Vulnerable Adults: Tackling Health Inequalities
Thursday 21 August
John Porter
 National Lead Nurse for Prisoner Healthcare
 Working within HIS - responsibility to NHS Director,
Health and Justice
 Provide support and guidance to NHS Leads
responsible for Prisoner Healthcare through the
National Prisoner Healthcare Network
 National Prisoner Healthcare Network
 Health Profile of Prisoner
 2013 Prisoner Survey Results
 Imprisonment Rates
 Alternatives to prison
 Opportunities and challenges
 Going Forward
National Prisoner Healthcare Network
 Responsibility for primary healthcare in prison transferred from
SPS to NHS Boards in November 2011.
 NPHN set up in November 2011 to coincide with formal transfer
 Membership included healthcare leads from each of the NHS
Boards with representatives from SPS and other agencies
including the third sector.
 Purpose. Initially to assist the transition of prisoner healthcare
from SPS to NHS by providing a strategic and national
coordinating role to support the delivery of a high quality, safe,
effective and consistent services to prisoners
National Prisoner Healthcare Network
 NPHN Workplan. Identified a number of key priority workstreams including:
Mental Health
Substance Misuse
Information Governance
Expert Advisory Group for Medicines
 2 year review
 Appointment of New NHS Director, Health and Justice.
Senior appointment to improve health outcomes of offenders with commitment
to supporting the Scottish Government Health Inequalities agenda.
Scottish Inequalities Agenda
 The reality in Scotland is that there is a significant
proportion of the population with poor health.
 Despite improvements we remain the “Poor man of
Europe” particularly in respect of those from deprived areas
 A NES publication “Bridging the Gap” quotes;
 “In Scotland men in the 10% of 'least deprived areas' can
expect on average to reach an age of 81.1 years, while men in
the 10% most deprived areas who could expect to live on
average 67.7 years, a gap of more than 13 years.”
Health Profile of Prisoner
 Prisoners are likely to come from a particularly
vulnerable group in society and face a wide range of
health issues that are often associated with their
offending behaviour.
 A strong indication of their life and health
circumstances can be drawn from the prisoner survey
the most recent being 2013
Health prevalence comparator
Prevalence on admission to Prison
Alcohol problems
Illegal Drug Use
Smoking Rates
Hepatitis C
Severe dental decay
29% male/
42% female
9% male/
36% female
Personality disorders
66% approx
Prevalence in the Community
10% male/3% female
5% approx
5% approx
Prisoner healthcare in context (drawn
from 2013 Prisoner Survey)
 The survey is conducted very two years and is sent to all those in prison
across Scotland. The questions asked most pertinent to the health and
lifestyle of prisoners has been analysed and a short precis of the key
themes shown;
 60 % of prisoners in all Scottish prisons completed the survey
 Information was sought in relation to alcohol consumption,
substance misuse, mental well being and attitudes to support to
address their offending behaviour.
 The highest responses were from HMP Barlinnie and HMP
Inverness however the lowest was from HMYOI Polmont and the
Open Estate – perhaps suggesting that they are most difficult to
engage with
Prisoner Survey statistics
 Impact of alcohol on offending behaviour
 Drunk at the time of committing offence
45% of all prisoners
50% of female prisoners
68% of young offenders
 The more often an offender has been re-imprisoned the
greater the association with alcohol
Prisoner Survey statistics
 Impact of being in “Care” as a child
 30% of all female prisoners were in care as children
 30% of young offenders were in care as a child
 Almost 2/3 of those who had been in care had witnessed
violence as a child from a parent or a carer
Prisoner Survey statistics
 Health profile of older prisoners
 Over 1/3 said they had a disability
 Nearly ½ said they had a long term illness
 Nearly 2/3 said they were smokers
Prisoner Survey statistics
 Looking at the custodial history
 Analysis of the results showed that there was a
correlation between the chaotic lifestyles of the
prisoners, their alcohol and substance abuse and their
offending behaviour
 Substances misuse increased the more often they were
in prison however 2/3 said they would respond to
assistance if it was offered
Prisoner Survey Statistics
 Young Offenders - top priority for SPS
 Most hopeful results
 Important to engage with this group and help them
reach their aspirations not to reoffend
 90% said they thought they would have a job, a partner
and a house 2 years after release
 60% said they would be free from offending 2 years after
Prisoner Survey statistics
 Helping them to meet their desire to break their offending
behaviour need to be aware that;
 1/5 had difficulty reading and writing
 ½ were under the influence of alcohol or drugs at the time of
their offence
 1/3 were in care as children
 They expressed a desire to learn through sports, practical
workshops and the internet
Imprisonment Rate
Scotland has one of the highest imprisonment rates in
Western Europe. Overcrowding, prisoner movement,
the prison regime, the relatively short time that
someone spends in prison, remain very challenging
issues. This creates huge challenges in relation to the
detection and assessment of health problems and
needs, and the delivery of integrated care, both within
prison and in the transition between prison and the
Imprisonment rate comparator
Incarceration rate per 100,000 population
Prisons - model
 It could be argued that Prisons should be used for minority
of cases for public safety
 Considerable financial resources spent sending people to
prison - no evidence on reducing offending
 Potentially by shifting resources upstream and making
investment more productive – to concentrate on
preventative / community development / early years
 I look forward to further discussion on this throughout the
 Healthcare provided in prisons can be the first
opportunity to receive access to health care services
 The transfer of prisoner healthcare to NHS Boards
places greater obligation on them to provide
equivalent healthcare.
 Greater degree of collaborative working and greater
understanding between those responsible for justice
and those responsible for health
 Scottish Government commitment to the Reducing
Reoffending Change Fund and the maintenance of
Public Social Partnerships
 NHS Chief Executives commitment to the
continuation of the National Prisoner Healthcare
 Scottish Government creation of a Director, Health
and Justice – now chair of the National Prisoner
Healthcare Network
 Shared governance and between NHS Boards and SPS
 Strong collaboration between the network’s
responsible for prisoner healthcare, forensic and police
 Engagement to ensure multiple agencies work together
and in unison without duplication of effort.
 Multiple Health Boards with different approaches
 Need to ensure throughcare arrangements are well
articulated and that prisoners are able to access vital
healthcare services after release.
 Creating and sustaining systems and processes across
multiple agencies that enable the best possible
healthcare to those in and leaving prison
 Creating opportunities for those in the poorest of
circumstances through education, employment and
appropriate housing
 Working towards breaking the cycle of offending
behaviour with particular focus on “the early years”
Going forward
 Look forward to discussing how we collectively address
the challenges and capitalise on the opportunities?

John Porter - Voluntary Health Scotland