I recently read a post by fellow blogger Alex Cavendish about the gross disregard that Her Majesty’s Prison Service (and the healthcare departments of prisons in particular) have for confidentiality. It made me think that I should write a little about my own recent experiences of this issue.
As a life sentenced prisoner I have to apply for parole every two years and, when I do, a file of reports are put together by various departments to form a dossier which will go before the parole board to assist them in making a decision. Since the prison healthcare departments are run by the NHS (or subcontracted to a private healthcare provider), their records are meant to be treated as “medical in confidence” and cannot be disclosed to any other party, including prison staff or the parole board, without the written consent of the prisoner/patient.
Last year I received a letter from the prison parole clerk asking me to sign a consent form for healthcare staff to prepare a report on me detailing my recent medical records. I declined to consent on the basis that I don’t think there is anything in my medical records which is relevant to the question before the parole board of whether or not to release me and I sent back the form they had given me to this effect. However, some months later I received a copy of the completed parole dossier and found that it contained not one but two reports which detailed my confidential medical information. One was written by a primary care nurse and the other was from a community psychiatric nurse, neither of whom have had any significant interaction with me or my treatment for a number of years. But not only had they done this without and against my consent, they had also failed to obtain a signature from the the healthcare manager, which is required for all healthcare parole reports in order for managerial oversight to ensure that such things as consent to disclosure and the relevant data protection principles are being adhered to.
I did pursue this directly with the healthcare department and the response I was given said that they had not received my returned consent form at all but that “In these situations they presume consent”. Well, I haven’t received notification that the nurses who wrote these reports have any objection to me obtaining a copy of their own records from their local GP and publishing them for all of their colleagues to read, but I don’t think that gives me the right to do so.
Prison Service Instruction 12/2016 section 2.17 specifically states that “a healthcare report must not be written without the prisoner’s consent […] a copy of the signed consent form must be retained locally on the prisoner’s file.” Since they claim not to have received the consent form back, they can’t possibly have retained it on file. I’m now in correspondence with Care UK (the private healthcare contractor who employs the nurses here at HMP Wakefield) regarding this incident. However, in the meantime, the Acting Deputy Head of Healthcare here has attempted to offer the resolution that I could ask for the reports to be removed from my dossier. The only problem with this is that it is simply too late. The dossier has already been sent to the parole board so, even if the dossier were changed, my confidential information would still already be out there for others to read.
Why should this matter? It matters to me because I want the dossier to be as concise as possible, detailing any positive or negative points about me without them being overwhelmed by page upon page of irrelevant information. The very format of many prison reports precludes that happening entirely as they include a great deal of information about the report and the format in itself, as well as information about the report writers which is (slightly) more relevant, but still not necessary for someone who is assessing whether or not I should be released. The fact is, some people have very short attention spans and I don’t want important information to go unnoticed because it is drowned out by white noise such as these two reports.
However, that is just the case for me. Other people in this situation may have even more important reasons. For example, what right would the healthcare department have to disclose to total strangers that a prisoner has cancer, HIV, or (reductio ad absurdum) leprosy? None of these are relevant to assessments of whether a prisoner should be released and so they should not be included in a parole dossier. But more than that, disclosing these things against the prisoner’s wishes is both illegal and highly distressing. Furthermore, it casts doubt on the parole process itself. What happens if someone who suffers from leprosy (or any disease which has historically created social outcasts) is refused parole and the reasons given are unclear, as they often are? The parole board may or may not have a very good justification for their decision, but how could the prisoner ever be sure that they hadn’t been knocked back because of stigma relating to their medical condition? The importance of confidentiality is widely understood by society but staff here seem to have a skewed view of it. One officer I spoke to in particular was under the impression that he was allowed to ask the nurses whether you suffered from a certain condition or whether you were prescribed a certain medication and the nurses were allowed to say “no” if you didn’t, but that they weren’t allowed to say “yes” if you did. Has this man never heard the phrase “I can’t confirm OR DENY”? The Data Protection principles set out that it is illegal for him even to ask this question, let alone for the nurse to answer it, whether that be in the positive or the negative. So I put it back to him, “If a stranger called your wife’s GP and asked whether she was pregnant, would you be ok with them saying no?” He looked at me in silence for a moment, and then shrugged. “If a stranger saw you coming out of a sexual health clinic and went in to ask whether your hepatitis tests had been positive, would you be ok with them saying no?” He said that that was different. “If a stranger saw you popping pills and asked your doctor whether you were actually on a prescription for them, would, you be ok with them saying no?” Then he said what I knew he had meant all along: “But in here we have to put security first. That’s why it’s different for us.” I smiled. “I see,” I said. “In what way does a diagnosis of cancer or a prescription for prozac impact on security to such an extent that the nurses simply MUST make sure the parole board know about it?” Suddenly he didn’t want to talk anymore.