Health and Justice

Thursday, 03 April 2014

From 1900 to 2100

Medico-Chirurgical Hall

Experiences of a GP with an interest in the health and wellbeing of offenders.

Dr Lydia Harris - Medical Director for the Substance Misuse and Associated Health Unit - Royal College of General Practioners.


Minute of meeting held on Thursday 3rd April 2014 in the Society Hall, Foresterhill.

The President, Dr Colin Hunter presided.

The President informed the members of the death of a member, Dr Helen Milne. He spoke of her life and work and asked members to stand and applaud her life. An obituary will be filed in the Society's archive.

He then introduced the guest speaker, Dr Linda Harris, a GP in Wakefield and Medical Director of the Substance Misuse & Associated Health Unit of the Royal College of General Practitioners. Her topic was Offender Health and Wellbeing.

She told of starting her career as a GP in East London where she developed an interest in stigma associated with cultural problems as well as drug and alcohol misuse. In 2001 she became clinical lead for Wakefield Integrated Substance Misuse Team and that led to an interest in prison detoxification units. She eventually set up "Spectrum", a company which delivers medical care to four prisons and which places emphasis on recovery and respect for dignity.

Dr Harris spoke of the many factors which lead to health inequality in offenders, mentioning addiction, chronic ill health, poor education, lack of previous use of NHS services, lack of trust in health professionals, mental illness, lack of knowledge amongst NHS commissioning groups and the often poor and overcrowded prison estate.

She said that the prisoners should be entitled to the same level of care as any other patients but mentioned some of the difficulties in achieving this. Tensions arise between patient confidentiality and legislation and prison policies. Her team get a lot of complaints because of this conflict but do have forum where such issues can be discussed.

All prisons have their own different populations and characteristics, especially in the highly secure units. She reviewed various reports and prison reforms over the years from 1784 onwards, mentioning particularly the role of philanthropists and also reports by Corston and Bradley. The former dealt with suicide in prisons and made the point that society should not be locking up as many women as it did, and continues to do. The Bradley report looked at offender health problems, especially highlighting the significance of mental illness.

Dr Harris then spoke of her work at HMP Styal, a woman's prison and the problems common to many of the women including poor education, homelessness, history of domestic violence and children in care. So the management plans have to deal not only with physical problems such as sexually transmitted diseases and chronic diseases including chronic pain but also many other problems. She said that the services available are better than outside in that there is rapid access to methadone if required, to dental and mental health services and full medicines management. All prisoners are assessed within 3 hours of admission and reassessed at 72 hours.

She illustrated some of the issues by way of a hypothetical patient but one who had most of the common problems and illustrated that many issues can be address by a structured approach with a multidisciplinary team. Teleconferencing is used which is particularly useful in saving sending high security patients out of prison. Her teams have been recognised by national award such as the Quality Practice Award.

Dr Harris asked for feedback about a real problems. One male patient is requesting a sex change operation and is backed by a legal team - members thought the request should be refused.

The use of sildenafil and related drugs is being reviewed. Drugs get into prisons and prescription drugs are traded, so pain management is very important as is liaison with prison staff. Support of health care staff is very important.

Dr Harris finished by mentioning that terminal care is often carried out in prisons.

There were several questions. One was about mother and baby units (Dr Harris said they work well); one member asked whether previous health care work had 'stuck' when people were re-admitted (often not); is compassionate release considered for terminally ill prisoners (yes, but prisoners do not always wish it); is it difficult to recruit staff? (yes)

The President gave a vote of thanks, mentioning the insight to an area of which most members had no knowledge.

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