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 But an awful lot of prisons haven’t done one since 2002-03, so they are woefully out of date in terms of what healthcare is needed.”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.”