, and the number of COVID-19 vaccinations offered and taken up among the prison population.

Dr Dai Lloyd MS, Chair of the Health, Social Care and Sport Committee said:

“Prison health and social care services are not often on the agenda but COVID-19 has once again brought the problems to the forefront.

“The pandemic is highlighting a lack of transparency from prisons and the Welsh Government and we simply don’t have a full picture of how it is impacting the prison population. We’re calling on the Welsh Government to urgently publish data so that we have a clear understanding of the problems.

“The way prison health and social care is funded, commissioned and delivered is complex and confusing resulting in a very mixed bag of services across Wales’ six prisons.

“As a Committee we’re alarmed at the number of prisoners missing healthcare appointments through no fault of their own, meaning a risk to their health and a waste of NHS time and resources – the Welsh Government must act to tackle this problem.

“The prison population in Wales is ageing, and with that comes further challenges. Now is the time for the Welsh and UK Governments to work with prisons and partners to make sure older prisoners have the care and support they need and that staff are properly trained.”