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Care behind bars: nursing in the UK’s largest prison

With a burgeoning population and chronic staff shortages, UK prisons are in crisis. Nursing staff caring for inmates at HMP Wandsworth in south London are frank about the problems - but insist it is great place to be a nurse.     
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With a burgeoning population and chronic staff shortages, UK prisons are in crisis. Nursing staff caring for inmates at HMP Wandsworth in south London are frank about the problems - but insist it is a great place to be a nurse

HMP Wandsworth is the largest prison in the UK. With 1,600 prisoners and more than 500 new and transferred prisoners each month, it is also one of the largest prisons in western Europe.

Behind the perimeter walls, nurses are doing their best to care for men who are physically or mentally unwell, and who are often angry or distressed. Wandsworth's inmates inlcude men serving life sentences, those on remand or awaiting extradition, and a growing number of older men.

The complexity of what happens in here every single day is

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With a burgeoning population and chronic staff shortages, UK prisons are in crisis. Nursing staff caring for inmates at HMP Wandsworth in south London are frank about the problems - but insist it is a great place to be a nurse 

Wandsworth has 130 healthcare staff, including 73 nursing posts. Picture: Alamy

HMP Wandsworth is the largest prison in the UK. With 1,600 prisoners and more than 500 new and transferred prisoners each month, it is also one of the largest prisons in western Europe.

Behind the perimeter walls, nurses are doing their best to care for men who are physically or mentally unwell, and who are often angry or distressed. Wandsworth's inmates inlcude men serving life sentences, those on remand or awaiting extradition, and a growing number of older men. 

‘The complexity of what happens in here every single day is enormous,’ says nurse Jo Darrow, who is also general manager and head of the Offender Healthcare Service, set up to improve the health of offenders in the prison environment. 

‘I can’t provide healthcare services when and where I want to, as prisoners need to be escorted to health appointments,’ she adds. ‘Without prison officers, they can’t attend.’ 

Growing demand 

At present, 70% of the men are convicted prisoners, and 30% are on remand. In 2017 the prison will take more remand prisoners, increasing turnover and creating even greater demand for nursing services. 

Wandsworth has 130 healthcare staff, including 73 nursing posts, but Ms Darrow is desperate to recruit more staff. ‘Six months ago, we had a 50% vacancy rate, which nearly killed me. It’s currently 33%, but we are heading in the right direction,’ she says.

Prisoners are entitled to a level of health care equivalent to that of the general population, but this is challenging, with a constant stream of prisoners being sent to court, transferred elsewhere, or confined to their cells when the prison goes into lockdown.

Of the nursing posts, 19 are mental health, and there is one advanced nurse practitioner. Mental health nurse James Tighe, a band 7 practice educator, says: ‘This is a security-centred organisation and our job is to run alongside that. We take every opportunity we can to intervene. Sometimes you have to be very creative.’

High infection rates 

There is a six-bed medical unit for people who need care but don’t require hospitalisation, numerous primary care clinics, including dental, podiatry and vaccination, and an older person’s mental health clinic.

Many prisoners were brought up in care, or have been homeless, and there are high rates of infections, including sexually transmitted infection (STIs), hepatitis B and C, tuberculosis (TB) and HIV. Smoking and substance misuse are also highly prevalent, and there is low vaccination coverage.

Prisoners cannot be sectioned under the Mental Health Act, but they can be treated in one of the prison's 12 mental health beds until a bed becomes available in secure pyshciatric unit on the outside.

According to Public Health England, as many as 49% of prisoners have an identifiable mental health problem. Nurses deal with depression, post-traumatic stress disorder, psychosis and personality disorders.  

Suicide ‘epidemic’

Every prisoner sees a primary care nurse on arrival, and anyone with drug or alcohol addiction is referred to a substance misuse nurse. This is followed by a second, more thorough health check, which includes screening for STIs and TB. 

Ms Darrow says newly arrived prisoners are the most vulnerable. ‘They may have been given a sentence they weren’t expecting, so there’s a greater risk of self-harm or suicide on the first night.’

A report published at the end of November by the Howard League for Penal Reform and Centre for Mental Health revealed that the prison suicide rate has reached ‘epidemic proportions’, with more than 100 deaths by suicide reported so far this year – the equivalent of 1 every 3 days.

The prison suicide rate is about 10 times higher than that of the general population, and the prison death toll for 2016 is the highest in a calendar year since recording practices began in 1978.

Unique presentations 

Two men share each small cell –  intended for one person – and, unsurprisingly, stress builds up. ‘When people are angry, they’re not angry with you, they’re angry about being in prison,’ says Mr Tighe. ‘You need to stay calm. If it does boil over into violence, prison officers will be there quickly.’

The nurses are frank about the obstacles they face. Peri Hambley, a band 6 nurse who has worked at Wandsworth for 23 years, says: ‘Staff and resources have been reduced, and there’s frustration among prisoners and staff. But we still have to run our clinics, and prisoners still need to see the doctor or the dentist.’

Despite the daily challenges, the nurses seem to genuinely enjoy their jobs. Ms Hambley says: ‘We really can provide holistic care. We deal with physical and mental health, substance misuse, or a combination of all three.

‘If someone has tried to harm himself and is distraught, you can offer lots of practical assistance. We see trauma, self-harm and medical problems that weren’t picked up on the outside. It’s rewarding when you identify something and you can treat it.’

Mr Tighe says prison nursing can be a good career move. ‘Nurses who want a career in the community will get concentrated experience here, treating leg ulcers, type 2 diabetes, stab wounds and occasional gunshot wounds. You see clinical presentations you wouldn’t see anywhere else. If you want to update your skills and gain in clinical confidence, prison is a great place to work.’


Alison Whyte is a freelance journalist 

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