conference focus :

NHS staff may complain that they are working in primitive conditions, but the worst of the NHS doesn't begin to compare to the state of some healthcare centres in Britain's prisons, Prison Service director general Martin Narey told the conference.

'Some, like Pentonville and Birmingham and Chelmsford, are worse than the kennels I leave my dog in when I go on holiday, ' Mr Narey said, outlining a service which for years has failed to meet the health needs of some of society's most vulnerable people.

The statistics Mr Narey and Dr Sheila Adam, deputy chief medical officer at the Department of Health, presented were stark:

90 per cent of prisoners have a diagnosable mental health problem or are substance misusers or both; 80 per cent smoke; 20 per cent of men and 40 per cent of women in prison have tried to commit suicide; thousands are infected with hepatitis B, hepatitis C and HIV.

'The problems of the prisons today are the problems of the NHS tomorrow, 'Dr Adam said.

Mr Narey acknowledged that the 'gross' conditions in which many prisoners are kept and the professional isolation of prison healthcare staff were a serious problem, but the situation had been improving since the joint taskforce was set up last April.

'To be frank, the majority of our staff are staff you in the NHS would not want to employ - with the increased emphasis on quality in the NHS, they come down the pecking order and they end up with us, 'Mr Narey admitted.Historically, prisoners who were ill had been seen as malingerers, but with a - literally - captive group with severe and complex health needs there were prime opportunities for health promotion and treatment of people who had had very little contact with mainstream health services.Many had families, often with young children, so the opportunities were there to tackle the health needs of some of the most socially excluded.

Both speakers highlighted the changes taking place since the Home Office-Department of Health partnership was forged.

Much work had gone into tackling mental health problems of prisoners, and indications were that the 'inexorable' rise in prison suicides had fallen by a third in two years, Mr Narey revealed.