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ALAMY
Dr Davies ’ research also revealed that security constraints have led people in prison , and especially pregnant women , to miss important hospital appointments . Prisons only have three of four ‘ escort ’ slots a day , she explains ; just a few patients each day can be escorted to a nearby hospital .
‘ If you are in a prison with someone on a dialysis machine then one of those four slots is automatically taken up . Then , if there is a security incident more of those escorts might be cancelled .’
In her research , Dr Davies found that in 2019-20 almost 45 % of all outpatient appointments for women in prison were missed . 10
An estimated 600 women accessed antenatal care in prison each year , she found . But in 2019 / 20 , women in prison missed 31.5 % of obstetrics appointments and 21.5 % of midwifery appointments ( in the general population , the figures are 16.8 % and 16.0 % respectively ). 9 This is compounded by the fact that women in prison were twice as likely to have a premature birth compared with women in the community .
The RCN ’ s Liz Walsh tells Nursing in Practice : ‘ Prison officers are needed to escort people attending outside hospital appointments , and it seems the lack of availability of prison staff to do so impacts people ’ s ability to get to hospital appointments .’
There are grounds for hope , as the latest NHS England service specification , published in July , made the radical move to consider all pregnancies in prison high risk .
It states : ‘ The traditional community midwifery approach is not suitable for this group of women as all pregnancies within the detained estate are classified as high risk .’ 11 Ms Hutchings says this change is ‘ significant
References 1 Ministry of Justice . Prison Population bulletin : weekly 2 September 2022 . bit . ly / 3RxgUEO . 2 Prison Reform Trust . Prison : the facts . Summer 2022 . bit . ly / 3xdlEap 3 ONS . Healthcare expenditure , UK Health Accounts provisional estimates : 2021 . bit . ly / 3AWdt3e . 4 HM Prison and probation Service . Annual report and accounts , 202021 . bit . ly / 3RwTe3v . 5 Prison Reform Trust . Prison Factfile , Winter 2022 . bit . ly / 3xb9crM . 6 House of commons Justice Committee . Ageing prison population . July 2020 . bit . ly / 3BCNtvH . 7 Ministry of Justice . Safety in Custody Statistics , England and Wales : Deaths in Prison Custody to September 2021 , Assaults and Self-harm to June 2021 . bit . ly / 3KZHyUc 8 HM Inspectorate of Prisons . Focus on women ’ s prisons . February , 2022 . bit . ly / 3eBH4Ym 9 UK Health Security Agency . Preventing and controlling outbreaks of Covid-19 in prisons and places of detention . August 2022 . bit . ly / 3BvcjgY . 10 Davies M et al . Inequality on the inside . Nuffield Trust , July 2022 . 11 NHS ENgland . National service specification for the care of women who are pregnant or post-natal in detained settings . June 2022 . bit . ly / 3B6lm6k . and important because it recognises that prison is not an appropriate place to be pregnant ’.
However , healthcare for women in prison still has a long way to go , says Kirsty Kitchen of Birth Companions , a charity giving support to pregnant women in prison .
While the service specification ‘ has the potential to change a lot of issues , the main problem is that you are in a system where you have no control over your health ’, Ms Kitchen says . In no other situation is a woman so dependent on others for the healthcare she needs , and in no other situation can she be so easily ignored , she adds .
‘ You are in a system based on control and punishment and that is incompatible with trauma-informed approaches to healthcare .’
Making a difference There are serious problems with healthcare provision in prison but many prison nurses feel the public does not understand , or perhaps care , about these issues .
‘ There is an assumption that it is fine if things are wrong in prisons ,’ says Dr Davies . ‘ It might take more resources to meet the same healthcare needs in prison but healthcare is an important part of rehabilitation .’
However , for nurses such as Ms Woods who work with some of the most vulnerable people in society , these challenges are what make nursing in prisons rewarding . ‘ A little can mean an awful lot in that setting ,’ she says . ‘ You can have an impact on the patient ’ s life after prison and on their risk of reoffending .
‘ The difference you can make for someone can change the way they relate to their family . That patient is somebody ’ s son , somebody ’ s dad . Then they leave , and you can have an impact on the whole community .’