A report entitled Healthcare in Irish prisons, prepared by the Inspector of Prisons, the late Mr Justice Michael Reilly, was presented to the Tánaiste and Minister for Justice and Equality on 25 November 2016.1 There were three specific aims of the report:

• To point out the absolute entitlement of prisoners to healthcare and the case for such healthcare to be provided by the Department of Health.
• To point to the necessity of carrying out a health needs assessment of prisoners and a staffing needs analysis in each Irish prison.
• To give guidance to the Irish Prison Service (IPS), to the management of prisons, and the providers of healthcare in the prisons on what will be expected of them in the area of healthcare when inspections are carried out in the future. 

Obligation to provide healthcare in prisons equivalent to that in non-prison community

The report stressed that the right to health is a fundamental right and that Article 12(1)2 of the International Covenant on Economic, Social and Cultural Rights urges state parties “to recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health”. In addition, it is generally accepted as international best practice that the provision of healthcare in prisons should be equivalent to that available in the non-prison community.

Entitlement to health services in the Republic of Ireland is primarily based on residency and means. In particular, eligibility to access health services depends on whether a person is a medical card holder or not. It is well established that a majority of prisoners come from lower socioeconomic sectors of communities, and that many present with mental health and other preexisting health problems often resulting from a chaotic lifestyle. Therefore, the report urged that healthcare should be provided to prisoners on the basis that they are entitled to the same treatment and choices as people in the free community who are in receipt of medical cards.

Healthcare services in Irish prisons are, in the main, provided by the IPS. An exception is the provision of in-reach mental health psychiatric services by the Central Mental Hospital, which come at no cost to the IPS, as this service is funded by the Health Service Executive (HSE). Doctors are engaged either on a full- or part-time basis. The report noted that the recruitment of full-time doctors is proving difficult. As a result, the IPS are over-reliant on locum doctors, who by their nature are transitory, to provide medical services to prisons. Nurses are employees of the IPS and as such are answerable to the governors of the prisons to which they are attached.

The report suggested that Ireland could comply with best international practice by ensuring that the present prison-administered healthcare services form close links with the HSE. However, Judge Reilly also stated that the Department of Justice and Equality have acknowledged that the international trend is now towards a service that is within the responsibility of the Department of Health, and that the Committee of Ministers of the Council of Europe, in its official commentary to the revised and updated European Prison Rules 20063, states:

The most effective way of implementing Rule 40 [organisation of healthcare] is that the national health authority should also be responsible for providing health care in prison, as is the case in a number of European countries.

Judge Reilly noted that there may well be resource issues in transferring responsibility for prisoner healthcare from the IPS to the HSE and the Department of Health. However, he also stated that this cannot be used as an excuse for delaying such a transfer of responsibility. The report stressed that it must be borne in mind that the State accepts a heavy responsibility when it detains a person to ensure the well-being of that person, and that it is internationally acknowledged that a lack of financial means cannot reduce this responsibility.

Necessity of carrying out health needs assessment of prisoners and staffing needs analysis in each Irish prison

The report stated that irrespective of which body is responsible for healthcare in Irish prisons, be it the IPS or the HSE, a comprehensive assessment of the healthcare needs of prisoners in the 13 prisons in the Republic of Ireland must be undertaken. This must be followed by a staffing needs analysis of healthcare personnel within each prison. Judge Reilly noted that no such assessment has ever been undertaken within Ireland, and that it was impossible to express a view on the adequacy of the healthcare currently provided in Irish prisons, as it seemed to operate on an ad hoc basis.

Judge Reilly recommended that a Director of Healthcare, who is a registered healthcare professional, should be appointed immediately. The duty of the director would be to manage the healthcare in prisons and to oversee the transition of healthcare from the IPS to the HSE. The report also stated that the provision of healthcare in Irish prisons should not be confined to that which is provided by doctors and nurses, but should embrace all aspects of care, including addiction, psychiatric and psychology services.

Guidance to IPS on what will be expected of them in area of healthcare when future inspections are carried out

The report indicated that at any time upon request, prison governors and/or healthcare staff should be in a position to make the following available to inspecting officials: 

• The health needs assessment for the prison.
• The staffing needs analysis for the prison.
• The number of nurses, doctors, psychiatrists, dentists, other specialists, psychologists, auxiliaries, etc. (engaged full or part-time) and their hours of duty.
• The number of medical referrals to hospital emergency departments for a given period.
• The average time for transfer of prisoners to emergency departments, with the longest and shortest time, for a given period.
• The number of medical referrals to external consultants for a given period.
• The number of cancellations of appointments with external consultants, with reasons for such cancellations, for a given period. 

1    Reilly M (2016) Healthcare in Irish prisons. Dublin: Department of Justice and Equality. https://www.drugsandalcohol.ie/26885/

2   United Nations Human Rights Office of the High Commissioner (1966) International Covenant on Economic, Social and Cultural Rights. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx

3   Council of Europe (2006) Commentary to Recommendation REC(2006) 2 of the Committee of      Ministers to member states on the European Prison Rules. In European Prison Rules. Strasbourg: Council of Europe Publishing. https://rm.coe.int/16806f3d4f