Healthcare on the Inside
Posted by News Editor
Thursday, January 03, 2008
The following article appeared in the TIMES (Public Agenda) on 13th November
Elizabeth Tysoe, the head of prison health inspection, tells Jennifer Taylor that people in custody are as much a part of the local health economy as all the rest of us.
“Any prison governor who says that there aren’t any drugs in his prison is lying,” says Elizabeth Tysoe, the head of health inspection at HM Inspectorate of Prisons. Substance misuse falls under her remit, and while she says that prisons are getting better at supporting people with drug problems, “there’s still some way to go”.
Prison overcrowding is also taking its toll on the health of inmates, not least because the number of work and education places for prisoners does not rise to keep pace. This is despite evidence that suggests that having something to do has a major impact on prisoners’ mental health.
And it becomes “a bit of a sausage factory” getting new prisoners into the prison before it’s locked up at 8.30pm. When they first arrive, prisoners have a health screen to check that it’s safe for them to be there overnight. “If you’re churning 30 people through that procedure... you can bet your bottom [dollar] it’s always the man on the last bus that comes in at eight o’clock in the evening that’s got the biggest medical problems.”
The NHS began commissioning health services in prisons in 2003. The transition happened in three waves and by April last year all prisons had moved across. Money for healthcare in prisons now comes via the Department of Health and primary care trusts (PCTs) do the commissioning, except at private prisons and immigration centres.
When the commissioning function was first given to PCTs, the money was ring-fenced, but that stopped this year. The idea was that prison healthcare should be mainstreamed and that prisoners, as part of the PCT’s population, should be treated the same as everyone else. But the reality, Tysoe says, is that some places “just tick the box to say ‘yeah we do prison healthcare’ ”.
“When the NHS first took over, one of the things it had to do was a health-needs assessment to identify what it needed to commission. But an awful lot of prisons haven’t done one since 2002-03, so they are woefully out of date in terms of what healthcare is needed.”
Tysoe would like to see health-needs assessments performed every couple of years. She also wants PCTs to commission healthcare in private prisons, where many contracts are old and do not include certain services. As she points out: “Prisoners don’t choose which prison they get sent to or get moved to.”
She concedes that, given PCTs’ competing priorities, spending money on prisoners may not be popular with local people. “This is a constant dilemma, isn’t it,” she says. “Do you pay for a hip replacement for a patient or to maintain a drug addict on methadone?” She answers her own question: “The prison population is part of the local health economy. They are NHS patients just like you and I.”
One of the things Tysoe found difficult when she first started working in prison health was that the officers didn’t know what the prisoners were in for. She had come from a senior nursing post in the NHS where she knew exactly why each patient was there.
But it all became clear on a visit to an inpatient unit. “I had two prisoners, both of whom had committed fairly horrendous crimes involving children. Suddenly there was the potential for my personal prejudices to come to the fore. And I had to suddenly think, as a nurse with 20-plus years’ experience, ‘I have probably treated a paedophile, I have probably treated a thief, I have potentially treated a murderer – they just didn’t tell me’.”
And her philosophy now? “Poor healthcare isn’t part of the sentence. It doesn’t matter why they’re in.”
Born: April 8, 1962, in Isleworth, Middlesex.
Career: Qualified as a general nurse at St Bartholomew’s Hospital, London; held various nursing posts in the NHS; while in senior management posts completed a BSc in nursing and a masters degree in management; head of healthcare at HMP Woodhill; deputy, then head of health inspection at HM Inspectorate of Prisons, the first nurse to hold the post.
What she says: “Most nurses would tell you that they feel safer working in a prison than they do working in A&E or even in the NHS.”
Little-known fact: “I hate sat-nav. I prefer to rely on a map and AA route planner.”
Three out of four judges and lawyers make no checks on the qualifications of expert witnesses, whose evidence can be crucial to a finding of guilt or innocence, research suggests.
The first study of its kind shows that the training of expert witnesses to give evidence is still patchy and unregulated, creating a continuing risk of miscarriages of justice.
The research, by City University, London, comes after a High Court ruling on Friday that upheld findings of serious professional misconduct by the General Medical Council against Alan Williams, a Home Office pathologist. Dr Williams, 58, conducted post mortem examinations for both of the babies of Sally Clark, the solicitor who served three years for murdering her two sons until her conviction was quashed on appeal.
Penny Cooper, associate dean at the University, a barrister and a governor of the Expert Witnesses Institute, who conducted the research, said that nearly one in ten experts had no training at all and did not intend to undertake any. “The quality of expert evidence has been criticised in a number of recent, high-profile miscarriages of justice. This issue is inextricably linked with training, which is voluntary and unregulated,” she said.
The finding was of concern, she added, given that solicitors and barristers were involved in selecting experts and judges decide whether to permit them to give evidence or not.
“I think the court rules should be changed to impose a duty on judges and lawyers to consider the training an expert has had before allowing them to give evidence,” she said.
The High Court ruling on Dr Williams was welcomed by the GMC.
Source: The Times
The following article by Mick Hime appeared in the Times on the 13th November 2007 under the title "Come over here, kiddies, and listen to a scary story"
If you're an octogenarian Nazi war crimes suspect or Chilean dictator accused of atrocities, you can escape trial and jail in Britain by arguing you are too old and it was all a long time ago. But not if you are an 80-year-old Roman Catholic monk accused of touching some schoolboys more than 30 years ago.
