So in the last few months my team and I have been in many prisons, generally male prisons (as there’s more of them). However, when I recently visited a couple of female prisons I was struck by the sheer difference …

I am no stranger to the Criminal Justice system. I went in to these women’s prisons already armed with a report full of data on prisoner demographics, i.e. women tend to have shorter stays than men, higher level of mental health needs, more likely to be highly medicated in the community and so on. None of this came as a surprise to me and neither will it surprise most readers who already work in the field. Women are different; nobody will dispute that.

What only became apparent when I was there talking to people was just how quickly some of these women churn in and out of the prison system, for a whole host of reasons, including the new(ish) Offender Rehabilitation Act; an unintended consequence of this being women frequently returning to prison on breeches. In many cases women are out for just days certainly less than a handful of weeks before re-appearing.

These ‘fast track’ women are becoming more and more vulnerable as our tried and tested systems are repeatedly unable to meet their ever-increaisng needs.

The Act, of course, applies equally to men and I am sure, in time, when we have the clarity that national data will give us on the number of breaches resulting in returns to prison, we will see that this plight affects both male and female prisoners. However, the nature of offending in women generally means they are more likely to be disproportionately affected. To substantiate this assertion conside the following from the latest stats from MOJ on custody:

  • Just over 4% of prison population are women
  • 8% of the recalls to prison (breaches of license) were by women

In effect, women are almost twice as likely as men to be recalled to prison following a breach of license.

Prison healthcare has come such a long way over the years, NHS commissioning has certainly sharpened focus and practice and we have a robust market of service providers who do a great job in our prisons across the country. We have national service specifications, service standards, quality assurance processes, inspections, needs assessments … the list goes on.

BUT, BUT BUT ….. DESPITE SOME VERY HARD-HITTING PUBLICATIONS WHICH SPECIFICALLY OUTLINE THE PLIGHT OF FEMALE PRISONERS (NOTABLY, THOUGH NOT EXCLUSIVELY, CORSTON) OUR HEALTHCARE SYSTEMS CONTINUE TO BE ROOTED IN A MODEL WHICH HAS BEEN BUILT FOR MALE PRISONS. MALE PRISONS WHICH INEVITABLY DON’T SUFFER THE SAME HIGH TURNOVER/CHURN RATE AS WE SEE IN THE WOMEN’S ESTATE.

Prison healthcare is, rightly, rooted in screening for need on arrival (i.e. reception). This necessary process generates a list of healthcare needs of the individual. Over the coming months (I say months rather than weeks as some services are not fast to access) referrals will be made to various teams within prison healthcare to start to meet these needs; BBV clinics, mental health teams, substance misuse teams, dentist, smoking cessation .. the list goes on. For those ‘lucky’ enough to be serving long enough sentences their needs will hopefully be met during their prison stay. For those, particularly, though not exclusively, women who churn in and out very quickly, their needs will be identified, referrals may well be started and first assessments underway, then the whole process comes to an abrupt halt as the prisoner gets released. He/she will return to prison (statistically I can say this!) and, guess what? Yup – the merry-go-round starts again with a new reception screening of need!

Is it time to think about a two-tier approach to prison healthcare segmenting those who are short stay, revolving door prisoners so that we create a more robust ‘memory bank’ of their (unmet) needs so that we can pick up where we left off last time?

There are a thousand and one things that need to change in terms of the justice system for women, but let’s not overlook the importance of prison healthcare as part of some wider opportunities to be more innovative.