Head of prison healthcare Richard Knowles, left, and unit charge nurse Peter Gilliam in one of the end-of-life care rooms. Picture by Laura Holme.
WIGHT LIVING AS ONE of the few prisons in the country with its own hospital, HMP IW is leading the way in providing good quality healthcare.
An inspection earlier this year by health watchdog, the Care Quality Commission (CQC), found services were meeting all essential standards of quality and safety, and prisoners were treated with respect.
Many prisoners had nothing but praise for the healthcare on offer, provided by the IW NHS Trust and that meets 28 of 31 performance targets, and they told inspectors the services were the best they had experienced.
There was considerable praise for mental health services, particularly from prisoners who received swift treatment when they had started to self harm, including group and cognitive behaviour therapy, motivational sessions and drug treatment.
All good news, right?
In reality it’s not that simple, partly because prison healthcare is such a controversial issue.
As head of prison healthcare Richard Knowles explained: "The truth is some people think prisoners don’t deserve good quality healthcare. But prisoners are punished by being deprived of their liberty, not by removing everything else that makes them a human being. Everyone deserves access to good healthcare."
It is also better for society in the long term — healthy prisoners are less likely to re-offend on release, and less likely to burden the NHS.
"It’s a very political argument," said Richard, who has worked in NHS mental health services for some 18 years and is passionate about championing the rights of the underdog. And, as he points out, there are few groups as socially isolated and excluded as prisoners.
"From a healthcare perspective we try not to concern ourselves with why the prisoners are here, or it would be difficult to do our job. There have been occasions where I’ve looked through a prisoner’s offending history and it has made me feel differently about him, but the key thing is not to let it affect the care you provide," he said.
"It’s certainly not a job for everyone."
HMP IW currently houses around 1,700 prisoners, and around 1,000 are in receipt of some sort of healthcare at any one time. They are a far from healthy bunch, and many have long-term health conditions, drug and alcohol addictions and mental health issues.
The prison population at HMP IW is an ageing one, and access to exercise is largely limited.
The 18-bed prison hospital, opened at the Albany site three years ago, is able to deal with the bulk of healthcare complaints, from chronic long-term conditions, including diabetes, asthma and heart conditions, to physical injuries and mental health problems.
It even provides end-of-life care to terminally ill prisoners and has a serene garden, created by prisoners with a King’s Fund grant.
It has its own pharmacy — in fact, it is the only prison hospital in the country to have an automated dispensing machine, similar to the 'pharmacy robot’ at St Mary’s Hospital — and employs around 15 staff.
The upshot is that only patients who need emergency treatment or specialist care are transferred across the road to St Mary’s Hospital and this, as Richard explains, is why the prison hospital is so beneficial.
"We have significantly reduced the number of patients going to St Mary’s, and those who are transferred can be brought back sooner. That’s good news for the public purse, since it costs about £1,000 a day for a patient under escort to be at St Mary’s, and better from a security perspective, because any time spent out of prison increases the chance of an escape," he said.
The facilities at HMP IW extend beyond the hospital, or 'inpatient healthcare unit’ to use the official description.
Each site — Albany, Parkhurst and Camp Hill — also has its own health centre, providing GP and other health clinics, drug and alcohol treatment, treatment for minor injuries and dental care. It is where prisoners go for their prescriptions. Many take their medication in front of staff, in a bid to reduce the trading of painkiller and opiate-type drugs among prisoners.
GPs hold clinics most days, while dentist and opticians visit once a month.
One shortcoming picked up by the CQC was long waiting times for these services and some prisoners complained of delays of between two weeks and three months to see a doctor.
"The delays can be frustrating but we are commissioned to provide a certain level of service and it wouldn’t be practical or cost effective to get a dentist in every day.
"There are limitations but, on the whole, I think the prisoners are happy with services," said Peter Gilliam, who transferred from St Mary’s in May and is now charge nurse at the prison hospital.
As a nurse at the coal face of prison healthcare, he has a unique perspective on what the job involves.
"It’s a really rewarding job, but challenging as well. Obviously, the prison priorities are security and discipline but to us these people are patients, not prisoners. These are bedrooms, not cells. It’s an unusual situation for a nurse, to work within the prison system, and often you don’t want to know their crimes. I’m not here to judge," he said.
"You never forget they are prisoners though. I’ve seen prisoners inflict horrible injuries on each other, and in my first week I had this guy tell me: 'My name is John today, John likes to hurt people,’ and I did wonder what I’d let myself in for. But at least here you know what to expect, unlike A&E on a Saturday night."
Richard and Peter have learnt to embrace the challenges of their job, and are convinced the hospital can be a model for prisons across the country. However, the day-to-day care of prisoners remains their primary concern.
"It’s the little things that make a difference, like ensuring the nurses can access patients 24 hours a day," said Richard.
"That’s something you would take for granted in a normal hospital, but it’s something we had to work for. And when you’re talking about someone receiving end of life care, who will die within weeks, it’s those things that count."