Health Document Gives Insight To Wrexham Prison Challenges

A document prepared for the local health board has given an insight to challenges faced for health provision once the new prison opens locally.

The document is titled ‘Prospective Initial Health Needs Assessment for North Wales Prison’ and was prepared to allow Betsi Cadwaladr University Health Board ‘support the planning and provision of health care for the new North Wales prison’.

The PDF states the version is ‘final confidential’ is publicly hosted on the Wales.NHS.uk site here, and although it is from May 2015 we have yet to see any reference to its contents.

Comparison information is provided from HMP Northumberland and HMP Oakwood to predict the added demands to the local health services. Oakwood has a capacity of 1,605 with Northumberland being 1,348. For comparison Wrexham’s yet unnamed prison will have a capacity of 2,106 , that is to say 31% bigger than Oakwood and 56% bigger than Northumberland.

It is ‘assumed’ in the document that Wrexham’s prison will be a Category C training and resettlement prison, however will provide a category B remand function, with up to 200 such places.

It is noted:

• In the year 2012/13 HMP Oakwood called the GP out-of-hours on 460 occasions.
• HMP Oakwood reported that there were 196 referrals to hospital services.
• The HMP Northumberland HNA reported that the total number of escorts from HMP Northumberland ranged from 74 to 107 per month.
• An estimated 44% of the prison population takes prescribed medication, this would equate to an estimated 926.6 prisoners in the North Wales prison taking prescribed medication
• In HMP Northumberland, there were 49 unplanned escorts to hospital between March 1st and May 31st 2013, the most common reason for unplanned escort to hospital was injury (HMP Northumberland, 2013).

The document explains: “If a prisoner attends a hospital they will require an escort. If they are admitted to the hospital they require a bedwatch.”

The above numbers on ‘bedwatch nights’ are scaled up in the document, showing a predicted 325 nights a year likely at the Maelor Hospital from the prison, however the escorts do not appear to be calculated. Using HMP Altcourse as an example it is noted that the escorts are often for planned outpatient appointments, however can also be attendance to accident and emergency. With Northumberland’s 16 unplanned escorts a month (196 pa) scaled up to Wrexham’s level would mean in the region of 300 unplanned visits a year to the Maelor Hospital, again likely via the Accident and Emergency department.

Data from HMP Wymott (population 1,176 around 55% the size of Wrexham) is also given showing up to 6 escorts a day to hospital at that prison, with a possible link to an higher proportion of older prisoners explaining the larger numbers. This suggests the impact on the Maelor Hospital and associated ambulance call outs, and A&E visits will depend on the make up of the prison population as well as the size.

The ‘Category of Healthcare’ for the prison being built at the industrial estate is pegged at Level 3, however under the basic description of the prison it is noted ’24 hour access to healthcare – no inpatient beds’. The latter appearing to be the main differentiator between Levels 2 and 3, noting the lack of inpatient beds being a ‘variation to the widely excepted definition of prison healthcare level 3′ which is stated as ’24 hour nursing cover with in-patient unit’. No explanation is given to this apparently conflicting information.

The lack of inpatient beds is mentioned when discussing end of life care, appearing to suggest a cell could be used instead: “For end of life care in prisons with no in-patient beds, there may need to be dedicated cells where staff can have 24 hour access.”

The below ‘social characteristics of prisoners in comparison to the general population’ table is also provided in the document, citing 14 year old data from 2002:

One other grim prediction in the document is that there is likely 3.4 deaths a year in the prison from natural causes, and 2.1 deaths due to ‘self inflicted cause’, with 457 people expected to self harm every year.

383 assaults, presumably prisoner on prisoner, are predicted with 84 assaults on staff also noted in the projections.

A note is added to the statistics, “When considering these estimates it must be noted that the extent to which these nationally based rates apply to the North Wales prison population is unknown and that some of the rates used are based upon males and females in custody. Therefore the estimates may not provide an accurate reflection of the need within the North Wales prison.”

The document lists several recommendations , including the statement “The majority of healthcare will be delivered within the prison”, which then leads on to other areas of support such as healthy eating and smoke free prison status. It is noted that prisoners with ‘complex needs’ could be avoided, specifically in the ‘ramp up period’ as stabilisation of healthcare provision occurs.

There is no information to why the document was labelled as ‘confidential’.

The full PDF is here and is 193 pages long.