• J Reed and M Lyne.
• HM Inspectorate of Prisons, Home Office, London. JohnReedCB@compuserve.com
• BMJ. 1997 Nov 29;315(7120):1420-4.

ObjectivesTo assess, as part of wider inspections by HM Inspectorate of Prisons, the extent and quality of health care in prisons in England and Wales.DesignInspections based on a set of "expectations" derived mainly from existing healthcare quality standards published by the prison service and existing ethical guidelines; questionnaire survey of prisoners.Subjects19 prisons in England and Wales, 1996-7.Main Outcome MeasuresAppraisals of needs assessment and the commissioning and delivery of health care against the inspectorate's expectations.ResultsThe quality of health care varied greatly. A few prisons provided health care broadly equivalent to NHS care, but in many the health care was of low quality, some doctors were not adequately trained to do the work they faced, and some care failed to meet proper ethical standards. Little professional support was available to healthcare staff.ConclusionsThe current policy for improving health care in prisons is not likely to achieve its objectives and is potentially wasteful. The prison service needs to recognise that expertise in the commissioning and delivery of health care is overwhelming based in the NHS. The current review of the provision of health care in prisons offers an opportunity to ensure that prisoners are not excluded from high quality health care.

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