A female inmate remained handcuffed to a male prison officer while she had a mammogram, in an example of prisoners being denied their dignity while receiving NHS care, a watchdog has revealed.
The incident is highlighted in a report by the Health Services Safety Investigation Body (HSSIB) into the difficulties prisoners can face when they leave jail to see a GP or visit a hospital.
Some inmates are put on a long chain, with the prison officer guarding them staying just outside the room, while others are made to wait in cupboards for their appointments, it found.
A government spokesperson said the report’s findings, based on interviews with more than 120 prisoners, were “deeply concerning”, especially about problems experienced by female inmates.
The prospect that prisoners will not have the same dignity and privacy during NHS appointments as other patients is a key reason why more than half do not attend those which occur outside prison.
HSSIB found that “did not attend” (DNA) rates for outpatient appointments during 2024 for those in prison “were high, at 43% and 48% for males and females respectively. This compares to a DNA rate in the general population of 26% for both sexes”, it said.
Female prisoners being escorted to an external appointment by either male or mixed teams of prison officers “can affect the patients’ decision-making about whether to go or not, particularly for appointments that are for sensitive female clinics, such as obstetrics and gynaecology”, it added.
HSSIB identified a number of situations in which inmates can be deprived of their dignity when receiving NHS care outside:
• male and female prisoners being seen handcuffed in public and wearing prison-issue clothing
• prison guards remaining present during the clinical appointment
• escorts to outpatient appointments being the opposite sex
HSSIB was told by one unnamed national organisation that anxiety among patients about waiting to see a doctor or nurse with an inmate in the same room had led to “patients (prisoners) being made to wait in broom cupboards to avoid interaction with, or being seen by, other patients”.
One female prison which inspectors visited “has made efforts to try to reduce privacy and dignity concerns by using side entrances at one of the hospitals and not taking the patient into the hospital until the appointment was about to start”, to minimise interaction with other people waiting.
Dr Miranda Davies, a senior fellow at the Nuffield Trust health thinktank and expert on prison healthcare, said: “It’s understandable that women in prison may not want to go to a hospital appointment with a male prison officer for an intimate health procedure.
“Women in prison, just like those outside of prison, want to be treated with respect and feel listened to when they have concerns, and where this doesn’t happen it ultimately puts women’s health at risk.”
Research which Davies led, published in 2022, found that women in jail are almost twice as likely as the general population to miss an appointment for obstetric care – 31% compared to 17%.
A government spokesperson said: “This is a deeply concerning report.
“We are committed to improving care for every patient, including better addressing the specific needs of female prisoners and will work with NHS England to respond in due course.”
• This article was amended on 28 November 2024. An earlier version said, owing to information provided by the Health Services Safety Investigation Body, that “did not attend” rates for outpatient appointments during 2024 for those in prison were 52% and 57% for males and females respectively. The correct figures are 43% and 48%.
