When society gets it wrong, GPs are often left to pick up the pieces. The effect of benefit cuts or the bedroom tax, for example, both have their impact on health. Many a consultation is spent trying to give support to people in the impossible situations society has left them in, caught as they so often are between debt and disability.
Where social ills are at their sharpest – and the impact on health at its greatest – patients suffer.
Prisoner welfare is as much about our patients’ health as it is about society in general, and the voice of the medical profession needs to join this topical debate.
In case you have missed the furore, it was stimulated by an article from Frances Crook, a modern-day Elizabeth Fry who is CEO of the Howard League, a charity which campaigns for penal reform. The very fact that we need a figure like Frances Crook in our 21st century democracy tells a story in itself.
Her article picks up on the impact of changes which the government brought in last November – so long ago that poor Mr Grayling must have forgotten about them. Without anyone really noticing at the time, he introduced a blanket ban on prisoners receiving parcels: books, home-made cards from the children, and even clean underwear were stopped.
The protests against this ban have especially focused on the restriction on books – the restriction of access to the written word is usually being the hallmark of corrupt dictatorships and not something we expect in modern Britain.
Mr Grayling protests that there is no restriction on prisoners having books: books are allowed (prisoners are permitted 12 in their room at any one time, few of us would feel unrestricted if our bookcase were so diminished); they have access to prison libraries (perhaps 20 minutes a week if they are lucky and austerity cuts mean many councils have drastically cut back on library provision); and anyway they can buy books (on £8-£12 a week for all they need to buy, not likely). He also states that it would not be ‘secure or practical’ to screen parcels on a regular basis for prisoners.
I concede it would be a logistical challenge to check that parcels were safe for prisoners to receive. There are many practical hurdles to overcome in running a prison, however. Would opening a parcel once a week for each prisoner and checking its contents really be so difficult?As one of my partners is keen on saying: ‘we can put a man on the moon…’ Often it is not whether or not something is possible that matters, but whether or not you deem it to be desirable.
But what is beyond doubt is that incarceration is a health issue. The stresses and strains of arrest and court appearances will often need support from a GP. Anxiety and depression are common, letters and reports are required for the court dates, and families are often driven to the brink of collapse.
During a prison sentence the GP may need to support the family, but can have no influence of what happens on the inside; what state they are in when they return is entirely dependent on the quality of rehabilitation that is on offer. Some patients are transformed: drug or alcohol addiction may be broken, attitudes may have changed; others may simply feel they have even less reason to engage in society.
I am not naïve. I know that prisoners are the criminals and not victims, but once they are in prison, the emphasis should be on how best to prepare them for reintegration to society. I am inspired by the words of former Prison Governor, Gareth Davies who says he always lived by the principle that prisoners ‘are incarcerated as punishment, not for punishment.’
I am grateful for the fact that it is never my role to judge my patients, but to support their health in the best way I can, and prisons will make my job much easier by returning my patients in the best possible state. Allowing them to receive parcels from their families and friends could be one of the most important ways of ensuring this.
As far as I am aware, no health body has spoken out during the current row on parcels for prisoners. I have checked both the BMA and RCGP websites and found nothing.
Prisoner welfare is a health issue, and I would encourage both these organisations to throw their weight behind the campaign for reform – even if they just did a #shelfie it would be a start.
Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.