Investigations & Analysis - Northern Ireland
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Making sense of the prison healthcare spend

05 APRIL 2013

Over £22m has been spent on prison healthcare over the last three years
Over £22m has been spent on prison healthcare over the last three years

By Niall McCracken

THE Detail can reveal over £22m has been spent on prison healthcare here over the last three years. However, it has taken the South Eastern Trust over two months and two separate FOI requests, to release a breakdown of the cost.

The figures show that over £16m has been spent on salaries and wages for healthcare staff and almost £6m on what is described as “goods and services”. But we have been given little information beyond these headline figures about what the spend really means.

An analysis of the data available highlights that healthcare expenditure on “pharmacy drugs” has continued to rise across all three prisons since 2009, with the cost increasing by almost £247,000 in Maghaberry prison during the last last three years,

From April 1 2008 the delivery of all prison healthcare in Northern Ireland has been the responsibility of the South Eastern Health and Social Care Trust.

The budget comes directly from the Department of Health and is managed by the Health and Social Care Board (HSCB), which commissions the services to the South Eastern Trust through a block contract.

Until April 2012, healthcare staff were employed by NI Prison Service, which would then bill the trust for staff costs. The trust says this explains the extra cost heading for 2011/12 and reflects additional staff such as permanent mental health nurses who have been brought in as part of the process to “improve prison healthcare.”

Prison Healthcare expenditure by the South Eastern Trust
Prison Healthcare expenditure by the South Eastern Trust

Most of the prison health care spend was on salaries and wages for health care staff, with almost £10m spent on salaries and wages at Maghaberry prison alone.

Across all three prison sites from 2009-12, over half of the salaries and wages expenditure were in three main areas- SO (NURSE) (£1,457,219), OFF (NURSE) (£4,711,323) and OFF (HOSP) (£2,188,484). [We have asked the trust to explain these terms and will update this story when the it has responded.]

The Goods and Services expenditure includes pharmacy spend, dental fees and travelling costs for bringing other health professionals into the prison. In our initial FOI response we were only provided with the most basic breakdown containing basic headings such as “salaries and wages” and “goods and services”.

A second FOI response provided more detail including the cost of prescribed medication, and contracted services including General Practitioners who have supported doctors employed directly by the trust in the prison. Please click on the excel sheet below for a full breakdown.

When the second breakdown is compared with the first FOI response, it highlights that the original basic breakdown table sent to The Detail by the trust contains a mix of “budget allocated” and actual “expenditure values” from 2008-12, while other values have changed completely.

The trust said it was unable to provide a further budget breakdown for healthcare expenditure in 2008/09 and asked us to submit a further FOI request to obtain this information.

Figures provided by the South Eastern Trust
Figures provided by the South Eastern Trust

A breakdown of the goods and services budget shows that the majority of spend was on pharmacy drugs (£2,146,337), pharmaceutical services(£595,808) and addiction services (£1,406,631).

Healthcare expenditure on “pharmacy drugs” has continued to rise across all three prisons sites since 2009. In Maghaberry prison the pharmacy drug spend increased by almost £247,000 between 2009-12 and by almost £50,000 in both Magilligan (£46,537) and Hydebank (£50,076).

The cost of Pharmacy drugs in prisons here has continued to increase
The cost of Pharmacy drugs in prisons here has continued to increase

The data also shows that £1m has been spent on “High Cost Cases” with costs more than doubling from 2008-12.

Figures provided by the South Eastern Trust
Figures provided by the South Eastern Trust

The trust define high cost cases as those that include individual prisoners to “whom we are not able to provide the necessary healthcare within the prison and who need to be sent to a brain injury unit, for example, or a secure mental health unit.”

Chief Executive of NIACRO Olwen Lyner says it’s important that the most vulnerable prisoners receive the most appropriate care.

She said: " We know from our experience of delivering services to people with mental health needs that it is often the provision of appropriate treatment which addresses their underlying issues and is the key factor in reducing their risks of engaging in offending or anti-social behaviour. In summary, it is a waste of public money to keep incarcerating people in our prisons when what they actually require is treatment for a range of mental health problems.

“Not only that, but it is unfair to expect prison officers, who are not trained healthcare workers, to engage people with serious mental health needs in programmes to aid rehabilitation and effective resettlement. That is why we have been, and will continue to be, calling for political leadership to address the shortcomings in the provision of appropriate healthcare in prisons across Northern Ireland.”

The original breakdown sent by the trust for high cost cases outlined that there was no expenditure from 2010-12. However, when we queried this it confirmed that there was in fact £409,000 spent on high cost cases during 2010/11 and a further £410,000 spent during 2011/12. Click here to see the original breakdown released under FOI.

The trust said the reason for this error was that the “clients to whom this expenditure relates moved from the operational management of the Prison Service to the Mental Health Service which both sit within the Adult Services Directorate.”

Dr Linda Moore, is a professor of Criminology at the University of Ulster and has written extensively on prison conditions in the Northern Ireland. She believes that all information on prison healthcare should be widely accessible. She said: “It’s in the public’s name that people are being spent to prison and it is the public who are paying for prisons, and paying huge amounts, so we have a right to know what’s going on in many levels.

“In that respect the prison service should be putting figures out for public scrutiny so that our politicians and government committees can scrutinise it. Clearly there’s an issue of accountability here and I think it’s absolutely shocking how little information is made available. It’s important that such figures are dug out but it shouldn’t have to be done through Freedom of Information legislation.

“I believe that even from the trust and the prison service’s point of view, if this information was made readily available it would go along way in helping the public understand the complex and difficult space that prison healthcare currently occupies.”

© The Detail 2013