Commissioning conundrum for custodial care

Simon Wilson presents an editorial (2004) that questions the traditional role of the prison hospital wing. I have also questioned this over the years (Gannon, 2002). However, a factual inaccuracy in his introduction flaws his conclusion.

The Health Secretary for England announced that there would be a transfer of responsibility whereby the NHS in England would become responsible for commissioning health care in prisons from April 2003. It is very different to announce ‘commissioning’, as distinct from ‘provision’ – as Dr Wilson claims. It is, I fear, less of a take-over than a make-over by the Department of Health. Primary care trusts can commission provision from a range of providers – including the current prison provider. The governor will continue to maintain control over the ‘cells’ in the hospital wing.

Once the reader understands the distinction between commissioning and providing, it provokes thought about the appropriate allocation of health care spending. Why spend the commissioning money twice, on the same citizen, in two different places? Why construct a parallel health care system?

Choosing to highlight capital investment on prisoners may be a public relations disaster. The general public is easily swayed by popular media headlines. Health care spending on special-care baby cots is more palatable than making the prison experience more decent for citizens.

There are hundreds of people in the secure hospitals who have been assessed as no longer requiring that level of security. Capital investment is required urgently at the lower end of the security scale – it is an illusion that more high security is required – thus creating remand beds (not cells) made directly available to courts. This is the only way to seek equivalence. Our mentally ill citizens should not be in prisons at all – we should argue for nothing less.

Eroding this principle, however well intended, just sanitises society's tolerance of this essential injustice. It is all too collusive to believe that we are somehow caring more appropriately if we allow an expansion of common law – lest it just become common lore.