In 2017 an independent review into deaths and serious incidents in custody was published, with calls for reform of the police, justice system and health service (Angiolini, 2017). Although 110 recommendations were made, there has been little progress in implementing them.
The recommendations focused on improving the way the police and health authorities in England and Wales manage and care for vulnerable people. One key finding that emerged is the failure to learn lessons and to properly consider and implement recommendations and advice from previous reports and studies (Angiolini, 2017). Four years on, it would appear that little learning has taken place, the key recommendations have not been acted upon.
The Prisons and Probation Ombudsman (PPO) is an operationally impartial office. The PPO reports on facilities provided by Her Majesty's Prison and Probation Service (HMPPS), the National Probation Service for England and Wales and other detention and justice services. In 2019-2020 the PPO investigated 311 deaths, including 176 from natural causes (61% occurring in men over the age of 60 years dying of circulatory or respiratory problems or cancer); 83 self-inflicted deaths, two apparent homicides and 31 other non-natural deaths. There were also 17 deaths of residents living in probation-approved premises, and one death of a resident of the immigration removal estate (PPO, 2020).
When investigating fatal incidents, the PPO determined that, in some prisons, the healthcare provision did not meet the standard required and was not comparable to care in the community. The provision of healthcare in some instances was very poor, failing to meet the physical and mental health needs of patients. Examples of good practice were observed in some areas (for example, the delivery of end-of-life care); in others areas it was noted that staff were not adequately trained, there were not enough staff and, in some cases, health professionals had failed in their duty of care to patients.
The PPO made 1050 recommendations following deaths in custody, with 312 related to the provision of health care, 161 associated with emergency response, 90 related to substance misuse and 89 concerning preventing suicide and self-harm.
The PPO (2020) has called for prompt mental health assessments, care plans for people with long-term conditions (adhering to national standards), the provision of additional training for staff with regards to particular conditions, improved record-keeping and communication, ensuring that prisoners attend appointments without delay, and more understanding among healthcare staff concerning their role in identifying those prisoners who may need a mental health referral or assessment.
Inquest, an independent charity, provides expertise on state-related deaths. It noted in its report that there are ‘indefensible levels of neglect and despair in prison’ (Inquest, 2020). Recommendations of coroners, the prison ombudsman and inspectorate and others are being systematically ignored and lessons are not being learned. This is a national scandal. Prison healthcare is in urgent and immediate need of attention to prevent unnecessary deaths.
Although it is acknowledged that the prison service has a duty to protect the public, this has to be offset with a responsibility to treat those in detention with compassion and humanity. Nelson Mandela (United Nations Office on Drugs and Crime, 2015) said: ‘It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.’ People in prison, just like every other person, have a right to life and they should not have their lives prematurely shortened by systemic failures (Inquest, 2020).