Cooperation between the prison medical service and the NHS: a conversation.

Abstract

Listen

Translate article

A great deal has happened with prison health care since we began publishing our series two years ago. ' Dr John Kilgour had then just taken over as director of the prison medical service, and he has now had a chance to make his presence felt. Twenty six new doctors have been recruited, and the service is almost up to full strength.2 A plan has been launched to increase the number of fully trained nurses. The Chief Inspector of Prisons has published a report on preventing suicide in prisons and been trumped by a more radical one from Scotland.34 The physical state of Holloway Prison's psychiatric wing has been described by the Home Secretary as wholly unsatisfactory, and plans have been made to resite and reorganise it.5 Plans have been produced for improving the service offered by Grendon, the psychiatric prison.6 And, perhaps most important of all, Mrs Ren?e Short's House of Commons Select Committee for Social Services has begun an investigation into the prison medical service: huge amounts of written evidence have been received, and the committee is now visiting prisons and taking oral evidence. All of these developments might be seen as steps forward but might be stymied by the continuing problem of overcrowding. Since our articles were published the number of people has risen by 4000?to 48000. Two years ago the Home Office was predicting that this figure would not be reached until the end of the decade. The 16 new prisons that are being built will help but not solve the problem. To make a further contribution to this continuing debate and throw a little more grist into Mrs Short's mill we organised a small meeting in October to discuss cooperation between the prison medical service and the National Health Service, and the rest of this article is a report on the conversation. Undoubtedly the select committee will discuss the possibilities that the prison medical service might either be absorbed into the NHS or that a special health authority directly responsible to the Department of Health and Social Security might be created to oversee the medical services in all secure institutions (including the special hospitals), but the arguments for and against these schemes have been well rehearsed,1 and we did not want to repeat them. Present at the meeting were: Mr Brian Edwards, the general manager of Trent Regional Health Authority; Professor John Gunn, professor of forensic psychiatry at the Institute of Psychiatry; Dr John Kilgour, director of the prison medical service; and Dr Richard Smith, assistant editor of the BMJ and author of our series on prison health care. The article has been written by Dr Smith and approved by the other three. Aptly and ironically we held our discussions at the Caf? Royal, a regular haunt of Oscar Wilde, a man who did not enjoy his stay in either Pen ton ville or Reading prisons.