Progress in the
Penal System (PIPS)

12: Access to healthcare services

Standard 12:

The healthcare needs of individual prisoners are met. Every prisoner has access to healthcare that goes beyond the ‘equivalence of care’ principle, with a full range of preventative services and continuity of healthcare into the community.

Rationale:

The World Health Organisation [320] outlines a clear rationale for why there should be political support for good prison health:

(i.) good prison health is important to good public health
(ii.) good public health will make good use of the opportunities presented by prisons
(iii.) prisons can contribute to the health of communities by improving the health of some of the most disadvantaged people in society.

Transfer of healthcare to ministries of health from prison services is viewed as a principle of good governance. It is linked with many benefits: independence of medical judgement; building the capacity of independent professionals to advocate for public health measures; better trust between prisoner and healthcare professionals; and continuity of care for prisoners inside and outside prison. [321]

Current context:

Prisoner healthcare in Ireland is currently managed by the Irish Prison Service. In 2016 the Inspector of Prisons published a review on healthcare in Irish prisons recommending the transfer of the provision of healthcare from the Irish Prison Service to the Health Service Executive, as well as recommending that a health needs assessment be undertaken and published for the prison population in each prison. [322] This report was welcomed by the Tánaiste at the time of its publication in which she stated that the “report made a number of timely recommendations regarding the provision of healthcare in prisons.” [323] However these recommendations have yet to see visible progress.

Indicators for Standard:

Indicators for Standard 12

Indicator S12.1: Responsibility for prisoner healthcare moving to the Health Service Executive (HSE), with independent inspections by the Health Information and Quality Authority (HIQA): This has not been delivered upon. While the Terms of Reference of a review of healthcare (recommended by the late Inspector of Prisons in 2016 [324] ) were agreed upon between the Department of Justice and Equality and the Department of Health, the review of healthcare will not be completed until Autumn 2018. [325] The Irish Prison Service appointed an Executive Clinical Lead during summer 2018. [326]

Indicator S12.2: Publication of an annual report on prison medical services as recommended by the CPT: There is no annual report on prison medical services or inclusion of data on prison medical services in any publication, including the Irish Prison Service’s Annual Report.

Progressive Practice:

Prison Healthcare Governance in Other Jurisdictions

In 2011, Scotland transferred governance of healthcare in prisons from the Scottish Prison Service to the National Health Service. [327] The two key priorities for Scotland were (i) to ensure the principle of equivalence of care and (ii) to tackle health inequalities. Success factors associated with the transfer in Scotland included strong leadership by the National Health Service and the creation of a National Memorandum of Understanding between the Scottish Prison Service and the National Health Service in terms of defining roles and responsibilities. [328] Prison healthcare inspections are undertaken by Healthcare Improvement Scotland. Complaints are the responsibility of the National Health Service. If not satisfied with the outcome of the complaint, a prisoner can take the complaint to the Scottish Public Services Ombudsman. [329] Healthcare in prisons is also managed by the Ministry of Health in Norway [330] and in France since 1994. [331]

Special Post Boxes to Require Medical Consultations, France

Following a recommendation by the French National Preventative Mechanism (NPM), the majority of prisoners have access to special post boxes where they can request medical consultations confidentially, with only medical staff having permission to open boxes on a daily basis. [332]

Actions required:

Action 12.1: The Irish Prison Service should under-take a health needs assessment of the prison population and a staffing analysis as recommended by the Inspector of Prisons [333] and publish these findings by end of 2018.
Action 12.2: The Department of Justice and Equality and the Department of Health should complete and publish the agreed review examining the feasibility of transferring healthcare services in prisons to the Department of Health by end of 2018.

References:

IPRT Irish Penal Reform Trust

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