HMP Working

Dr Gerard Bulger FRCGP April 2008

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HMP Wandsworth 1,600 prisoners 9,000pa

Length of stay average 8 weeks: 24 hours to many years.

Prisoners from police stations, courts, other prisons, hospitals

HMPCat B local

© Google

Health centre

Reception

Main wings

Gym

Kitchen

Workshops

Vulnerable Persons Unit

Health Centre Rooms

Prison Stats: 150,000 prisoners a year: 81,000 daily population

Male prisoners consulting doctors 10 x year (effect of Turnover)

Male prisoners consulting others 20 x year (effect of turnover and medication)

450,000 prison movements a year (court, between prisons, hospital)

Average 1 year sentenced prisoner will see 2 establishments

Average 4 year sentenced prisoner will see 7 establishments

Stats and Myths 90% of Prisoners are said to have a diagnosable mental health

problem…. (or dependency, or personality disorder or both). We now include personality disorders and associated drug dependency as mental health problem. At Mount we had five genuine schizophrenics and none with mania. Perhaps 20 at HMPW. And sever mental problems are 10%.

90% of frequent attenders at GP surgeries may have a similar profile. 80% of Prisoners Smoke (small amounts) HMP Wandsworth 1,400 prisoners, 8,000 a year: The Mount 700

prisoners: 1,500 a year Hep B rare thanks to immunisation Hep C more common: 23% HIV static but complex medication TB rising and new X-ray screening programme bid success gives

opportunities for seeing each patient in health check clinic after reception

HMP

Medicine

A Tuesday Surgery New Diabetic from new screening at reception. Sarcoidosis with myocardial involvement and Lupus pernio. Medicine Review for BP but he is a New COAD (spirometry). First presentation of Guillan Barre syndrome. Unusual X-ray old Gunshot Wound and radial nerve palsy. Heamoglobin H Disease: never been told. Potts Disease of Spine: finishing treatment. Hepatitis C: new case. Drug Dependency presenting as psychosis. Carpal Tunnel Syndrome. Gall stones (sickle trait). Prostatic hypertrophy in 36 year old: from failed MDT. Gynaecomastia. Graves Disease, eye disease: T4 T3 still raised.

Bored medical student from Barts…..

Problems

Notes coming from other prisons confused or poor. For each sentence a new set of notes made up. Prisoners moved just before hospital appointments. Ignored Results hidden in records (setting up up path links). Poor or no Follow Up Crisis Led System: ex A&E staff No acute, repeat prescription system and medication review, no QOF The role of the doctor was form filling and home office, derrier

protection Suicide prediction. Visiting doctors concept as against doctors being responsible for

patients on a list. Fragmented Service: In Reach, Drug Dependency, GUM, Primary

care, Pharmacy, Dual Diagnosis. Bringing it all together and changing things we now have

Problems

Wing Clinics: Phone, many people in the room, unable to examine patients. No privacy.

Rooms double up for medication rounds Stock poor control (6x everything): cannot

treat patients there and then. Distant from administration/secretarial support Pharmacy controlled its expenses by imposing

huge expense on others: No daily dispensing: In possession is either a month at a time or a table at a time. Queues.

Pharmacy and clinical judgement: refusing to dispense.

Drug Dependency Policy

Followed BNF to the letter Co-drugs Diazepam: paradoxical reactions and must be avoided at in this

group Dr No But need to treat dependency as on the outside “Not done” in Cat Cs: Prison drug free zones? So we intend to start slow detox, aka maintenance for 30 severe

long term addicts. Will be following new Prison guidelines and national NHS

guidelines. Healthcare as the supplier… Evidence based approach.

Diet: Officers’Weekend Breakfast

Case History Aged 42. They are all have interesting stories:

Parents married both had work, and did not have addictions. He is the middle three children, the black sheep of the family. Father died two years ago. His sibs doing well for themselves. Family given up on him; he used to steal from all of them as well.

First used glue at 8. Then cannabis. Smoked Heroin at 14. In trouble at 15 and went to “borstal” (YO). Since 15 has spent 18 years in Prison, has not managed a whole year out of prison. Been on every rehab course many times. Reading and writing OK. Not clear what training occurred at HMP or reading ability. Hep C positive.

He can count a total of six months since aged 14 when he has not used heroin. 72 indictments, over 30 sentences.

Prison Discharge plan: Ticket to Norwich and appointment for B&B.

Our Discharge Plan: Start Subutex get him up to 8 to 16mg in last weeks in prison. Liaise with prospective G.P. Housing report, Social services contacts…

But no address, no G.P., no system…Try again next time… he will be back, but perhaps to another prison.

Message

Escort prisoners to properly equipped consultation rooms for quiet private consultations in healthcare

Nurse Clinics on wings Admin Support Pharmacy: daily IP and shorter IP other than

a month.

For References

Website

www.careprovider.com/prison.htm