28 November 2023

The populations served by CNWL’s Health and Justice Directorate experience considerable health inequalities both through their experiences of adversity, poverty and trauma as well as their access to, and use of, healthcare services.

On Friday 24 November, staff from Health and Justice gathered at Hamilton House in Central London to reflect upon their work, and the innovative practices addressing health inequalities.

Service Director, Patrick Gillespie opened the conference by highlighting some key statistics, explaining that patients in secure settings “face significant disadvantages” compared with the wider population:

  • Women who come into prison have higher rates of cervical cancer
  • 15 per cent have been homeless before coming into custody, compared with 3 per cent in the general population
  • People in custody are 4.7 times more likely to have a mental health condition than the general population
  • Between 60 and 90 per cent of young offenders have below average communication skills

“Everyone can contribute to addressing health disparities in the course of their everyday work,” Patrick said.

The conference brought together senior leaders, including Chief Executive, Claire Murdoch. Claire gave thanks to our “passionate, committed and expert staff” – over 500 working in more than 20 sites.

“It’s the interactions you have,” she said. “Never underestimate a kind act because people remember it. The work you’re doing is important and you make a difference every day”.

Claire spoke about CNWL’s focus for Health and Justice saying:

“Our focus is staffing and the workforce, which is also our greatest opportunity and pride. Prisons can be places of trauma and they can create trauma, but that’s true for our staff as well.

"Having been through a period of growth, we want to focus on stability, growing our expertise and becoming an authoritative voice”.

We were thrilled to welcome Kate Davies, National Director for Health and Justice at NHS England, who reflected on the achievements of NHS services who are driving collaborative working to address health inequalities in the criminal justice system.

Mindful of the complexities within these environments, Kate urged staff to “influence the bigger picture” and think about ways to support continuity of care across estates and facilities.

Kate discussed the strategic recommendations from the National Women’s Prisons Health and Social Care Review, and how to innovate in prison estates. “The voice of people with lived experience is so important,” she said.

In between keynote presentations, attendees joined various breakout sessions:

  • Prioritising the wellbeing of young Black men in the criminal justice system
  • What does good care in the last year of life look like in prison?
  • Reducing vaccination waiting list for children in custody
  • Relating self-harm and trauma in women’s secure settings
  • Addressing inequalities for women in prison
  • YourStance: an innovative way of reaching at risk young people and empowering them
  • Liaison and Diversion: addressing inequalities across the pathway

Download the full programme here.

We finished up with a presentation from Dr Frances MacLennan, Consultant Psychologist and Dr Ron Dodzro, Clinical Psychologist on the alternative routes to addressing trauma such as music therapy.

“There are many negative stereotypes about prisoners… and there is resistance to thinking about the offender as a victim too. But we need to accept the juxtaposition that people can both an offender and a victim,” said Dr Dodzro.

“Reframing this narrative can have positive impacts on an offender’s journey”.

Dr MacLennan continued:

“Health professionals have a difficult job because we sit in a system that is traumatic. Prison becomes the enemy for many inside it and this is ongoing, with many acquiring new traumas all the time. There are different ways of expressing trauma, and we need to find a balance. Meet the person where they are, so they don’t have to step up to access us.”

Clinical Director, Dr Satinder Sahota, closed the conference by reflecting on the day, encouraging everyone to stimulate conversations on health inequality within their services.

Dr Sahota praised colleagues who carry the “caring not judging ethos… in extremely challenging circumstances and who do this day in day out”.

Find out more about CNWL's specialist Health and Justice service lines here: https://www.cnwl.nhs.uk/health-and-justice