William Manahan, former Abbot of Buckfast Abbey in Devon, has been jailed for 15 months after pleading guilty to eight charges of sexually assaulting boys at the Abbey prep school in the 1970s. He was said to have touched boys with “angelic faces” when they sat on his lap at the front of Latin class, and while he watched television with them or gave them piggy-backs. He also gave them sweets.
As a godless Marxist and a caring parent I hold no brief for the Catholic Church or any pervy priests. But the way this old man has been made an example of, imprisoned and branded “the Beast of Buckfast” decades later, for offences near the lowest point of the scale, suggests somebody is guilty of an unhealthy obsession with child abuse.
Monahan was caught by the new policing practice of trawling for victims of abuse. After an allegation of serious sexual abuse against another monk at the school � since jailed for ten years � the authorities sent out 700 questionnaires cold-calling former pupils about their experiences. Monahan's name was mentioned, and he ended up behind bars.
If the police have so much time on their hands, perhaps they will now ask all school pupils of the Seventies if any teacher ever touched them? The results could also give any underemployed judges and jailers something to do.
But who benefits from dredging up long-forgotten episodes for public display and titillation? The effect on the boys involved � now men in their forties � is questionable. The wider impact on society seems worse. The judge, John Neligan, said that he jailed Monahan because “the message must go out” to “those in a position of trust in schools” today that they face prison if they “prey sexually on the children in their care”. Leaving aside the issue of whether the courts should be used, showtrial style, to send “the message” to others, when that message raises the spectre of sexual predators in our schools it can only do harm.
The notion that our children may be menaced by groping teachers today is as far removed from reality as Buckfast Abbey. The real problem is that everybody is already so scared of allegations of abuse that almost no teacher, however well meaning, would dare to sit a child on his or her knee, let alone give them a piggy back. Such fear and mistrust of adults pose a far bigger risk to growing up in a civilised society.
Or do we want to lock 'em all up and throw away the key? The children, that is.
The following article by Mangus Limklater appeared in the Times on 28th November (here)
Make 'that bastard verdict' legitimate
'Not proven' , as used in Scottish courts, is a third option for jurors after guilty and not guilty. It should be adopted in England
A drunken brawl, a stabbing, a man falls dead, pierced through the stomach as he attempts to prevent a violent attack. The assailant is arrested, charged and brought to trial. The jury is required to reach a simple verdict. Has enough evidence been produced in court to convict the accused, or not?
So far so familiar. But the date is May 1728, and the whole course of judicial history is about to be rewritten. The dead man is the Earl of Strathmore, a Scottish grandee, his assailant one James Carnegie, and the defence is that there had been no intent to kill – the Earl was simply in the wrong place at the wrong time. “I had the misfortune to be mortally drunk, for which I beg God’s pardon,” Carnegie told the court.
Until that date, under Scots law, the verdicts “guilty” or “not guilty” had been unknown. Instead, a jury determined whether the case was “proven” or “not proven” – resting its decision entirely on evidence heard in court. But in the Strathmore case, a flamboyant lawyer, Robert Dundas, urged the jury to clear his client completely. To everyone’s surprise, it pronounced Carnegie “not guilty,” thus introducing a third verdict into the legal system. As the not guilty verdict became more widely used, “proven” was replaced by “guilty” – but the third option was retained. To this day, anyone in Scotland accused of a crime has the privilege of being found guilty, not guilty, or, if there remains some uncertainty about the evidence, “not proven” – effectively acquitted.
The “not proven” verdict – unknown in English law – has been controversial ever since. Sir Walter Scott, writer and lawyer, described it as “that bastard verdict” after a woman he had been prosecuting for poisoning her servant was let off by the jury, who found the case not proven. “All I can say,” snarled Scott, “is that if that woman was my wife, I should take good care to be my own cook.”
Now there are renewed attempts to scrap it altogether, with the Scottish Nationalist government considering strong pleas from victims’ groups that the bastard verdict should be abolished because it offers juries a “get-out” clause and allows guilty offenders to escape the retribution of the law.
In fact, the case for a “not proven” verdict has grown, not shrunk, in recent years. Not only should it be retained in Scotland, there are strong grounds for the English legal system to embrace it too. If justice means defending the innocent from wrongful conviction as well as representing the victim of crime, then allowing a jury to decide that there remains an element of doubt about the prosecution case would be of enormous benefit.
The case against Barry George, convicted of the murder of Jill Dando on doubtful scientific evidence, could have been set aside by a jury deciding that neither side had definitively proved its case.
Stefan Kiszko, who served 16 years for a murder he never committed, and who died a year after his release, might have been spared his ordeal. Other cases of wrongful conviction stretch back over the years – the Birmingham Six, the Guildford Four, the Carl Bridgewater case, Judith Ward, accused of a series of bombings in the 1970s, Angela Canning, convicted on the faulty evidence of a pathologist, Andrew Adams, wrongly convicted of the murder of a retired teacher, and whose sentence was finally quashed in January. In each case, a jury, offered an alternative to the unequivocal extremes of guilt or innocence, might have chosen a third way and prevented a gross miscarriage of justice.
Juries in Scotland use the third verdict infrequently, but effectively. In 2005-2006, the