What is happening to healthcare in Northern Ireland prisons?
The NI Prison Service has been in the spotlight recently over its handling of serious incidents of self-harm and the potential for overdoses to occur through the use of prescription medication. Dr Michelle Butler highlights that less attention has been paid to the role of the health service in these events despite significant failings on their part and argues that a closer look at the role of our health service is required if we are to properly hold these organisations to account for their shortcomings.
In the past month, two Prisoner Ombudsman reports have identified significant shortcomings in prison healthcare In Northern Ireland, concluding that the healthcare received in prison was worse than that available in the community. This is very worrying for a number of reasons.
Firstly, those in prison tend to have higher mental health needs and substance misuse issues than the general population. They frequently present with both mental health problems and substance misuse issues, adding to the difficulties involved in managing and addressing their needs while in prison. Often these mental health and substance misuse issues are behind the illegal behaviour leading to their imprisonment. If unaddressed, these needs can result in continued re-offending. For these reasons, an efficient and effective healthcare service is essential in prison.
Secondly, concerns about the quality of healthcare in UK prisons led to responsibility for these services being transferred to the NHS. It is internationally accepted that those in prison have a right to the same standard of healthcare as those in the community. This is known as the ‘principle of equivalence’ or ‘equivalence of care’. The UK government committed itself to ensuring that those in prison receive the same standard of healthcare and mental health services as those in the community and sought to achieve this by transferring responsibility for prison healthcare to the NHS.
In Northern Ireland, the then Department for Health, Social Services and Public Health took over responsibility for prison healthcare from the Northern Ireland Prison Service in 2008, although the prison service continued to employ some healthcare staff until 2012. The South Eastern Health and Social Care Trust (SEHSCT) was given lead responsibility in this area and oversees the delivery of healthcare and mental health services in prisons in Northern Ireland.
One of the reasons why the two recent Prisoner Ombudsman reports are so concerning is because they have found that the standard of healthcare and mental health services those in prison receive continues to be poorer than that available within the community. Moreover, these reports concluded that these healthcare failings contributed to the serious self-harm incident of Sean Lynch in 2014 and the death in custody of Patrick Kelly in 2015. This raises questions about the extent to which the transfer of responsibility for these services to the now renamed Department of Health and SEHSCT has delivered on the hoped-for improvement in prison healthcare.
Thirdly, while there has been considerable media coverage of the role of the prison and prison staff in these cases, less attention has been made to the role of the SEHSCT and their staff. This is a serious omission as recent Criminal Justice Inspectorate reports have continued to express significant concern about aspects of prison healthcare.
In its 2015 inspection of Maghaberry prison, the Criminal Justice Inspectorate said that healthcare provision had deteriorated since 2012 and drew attention to staffing uses, poor clinical governance as well as delays and serious problems in how medication was being managed. Additionally, as was widely publicised at the time, they also expressed serious concerns about the operation of Maghaberry prison and called for the Northern Ireland Prison Service to take immediate action to stabilise the regime.
In its most recent inspection of Maghaberry prison in 2016, the Criminal Justice Inspectorate stated that while some aspects of physical healthcare had improved, mental health care had deteriorated further and urgent action was needed by the SEHSCT to address this issue. They also recommended the SEHSCT review their decision to close an inpatient facility within the prison, as they were worried about how the healthcare of men with significant physical and mental health care needs would be met. These findings are concerning because they suggest that some aspects of healthcare, particularly mental health services, may actually be worsening.
In discussing the serious self-harm incident of Sean Lynch with the Committee for Justice on 6 October 2016, the Prisoner Ombudsman reported that two hospitals in two different Health and Social Care Trust areas had treated Sean Lynch less favourably compared to ordinary members of the public. This again raises questions about the extent to which those imprisoned are receiving the same standard of healthcare as those in the community and suggests that the Health and Social Care Trusts are failing to adhere to the ‘principle of equivalence’ in their treatment of those in prison. The Prisoner Ombudsman also raised wider questions about why people with serious mental health needs are being sent to prison when they may need secure psychiatric care. Similar concerns have been expressed by Stephen Davis, the Governor of Maghaberry Prison when talking to the BBC on the 13 October 2016.
During the Committee for Justice meeting, it was stated that the SEHSCT were now considering the case of Sean Lynch to be a ‘landmark’ case. Yet, whether it will become a landmark case for the SEHSCT and Department of Health will depend on the actions they take to improve prison healthcare. The decision by the SEHSCT to not appear before the Committee for Justice on 6 October 2016 to discuss the case of Sean Lynch is therefore disappointing.
Consequently, the Health and Social Care Trusts and the Northern Ireland Prison Service are BOTH being asked to learn from past mistakes. For this reason, it is important that we focus on the performance of the Health and Social Care Trusts, in particular the SEHSCT, in addition to the Northern Ireland Prison Service, when assessing the provision of healthcare in Northern Ireland prisons.
Article originally appeared on the RightsNI Blog.