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Prisons: Healthcare

My Lords, my noble and professional friend Lord Chan is to be congratulated on continuing what has become a worthy tradition in your Lordships’ House of keeping conditions in prison under scrutiny. I very much welcome the decision to bring the prison medical services under the wing of the National Health Service and, unlike him, I can detect an improvement in morale—not just a glimmer of hope. Certainly, that has not happened in some prisons; the improvement is patchy and it is early days yet. In our debate in October on suicides in prison, many speakers brought home the fact that the prison population has an enormous burden of ill health, mostly of psycho-social origin, arising from the deprived background of most prisoners. It was also made clear in that debate that many mentally ill prisoners should not be in prison at all, but receiving treatment in mental hospitals or in the community. One reason for this is that mental hospitals are as overcrowded as prisons, if not more so. It is also simpler for judges to hand down a prison sentence than to go through the longer process of obtaining social and psychiatric reports and arranging a suitable placement. Perhaps there is a case for a handbook or set of guidelines for judges and magistrates that would set out the range of alternatives to prison that are available for sentencing miscreants who have mental health problems. As a former general practitioner, I am concerned that most prisoners have not been receiving the whole person healthcare that they need. Many former prison medical officers did not receive the vocational training that all GPs now receive before they can become a principal in the NHS. It should be a goal of all PCTs, which now commission and provide healthcare, that they should recruit doctors with vocational training in general practice. Indeed, every citizen in the UK, whether in or out of prison, has the right to receive healthcare from a competent general practitioner. At the moment, however, it seems that PCTs find it difficult to recruit enough doctors with even basic qualifications to staff the front line of the prison health service. This makes the task of the ““in reach”” psychiatrists much more difficult—since they are burdened with less severe cases, well within the competence of a trained GP—and have to waste their time sorting through a mass of complaints, many of which are not appropriate for them. I could give an example of good practice in Holloway Prison, but unfortunately time does not allow for that. One way to improve recruitment to the prison health service is to create a career structure in prison healthcare, recognising the particular skills needed, starting with training for the Diploma in Prison Medicine, which was established by the three colleges of general practitioners, physicians and psychiatrists as long ago as 1996. There is no time to spell that out in detail, but I think it is the way forward. The Trent Deanery, together with the three colleges, has just established a Masters degree in primary healthcare in relation to secure environments. Another issue that I wish to explore concerns the effect of nutrition on prisoner behaviour. I used to be a sceptic of claims made in this area, but a careful study in 1997 by Bernard Gesch, who was once a probation officer and works with Professor John Stein in the physiology department of Oxford University, has changed my mind. That study was supported by Natural Justice, an organisation of which the noble Lord, Lord Ramsbotham, is a founder member. In a young adult prison, Gesch gave a capsule containing a cocktail of vitamins, minerals and essential fatty acids to half of a group of 172 prisoners. The other half received an identical capsule containing a placebo, and the trial was conducted using strict double-blind methodology. Analysis showed that those receiving the supplement received significantly fewer ““governor reports”” of serious disciplinary infringements compared with the placebo group. Subsequent to that, in another carefully controlled study by Dr Alexander Richardson in the same Oxford unit, the behaviour of children with attention deficit disorder was shown to improve markedly when given essential fatty acid supplements. Studies in other countries have given similar results—particularly those of Professor Hibbeln in the United States. There are plenty of anecdotal reports of improved concentration and behaviour in schoolchildren on improved diets—one has only to look at the Jamie Oliver experiment, for example. A good diet should contain all the essential nutrients that were contained in the active capsule in the Gesch trial. It is possible, therefore, to conclude that the diet normally consumed by the prisoners in the study was deficient and that it probably contributed to incidents of violent and aggressive behaviour. Although prison food is supposed to have improved in recent years, the food consumed by prisoners is probably still deficient in fruit, vegetables, complex carbohydrates and food rich in essential fatty acids. Will the Government facilitate further studies of prisoners’ dietary intake and behaviour? If the results that I have outlined are confirmed and prisoner nutrition has improved, prisons should be easier to manage and reoffending may well be reduced. Bernard Gesch is fully aware that the results of his study need to be confirmed; other countries in Europe are already taking this forward, and I hope very much that we will shortly be doing the same.