Skip to main content
×
×
Home

Postcode lottery? Hospital transfers from one London prison and responsible catchment area

  • Simon Wilson (a1) (a2), Katrina Chiu (a3), Janet Parrott (a1) and Andrew Forrester (a2) (a4)
Abstract
Aims and method

To consider the link between responsible commissioner and delayed prison transfers. All hospital transfers from one London prison in 2006 were audited and reviewed by the prisoner's borough of origin.

Results

Overall, 80 prisoners were transferred from the audited prison to a National Health Service (NHS) facility in 2006: 26% had to wait for more than 1 month for assessment by the receiving hospital unit and 24% had to wait longer than 3 months to be transferred. These 80 individuals were the responsibility of 16 different primary care trusts. Of the delayed transfer cases (n=19), the services commissioned by three primary care trusts were responsible for the delays.

Clinical implications

There are significant differences in performance between different primary care trusts related to hospital transfers of prisoners, with most hospitals able to admit urgent cases within 3 months. This suggests that a postcode lottery operates for prisoners requiring hospital transfer. Data from prison services may be useful in monitoring and improving the performance of local NHS services.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Postcode lottery? Hospital transfers from one London prison and responsible catchment area
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Postcode lottery? Hospital transfers from one London prison and responsible catchment area
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Postcode lottery? Hospital transfers from one London prison and responsible catchment area
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Email: simon.wilson@kcl.ac.uk
Footnotes
Hide All

Declaration of interest

None.

Footnotes
References
Hide All
1 Smith, R. Prison Health Care. BMA, 1984.
2 HM Prison Service, NHS Executive. The Future Organisation of Prison Health Care. Report by the Joint Prison Service and National Health Service Executive Working Group. Department of Health, 1999.
3 Home Office. Report of an Efficiency Scrutiny of the Prison Medical Service. Home Office, 1990.
4 Home Office. Custody, Care and Justice: The Way Ahead for the Prison Service in England and Wales Cm 1647. HMSO, 1991.
5 Department of Health, Home Office. Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. HMSO, 1992.
6 Wilson, S. The principle of equivalence and the future of mental health care in prisons. Br J Psychiatry 2004; 184: 57.
7 Wilson, S, Forrester, A. Too little, too late? The treatment of mentally incapacitated prisoners. J Forens Psychiatry Psychol 2002; 13: 18.
8 Reed, J, Lyne, M. Inpatient care of mentally ill people in prison: result of a year's programme of semi-structured inspections. BMJ 2000; 320: 1031–4.
9 Isherwood, S, Parrott, J. Audit of transfers under the Mental Health Act from prison – the impact of organisational change. Psychiatr Bull 2002; 26: 368–70.
10 McKenzie, N, Sales, B. New procedures to cut delays in transfer of mentally ill prisoners to hospital. Psychiatr Bull 2008; 32: 20–2.
11 Forrester, A, Henderson, C, Wilson, S, Cumming, I, Spyrou, M, Parrott, J. A suitable waiting room? Hospital transfer outcomes and delays from two London prisons. Psychiatr Bull 2009; 33: 409–12.
12 Department of Health. Who Pays? Establishing the Responsible Commissioner. Department of Health, 2007.
13 Department of Health. National Service Framework for Mental Health. Department of Health, 1999.
14 Department of Health. Procedure for the Transfer of Prisoners to and from Hospital under Sections 47 and 48 of the Mental Health Act 1983. Department of Health, 2005.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Bulletin
  • ISSN: 1758-3209
  • EISSN: 1758-3217
  • URL: /core/journals/bjpsych-bulletin
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 13 *
Loading metrics...

Abstract views

Total abstract views: 44 *
Loading metrics...

* Views captured on Cambridge Core between 2nd January 2018 - 19th July 2018. This data will be updated every 24 hours.

Postcode lottery? Hospital transfers from one London prison and responsible catchment area

  • Simon Wilson (a1) (a2), Katrina Chiu (a3), Janet Parrott (a1) and Andrew Forrester (a2) (a4)
Submit a response

eLetters

It is not the seniority, it is the local knowledge

Sajid Muzaffar, Speciality Registrar in Forensic Psychiatry
21 June 2010

Wilson et al, make an interesting observation about the impact of thepostcode on the time to hospital transfer.

The authors suggest that the prison psychiatrist, being a senior psychiatrist, should be allowed to make decisions about the admissions to hospitals that they do not work at and may not have much first hand information of. Every hospital has its own strengths and weaknesses, the bed status varies from place to place and time to time, and a prison psychiatrist cannot be expected to have such a detailed and day to day knowledge of all the receiving hospitals. There maybe more than one referral for the same bed necessitating an order of preference. The staff at the receiving hospital is best placed to decide if they can or cannot meet the needs of an individual patient.

It would be interesting to know if any of the psychiatrists working at the prison in the study also work at any of the receiving hospitals. Ifyou are a consultant at the receiving hospital your referral may avoid doubling the assessment and maybe taken more seriously by the receiving hospital. Moreover, you would be well aware of the admission policies, strengths, weaknesses and bed status of the receiving hospital. Your referrals are expected to be more in tune with the receiving hospital's admission policies.

The experience of prison psychiatrists outside London would be interesting. There are more London prisoners outside London than there arethe other way round. It usually takes much longer to organize an assessment and a transfer for an out of area prisoner than it does for a local one. The system might work better if every Secure Hospital had designated list of catchment prisons. This would help the staff at both ends to develop a knowledge of the strengths and weaknesses of the of the other side and avoid many of the difficulties in transferring prisoners tosecure units, not to mention avoiding the inconvenience and distress that the mentally unwell prisoners face being moved from one corner of the country to another.
... More

Conflict of interest: None Declared

Write a reply

Hospital transfers need proper assessment

Oriana Chao, Consultant Forensic Psychiatrist
14 April 2010

The article by Wilson et al. highlights the delays in transferring prisoners to hospital, including a suggestion that a “postcode lottery” operates. Whilst we agree with much of the article, we would contest the statement that “(g)iven the extensive development of mental health in-reach services, and the fact that referrals are made by senior psychiatrists, it seems surprising that it has become routine for receiving units to undertake their own assessment, apparently duplicating work.”

Clearly it is important that the transfer of mentally ill prisoners needing hospital treatment is expedited, and this is no doubt a view shared by both prison psychiatrists and those in the receiving units. However, whilst this is the main concern of prison psychiatrists, receiving units have to also consider the appropriateness of the placementand issues of risk.

Furthermore, it is not always the case that referrals “are made by senior psychiatrists”. And, regardless of the author of the referral, assessment by a receiving unit provides an opportunity for additional and often significant information to be collected. This enables the unit to carefully consider risk issues and prepare for a safe admission to an appropriately secure unit, an issue highlighted by the core ‘Never Event’ relating to escape from medium or high security.(1) Sometimes this more properly informed assessment clarifies that a prisoner does not need transfer for treatment. This was highlighted in the sensible July 2007 guidance (2) from the Department of Health, which distinguished between routine and urgent referrals, allowing assessments to be appropriately prioritised.

Given that beds are usually at a premium in secure services, simply accepting every prison referral would lead to even further unacceptable pressure on beds and perversely exacerbating the very problem Wilson et al. seek to address.

1. NPSA, 20092. Best Practice Guidance: Specification for adult medium-secure services,DH, July 2007

Declaration of InterestBoth authors work equal time between a London remand prison and on secure admission wards
... More

Conflict of interest: None Declared

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *