Prison healthcare in England and Wales is in perpetual crisis
BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q562 (Published 11 March 2024) Cite this as: BMJ 2024;384:q562
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Dear Editor.
I fear that McLintock and Sheard are seriously understating the unpopularity of medical work in prisons when they say that "Prison healthcare careers are often considered unappealing because of negative preconceptions". Around 2000, after some Home Office staff attended one of the international addiction conferences organised by the Stapleford Trust, I was invited to set up a model treatment service for prisoners who misused alcohol and other drugs. The budget was extremely generous and we offered even recently qualified doctors an annual salary of £69,000 for a five-day, 9-to-5 week. It would have been an ideal one-year post for someone revising for specialist exams or wanting a well-paid break from their usual work but only two people applied. Only one actually appeared for interview.
Fortunately, through some international contacts in addiction treatment, I was able to recruit a doctor with both specialist knowledge and administrative ability. They quickly attracted recently qualified Spanish doctors keen to perfect their English while earning about three times what they would have earned in Spain and programmes were soon set up in at least two prisons. I don't know if they still exist but Google tells me their current annual equivalent would be about £105,000, a bit less than three times an FY2 salary.
Psychiatry was once an unpopular speciality but retirement, until recently, on a full NHS pension at 55 increased its appeal. GPs were once reluctant to prescribe oral contraceptives but extra payment quickly removed their reservations. However, the financial incentives to remedy the shortage of prison doctors will clearly have to be very large. I enjoyed my occasional prison visits to do medical reports and my work with offenders with alcoholism [1] but I would never have wanted to make it a full-time career.
REFERENCE.
1. Brewer C, Smith J. Probation-linked supervised disulfiram in the treatment of habitual drunken offenders: results of a pilot study. British Medical Journal 1983;287:1282-3
Competing interests: No competing interests
Re: Prison healthcare in England and Wales is in perpetual crisis
Dear Editor
There is another problem with prisoner healthcare, what happens when released.
CRI (now CGL) was a large charity commissioned to provide community drug services when I worked for them 2009-10.
Prisoners were usually released mid-late Friday afternoon. Information about their release plus medical and medication often came as a late poor quality fax or not at all. There was very little time to arrange accommodation, support and medication.
Sometimes the released prisoner ended up sleeping rough without medication, encouraging a relapse straight back into crime.
I was told that repeated requests to the Prison Service by multiple organisations for a mid-week release with earlier notice were not acted on. An example of the organisations was the CRI charity employing about 1,400 working in 250 projects then.
This was 15 years ago when the whole situation was not in the current crisis.
Competing interests: No competing interests