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

Abstract

Aims and methodTo 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.ResultsOverall, 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 implicationsThere 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.

Transfers from prison to hospital under Sections 47 and 48 of the Mental Health Act between 2011 and 2014

“…In our view, our data also supports the views advanced by Wilson et al (2010) that there should be greater flexibility in arranging these admissions so that at least some are accepted without further assessment by the inpatient unit. We appreciate that secure psychiatric inpatient services are an expensive provision and that such units have a responsibility to protect these through gatekeeping.…”

“…Firstly, the time between a referral being made to the hospital making their initial assessment (Time 2) took an average of 28 days. This builds on evidence from an earlier evaluation which also reported delays in hospitals conducting their initial assessments (Wilson et al, 2010). It then took, on average, a further 29 days until the second medical recommendation was produced (Time 3).…”

“…This may be the case for prisoners with complex needs or those with acute episodes of severe mental illness who cannot be treated in prison, amongst other reasons because compulsory treatment under the Mental Health Act is not allowed in prison. Official statistics for 2013-14 showed that 862 male prisoners were transferred to a psychiatric hospital for the assessment and treatment of a mental disorder (HSCIC, 2014 ), a second finding that women were transferred more quickly than men with mean transfer times of 15 and 50 days respectively (Roberts et al, 2012) and another reporting that 24% of transfers had taken longer than 3 months (Wilson et al, 2010).…”

“…In addition, one study found considerable differences in transfer times between commissioners, suggesting that some commissioners are more efficient in transferring prisoners than others (Wilson et al, 2010). In an effort to understand more about the barriers to achieving timely transfers, Roberts et al (2012) conducted interviews with stakeholders involved in the process.…”

“…The most recent published evaluations on the transfers of male prisoners are based on data from 2006 (Wilson et al, 2010;Roberts et al, 2012). …”