This report on the inspection of Cork Prison identifies a number of such systemic issues. Chief amongst these is the scourge of overcrowding and the ongoing scandal of people living in prison being obliged to sleep on mattresses on the floor. Work, education and training opportunities are analysed in detail, enabling the Inspectorate to chart the curtailment of these activities due to the redeployment of prison staff to escorting functions outside the prison. Other recurring themes include shortcomings in record keeping, the absence of administrative support for Chief Officers and Chief Nurse Officers, an ineffective complaints system and unduly limited telephone contact with the outside world. The report also addresses the persistent presence in prisons of people with acute mental health conditions. Turning to the prison itself, while general areas were clean, windows across the prison required repair. There was a shortage of bedding and some mattresses were in a poor state. For those who could access it, the quality of education was excellent. We also recognise that the Open Door “Pop-up Kitchen” Initiative was a positive example of the power of collaboration, and could serve as a potential model for the Irish Prison Service to adopt across the prison estate.

P.45 Healthcare Services & Staffing
4.5 Healthcare services available in Cork Prison included general practice and nursing, psychology, psychiatry, and addiction and drug use treatment

P.47 Physical Setting & Infrastructure
4.12 Access to healthcare services benefitted from a degree of prioritisation in the prison’s Regime Management Plan, whereby the posts assigned to escort prisoners to attend general practice and hospital-based appointments were not often redeployed to other operations in the prison.
However, certain posts, such as prisoner officer escorts to addiction and drug treatment services, were not supported to the same extent.

P.50 4.27 The General Practitioner also provided same-day cover to Castlerea Prison, located a round trip of more than 500km away; this is not an effective use of a valuable primary care medical resource. In addition, the GP was expected to provide off-site cover on the weekends, at night and as required when other prisons need assistance. Drug detoxification and Opioid Substitution Therapy were also the responsibility of the GP. 
4.30 Locum doctors were employed to facilitate the provision of primary healthcare in the prison, but they were not provided with the necessary orientation training to support them in carrying out this work. For instance, locum doctors required more training on the PHMS and also in relation to strategies to avoid inappropriate diversion of prescription drugs.

P.52 In relation to harm reduction, initiatives such as provision of condoms and needle exchange programmes had reportedly not been instituted due to a belief that such practices could encourage behaviours of concern, rather than help prevent harm. Evidence internationally does not support this approach. For example, the World Health Organisation (WHO) has noted that health protection in prison involves the reduction of hazards in the prison environment which include the availability of harm reduction services. Given the commonality of drug use and sexual activity in prisons, the WHO recommends that health intervention packages include harm reduction interventions such as condoms and lubricants, needle and syringe programmes, opioid agonist maintenance therapy and naloxone for overdose management. Furthermore, the European Monitoring Centre for Drugs and Drug Addiction notes “prisons can be a core setting for engaging with people who inject drugs and who may have been hard to reach in the community, allowing the provision of harm reduction, counselling, testing and treatment services before they return to the community”. The approach to harm reduction in Cork Prison at the time of inspection did not sufficiently align with international standards in the area of harm prevention in prison settings.

P.55-56 Addiction
4.59 The management of substance use in the prison was underpinned by recommendations outlined in the 2012 Irish Prison Service Clinical Drug Treatment and Policies Manual. This document was under review by the Irish Prison Service at the time of inspection. 4.60 There were two full-time Addiction Counsellors assigned to Cork Prison. They conducted
4.60 individual sessions each week, and had received 43 referrals to addiction counselling in March 2023. There was a waitlist of 112 prisoners to participate in addiction counselling. More than one-third of the prisoner population was seeking but had not been facilitated to attend addiction support services. Given wait times and caseloads in Cork Prison, there was insufficient staff to provide effective addiction services to people in the prison.
4.61 Prisoner survey respondents (47%, 34 of 72) indicated they waited more than one month to engage with an Addiction Counsellor. Given that approximately 50% of the prisoner population in Cork Prison was either on remand or sentenced to less than 12 months imprisonment, this wait time did not allow for engagement with a large portion of people in the prison. Many prisoners reported challenges in accessing addiction counselling, with one prisoner stating “I found it hard to connect with a drug counsellor” and another stating, “I'm waiting over a year to see an addiction counsellor”.
4.62 Treatment for drug use, including detoxification and opioid substitution programmes, was available in the prison. Prisoners were initially screened for drug use with urinalysis at the point of committal to the prison. Prisoners had access to a General Practice-led detoxification program and subsequent Opioid Substitution Programme; the latter was facilitated by collaboration with community services to ensure that a community prescriber was in place at the point of release. Two out of every five prisoner survey respondents (41%, 55 of 133) agreed that people who come into the prison with a drug or alcohol problem are supported to detoxify safely.
4.63 Other strategies existed within the prison to minimise the risk of harm due to drug use. For example, direct observation of treatment, careful selection of those who could receive a weekly pack of in-possession medication and avoidance of the prescription of drugs prone to diversion.
4.64 In the aftermath of the response to COVID-19, some services had not returned to the prison. In particular, both staff and prisoners alike spoke about the need re-instate the Alcoholics Anonymous programme.

P.59 4.72 Screening was carried out at the point of committal, as set out in the IPS Healthcare Standards.82 The screening process included administration of a COVID-19 test, assessment for drug concealment and a medical and psychiatric assessment. Prisoners were also provided with a shower and clean clothing.

P.61 Patient Voice
4.81 Prisoner-patients had mixed views on the quality of healthcare provision they received in Cork Prison. Whereas 36% (47 of 132) believed the care they received was of good quality, 42% (55 of 132) disagreed.
4.82 On committal to the prison the top-three most pressing issues facing prisoners were concerns related to healthcare. These were identified by prisoner survey respondents as:
1. Problems getting medication: 39.4% (52 of 132 survey respondents)
2. Drugs or alcohol issues (withdrawal): 38.6% (51 of 132 survey respondents)
3. Mental health issues: 37.1% (49 of 132 survey respondents)