The provision of healthcare is a statutory obligation on the Irish Prison Service (IPS) as defined in the Prison Rules.
The objective of healthcare within the IPS is to provide prisoners with access to the same quality and range of health services as that are available to those entitled to General Medical Services in the community. IPS healthcare policy is to treat all prisoners, irrespective of background or offence, with the same dignity and respect as afforded to all patients in the community. All staff providing healthcare services to patients in custody should deliver that service consistent with accepted professional guidelines.
Prisoners have been identified as having significant health deficits relative to the “average” health status of the general population and imprisonment provides an opportunity to address these deficits and consequently have a positive benefit on the overall health status within the general community. The National Health Strategy (Quality and Fairness – A health system for you DOH&C 2001) clarified that persons in prison are defined as a special needs group.
The principle areas of need among the prison population can broadly be categorised into three groups, primary care and/or chronic disease management, mental health, and addiction issues. The prevalence of severe mental illness among prisoners presents a significant challenge for both prison staff and external mental health services. In relation to addiction, there is a consensus that most European prison systems are encountering a significant task in addressing the issues of drug dependence within prisons. It is IPS healthcare policy that priority is given to the promotion of health through the positive intervention of staff.
The overall aim of the IPS Healthcare Directorate is to integrate prisons within their local healthcare structures and provision. The effective delivery of prison healthcare services requires that prisons are accepted as part of the community and not regarded as a distinct and separate entity.
The IPS have developed a comprehensive set of Healthcare Standards, which represent an outline of practical provision at institutional level to achieve a consistent approach of service delivery across fourteen prison locations. The Standards seek to define the organisation of health service delivery and provide a benchmark for such provision. The Standards set out the processes for assessment, intervention, treatment and specialist service engagement. The Healthcare Standards are in line with best international guidance in the delivery of prison healthcare.
Delivery of quality primary care interventions is a central tenant of the IPS Healthcare strategy. Primary care is the linch pin that anchors all services such as mental health, addiction or chronic disease management. This service is provided using a multidisciplinary model and intra disciplinary working processes. Critical to this service is the initial health assessment and from this care interventions are developed. Along with medical assessment of need, these interventions include nurse led health screening clinics, diabetic care clinics, vaccination clinics etc.
The primary care service strives to provide proactive healthcare with a focus on preventative medicine.
Where the need for specialist services is identified, it is desirable, where cost effective that this is met by providing such service at local prison level on an inreach basis. Where practical this is facilitated through Service Level Agreements with the Health Service Executive or other relevant provider. Examples of such arrangements are recent Service Level Agreements to provide Consultant led drug treatment and sexually transmitted infection services in Cloverhill and Wheatfield Prisons.
To properly discharge our responsibilities to prisoners with a mental health disability it is essential that we seek to integrate and further develop services, with statutory and voluntary partners. Mental health service provision in prisons must form part of the overall community response to this disability. Current arrangements with the Central Mental Hospital, which witness twenty one Consultant led inreach forensic mental health sessions weekly in prisons across the east coast, serve as a good example of collaborative working.
The IPS has committed significant investment in recent years in responding to addiction issues in the prison system. A recent report has highlighted the high level of need for addiction services among the prison population and the upward increase in the number of prisoners treated. The IPS are enhancing prison based drug treatments services which include strategies aimed at improving harm reduction and reducing opportunities for the transmission of blood borne viruses as components of a range of multi- modality treatments.
The IPS Healthcare Directorate will continue to work to develop the range and availability of healthcare services available to prisoners consistent with our objective to achieve the standard of care which is equivalent to that available in the community.
