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The NHS has to work 'in partnership' with the prison service to provide healthcare for prisoners. But where will the money come from? Barbara Millar reports

Over-medicalised and reactive, patchy in its organisation and delivery, with confused accountability and poor communications - last week's report on prison healthcare reads like a litany of all the complaints ever made against the NHS.

The shake-up that will now follow publication of the joint prison service and NHS Executive working group's recommendations has been a long time in the making.

In 1996, chief inspector of prisons Sir David Ramsbotham suggested in a discussion paper, Patient or Prisoner? that it was no longer sensible to maintain a healthcare system for prisoners separate from the NHS.

He wanted an agreed timetable for the NHS to take charge of healthcare and health promotion in prisons.

Last week's working group report says there is 'some good work', giving prisoners in some places access to the same quality and range of healthcare services as the general public.

But prison healthcare as a whole is 'characterised by considerable variation in organisation and delivery, quality, funding, effectiveness and links with the NHS'.

'Prison healthcare is often reactive, rather than proactive, over-medicalised, with health needs assessments being the exception.'

Lack of direction, poor lines of communication, confused accountability and poor arrangements for continuing professional development of healthcare staff add to the problems, the report concludes.

But rather than follow Sir David's recommendations that the NHS should take full responsibility for prisoners' healthcare, the working group recommends a 'formal partnership' between the prison service and the NHS.

It calls for a change over the next three to five years, with joint work 'to ensure that health and healthcare are integrated into, and influence, regimes'.

The main recommendations, endorsed by health minister Baroness Hayman, are that health authorities and prison governors should identify the health needs of prisoners and develop prison health improvement programmes.

Health needs assessments would begin in summer or autumn 1999 and work on PHIPs would start in early 2000.

All prisons should have completed this work within the next three years.

There should also be a taskforce, with a defined programme of work, to help support prisons and HAs to drive forward health needs assessment and the changes identified by PHIPs.

Finally, a prison health policy unit should be created to replace the current prison service directorate of healthcare, with responsibility for developing policy, drawing on and integrating with wider national health policies.

The working group report also recommends that the care of mentally ill prisoners should develop in line with NHS mental health policy and national service frameworks.

Health organisations have welcomed the report.

But its warning that bringing all prisons up to standards of good practice could cost a further£30m 'for which no provision currently exists' has alarmed prison reform organisations.

Chris Duffin, prison overcrowding monitor at the Prison Reform Trust, says years of underinvestment in prison healthcare can only be addressed by new money.

Pointing out that the£30m shortfall is a third of the current budget, British Medical Association chair Dr Ian Bogle adds: 'The extra demands to be placed on community mental health teams require extra resources.

The Future Organisation of Prison Health Care: report by the joint prison service and NHS Executive working group. Fax orders: 01937-845381. Free.