In my role as a public health practitioner I have recently been working at my local prison to support the Scottish Prison Service in the move towards a smoking ban in all Scottish prisons, which came into effect on the 30 November 2018.
Now that this work is finished, I am able to reflect on the challenges and complexities of improving prisoner health.
Prisons, like all large institutions, are complex places to work with rules and regulations that must be followed – particularly important in a prison where safety and security are paramount and where there is a rigid routine.
Now, you may think that, as all prisoners are under one roof and the health centre is in the same building, it would be easy for prisoners to attend appointments. Far from it, I soon discovered it was not always the fault of the prisoner.
Yes, some prisoners often couldn’t be bothered attending or forgot they had an appointment, partly because the days are all the same. I did offer prisoners calendars, only to be told by several in no uncertain terms that offering calendars was not even funny.
All prisoner movement relies on staff being able to escort them and, on many occasions and for a variety of reasons, there were just not enough staff.
Seeing prisoners in the halls was an option that I tried. I definitely had less DNAs and CNAs, but taking the service to prisoners does not replicate what goes on in the community. Add to that the tension and stress levels in the halls and, after about 8 months, I realised that this way of working was affecting my health, so I reverted back to the old system – after all I am not a prison officer.
I also soon realised that prisoners often have an unrealistic expectation of what health professionals, and indeed the health service, can offer.
While we have easy access to over-the-counter medication, prisoners have time to dwell on their ailments and have no choice but to seek treatment from the prison health centre for issues that the majority of us would treat ourselves.
There is no doubt that the NHS and the demands placed upon it have changed in recent years, but someone who has been in prison for even a couple of years may not realise the impact this has had.
Demands on health professionals within prisons are no different and prisoners need to be reminded that, unless it is an emergency, then waiting is what you have to do. However, I do think that more communication to prisoners about the lengths of waiting times to see the prison GP and nurses and attend hospital clinics could be passed on, otherwise prisoners tend to think they have been forgotten about and end up putting in complaints about the NHS.
With my NHS lanyard round my neck, I was very aware that I was part of an NHS that many prisoners feel has let them down and doesn’t necessarily care about them.
”I did not want to be another NHS employee who prisoners felt negatively towards”
Throughout my many prisoner interactions, I rarely heard any good words said about the NHS – both within and outside of the prison. Therefore, building up relationships and doing what I said I would do, was absolutely paramount to the success of my work and the potential for other health improvement projects.
I did not want to be another NHS employee who prisoners felt negatively towards. I will admit that not every prisoner I encountered was happy with the service I provided – far from it – but I don’t take that personally.
Prisoner health is complex but, for me, that is one of the challenges. Seeing prisoners who had smoked all their lives stop smoking before they were forced to by the ban made up for the frustration and challenges of prison working.
For many this was the first positive thing they had achieved and, who knows, it may just lead to other changes for the better.
Carole-Ann Duff is public health practitioner, NHS Grampian Public Health Directorate