HIV and Hepatitis in UK Prisons - Prison Reform Trust

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HIV and hepatitis in prisons: addressing prisoners’ healthcare needs 5 3. Prisoners’ health: whose responsibility England The Prison Service was formerly responsible for prison healthcare. But following the recent development of a partnership with the NHS, responsibility for ensuring that prisoners receive adequate healthcare will lie with the Department of Health. Responsibility for the commissioning of health services in prison is being transferred, in three phases from 2004-2006, to the local Primary Care Trusts (PCTs). By April 2006, local PCTs will hold responsibility for healthcare in all publicly run prisons in England. However, general health services in the privately contracted prisons in England are part of the overall contract with the Home Office, and arrangements vary. The transfer means that prisoners are to be treated as temporary residents of the PCT in which the prison is located.The hallmark of the change is to describe the people under the responsibility of prison healthcare as patients not prisoners 2 . PCTs are responsible for commissioning prison health services and, at least for the next three years, can provide these services themselves 3 . Each PCT has to agree the specifications and arrangements with the governor of each prison.The prison governors facilitate the delivery of healthcare within their establishments and they continue to be accountable for clinical governance. The transfer of responsibilities is very likely to bring significant challenges. Its impact will depend on the priority given to prison health and the funds allocated, but also on the extent to which the PCTs can achieve healthcare in prisons equivalent to that provided in the general community.The transfer also means that NHS providers will have to develop their understanding of the cultural norms of the prison environment in order to respond to prisoners’ needs whilst adapting their services, care and support to the prison regime and its operational constraints. However, even in prison, healthcare staff should treat prisoners as patients and provide the same standard of care as that provided to patients in the general community. In turn, the prison will need to grapple with new concepts such as patient choice and involvement. Wales, Scotland, and Northern Ireland Healthcare services in Wales's four prisons are funded by the National Assembly for Wales, and are commissioned by the four local health boards in which the prisons are located: Cardiff, Swansea, Bridgend and Monmouthshire. In Scotland, the responsibility for healthcare in prisons remains with the Scottish Prison Service, an independent agency working closely with the Scottish Executive. Healthcare services in Northern Ireland’s three prisons are jointly funded and commissioned by the Department of Health, Social Services & Public Safety and the Northern Ireland Prison Service. Commissioning of health services in Northern Ireland prisons is through a range of contracts with Health Service providers. 2 The impetus for the change came from a Discussion Paper published by the Chief Inspector of Prisons,‘Patient or Prisoner A new strategy for health care in prisons’ (1996). 3 The Government White Paper 'Commissioning a Patient-Led NHS' suggests that from the end of 2008 PCTs will be limited to a commissioning function. See the Conclusion of this briefing paper.
6 HIV and hepatitis in prisons: addressing prisoners’ healthcare needs 4. HIV and Hepatitis C in the UK There are significantly higher rates of HIV and hepatitis C in prisons than in the general population. HIV in UK prisons Across the world, rates of HIV are higher in prisons than amongst the wider population, and the UK is no exception. In 1997 the Department of Health conducted an anonymous serosurvey of HIV in prisons in England and Wales. The survey established that there was a prevalence of 0.3 per cent amongst adult male prisoners and 1.2 per cent amongst adult female prisoners 4 . A survey in Scottish prisons also in 1997 found HIV prevalence of 0.3 per cent amongst adult male prisoners and 0.6 per cent amongst adult women prisoners 5 . As can be seen from the table below of 2003 HIV prevalence rates, even if these 1997 prison prevalence rates have remained unchanged, they would continue to be significantly higher than those of the UK population generally. But given the significant increases in HIV prevalence since 1997 (new diagnoses are now at over 7,000 a year, compared with 2,750 in 1997), it could well be the case that prison prevalence rates are now higher than those recorded eight years ago. Table: HIV Prevalence rates in the UK 2003 (source: Health Protection Agency) Prevalence Nation(s) No. PLWH Prevalence rate Prevalence men women England and Wales 50,000 0.096% 0.13% 0.055% Scotland 2,600 0.043% 0.063% 0.031% N Ireland 260 0.015% - - Hepatitis C in UK prisons The Hepatitis C Action Plan for England (2004) estimates the numbers in England chronically infected with hepatitis C as approximately 200,000, or 0.4 per cent of the population. 6 Others question this figure, citing estimates made by hepatologists as high as 500,000.The Hepatitis C proposed Action Plan in Scotland (2005) provides estimates of prevalence for 2004 at 37,500 chronically infected or 0.7 per cent of the population. 7 Only 38,000 of those infected by hepatitis C in England are diagnosed and according to a recent report by the Hepatitis C Trust the UK diagnoses and treats a far lower proportion of those with hepatitis C than France, Germany, Italy or Spain. Early diagnosis and treatment can cure between 60 per cent and 80 per cent of those treated. Without diagnosis and treatment, about a third of those infected with chronic hepatitis C will go on to develop serious liver disease, which can prove fatal without a liver transplant. In addition, those undiagnosed are not able to make the lifestyle decisions which could reduce liver damage and prevent further onward transmission of the virus. It is also the case that hepatitis C rates are higher in prisons than in the general population. The same anonymous serosurvey in England and Wales cited above found that the prevalence of hepatitis C was nine per cent amongst adult male prisoners and 11 per cent amongst adult female prisoners. 4 ‘Prevalence of HIV in England and Wales 1997' para.33 Department of Health 1998; see also Weild, Gill et al 'Prevalence of HIV, hepatitis B, and hepatitis C antibodies in prisoners in England and Wales: a national survey' Communicable Disease and Public Health Vol 3 No 2 June 2000 5 Scottish Prison Service Nursing Service Review 2003 section 2.6 www.sps.gov.uk 6 Hepatitis C Action Plan for England para.1.1 July 2004 Department of Health 7 Hepatitis C Proposed Action Plan for Scotland 2005 Scottish Executive p.14
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HIV and Hepatitis in UK Prisons - Prison Reform Trust

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